Supporting young

people who self-harm

This presentation will start at 18:00

Created CAMHS School in Reach Team

(adapted from PPEPCARE)

With thanks to

Kielly Alfoadari & Dr Pooky Knightsmith

Supporting young

people who self-harm

Delivered by Becca Sheahan

CAMHS School In-Reach worker

With thanks to

Kielly Alfoadari & Dr Pooky Knightsmith

Aims of the session

To help you think about what self-harm is and why young people may self-harm

To help you understand what it feels like to be a young person who is self-harming

To understand why your response to a YP matters and what can be helpful and unhelpful when talking to a young person

To help you support young people who self-harm by thinking about alternative ways to cope

Overview

Understanding self-harm

(including common

misconceptions)

Conversations with young

people

Offering practical support

Common

misconceptions

Some examples…

“People who self harm are

suicidal”

Self-harm is not a

particular ‘disorder’ – it is

a reaction to difficult

circumstances, distress and

life events.

Not really – for many, it is a

coping mechanism to deal

with extreme negative

emotions. In the short term

it can feel like an effective

means of coping with life

“People who self harm

could stop pretty easily if

they really wanted to”

There is a relationship in

that those who self harm

are more likely to try and

take their life, but it

doesn’t always go hand in

hand.

“It’s the self-harm that’s

the real problem”

“The more serious the

injury, the more serious

the problem”

Not true – research does not

back this up people may cut

more deeply than they mean

to for example-It can be

dangerous to label injuries as

superficial

Generally, self-harm is a

private act. Young people

may have go to great lengths

to hide scars/bruises etc and

may try to treat themselves

rather than seeking medical

attention. Self harm can be

seen as a communication of

distress – attention needing

rather than seeking

“People who self harm are

just attention seeking”

Some more examples…

Defining self-harm (what could it look like?)

• Picking and scratching

• Burning

• Cutting and biting

• Pulling out hair

• Substance abuse

• Self-poisoning

• Inserting objects

Self-harming behaviours may include:

• Overdose

• Taking personal risks

• Self-neglect

• Ligature tying

• Eating disorders

• Swallowing objects

• Risky behaviour

Prevalence estimates

Estimates will vary depending on

how self-harm is measured

Reports suggest around 12% of

young people overall may self-

harm (Doyle et al, 2015)

Rates have risen most sharply in

young females (e.g. an increase of

68% in 13-16-year-old females from

2011-14 (Morgan et al, 2017)

Understanding self-harm

Truth hurts (2006)

Cutting for me releases all the built-up

anger and frustration and pain I feel

inside. There are many things that happen

to me in my life which cause the pain I

feel and how I release it. Mostly the

feelings of isolation like being outcast

pretty much from relationships

altogether. I don’t feel like I am a very

stable person and I hate myself a lot of

the time. I think body image also has a lot

to do with my cutting. School is stressful,

home life I can’t handle sometimes.’

Self-harm can be:

Direct or indirect,

transient or longer term…

… but whatever the ‘type’ it’s usually

conducted at times of anger, distress, fear

or worry and is a way of coping with these

feelings

Put simply, self-

harm is a coping

mechanism

We’re more

accepting of

other types...

What individual factors are

associated with self harm?

Depression/anxiety

Low self-esteem

Poor problem-solving skills

Hopelessness

Impulsivity

LGBTQ+

Gender Dysphoria

Learning Difficulties

Drug/alcohol abuse

Neurodiversity

What family factors are

associated with self harm?

Extreme expectations from family

Abuse

Conflict

Mental health problems in parents

Domestic violence

Drug/alcohol abuse

What social factors are

associated with self harm?

Loneliness

Difficulties with peer relationships

Easy availability of drugs/alcohol

Emotional pain (sadness,

grief, hopelessness,

depression) 57%

Self-hatred (shame, guilt,

dirtiness) 51%

Anger (frustration,

powerlessness) 50%

Anxiety (fear, tension, panic)

34%

Neediness (unsupported,

unheard) 30 %

Unreality (numbness,

emptiness) 9%

Why do young people

self-harm?

Control Punishment

To appear ugly

Physical vs

emotional pain

To feel ‘real’

To feel cared for

Common motivations

include…

Self-harm, the autism spectrum

and sensory processing

For young people with ASD,

triggers to self harm may be

different (but not always) :

Can be associated with coping

with or counterbalancing

overwhelming sensory

information

Associated with increasing

distress (may be public,

blatant and common methods

include head banging,

scratching, biting and hair

pulling).

Common triggers

• Relationship difficulties (family & friends)• Life events (divorce)• Trauma (bereavement/abuse)• Bullying• Self harm in friends/the media• Pressure (exams)

Self

Harm

Cycle

BIG

feelings

Can’t cope

Unhealthy

copingRelief

Guilt &

Shame

What warning signs should you

look out for?

Key warning signs

Secrecy or disappearing at times of high emotion

Long or baggy clothing covering arms or legs even in

warm weather

Increasing isolation or unwillingness to engage avoiding

changing in front of others (may avoid PE, shopping,

sleepovers)

Absence or lateness

General low mood or irritability

Negative self-talk

Feeling worthless, hopeless or aimless

Individual warning signs

Changes in eating/sleeping patterns

Isolation from friends and family

Mood changes i.e. more aggressive than usual

Lowering of grades

Talking of self harm or suicide

Using drugs or alcohol

Talking of hopelessness or feelings of failure

Giving away belongings

unexplained scars, covering up (e.g. wearing long

sleeved tops in very hot weather)

Family & social warning

signs

Family

• Extreme expectations

• Abuse

• Conflict

• Mental health problems in the family

• Domestic violence

• Drug/alcohol abuse

Social

• Loneliness

• Difficulties with peer relationships

• Easy availability of drugs/alcohol

Suicide or Self-Harm?

Some people who self-harm have a strong desire

to kill themselves, but most will not

Even if the intent to die is low, self harm needs

to be taken seriously – people who do not

intend to kill themselves sometimes do so

because they don’t realise the seriousness of

their injuries

Self-Harm

or Suicide?

INTENTION is our best guide

Lethality is NOT a

reliable guide- if the

intention was suicide but

the means wasn’t lethal we

focus on the intention.

Overview

Understanding self-harm

(including common

misconceptions)

Conversations with young

people

Offering practical support

Seeking help

This is usually really difficult for YP

Seeking help is often the first step in breaking the cycle and sharing the experience can be a huge relief

How others react influences whether the YP seeks further help

YP need to feelcomfortable with who they speak to

How can we respond in the

most supportive way?

The most supportive first conversation is one where:

Your young person is the sole focus of your attention

You spend most of your time listening, not talking

Your young person tells their story, you never guess or assume

There is a feeling of acceptance and support, not judgement

Self-harm is not dismissed as attention seeking

This is recognised as the first step of a difficult journey

You recognise how hard this conversation must be for your

young person

You respond calmly – even if you don’t feel calm

You learn your

young person is

self-harming…

What next?

Four Helpful Responses:

LISTEN!1

Manage your reactions2

Offer practical support3

Involve your child/ YP in

decisions4

What if the young person

doesn’t want to talk?

Who is best placed to have the conversation?

How can you help them to communicate?

• Can you talk whilst doing something else?

• Is talking the only option?

Can you offer alternative sources of support?

Scenario- How would you

respond?

Rohan has been unwell with a fever.

He shows you cuts on his arm, they

look red, oozing & angry.

Questions to consider when

responding

Is there an immediate need for medical care?

Is your young person a danger to themselves?

What message do you want to give to your

child/ young person?

First Aid first A&E if neededWound

management

Is there an immediate need for medical care?

Questions to consider when

responding

If you are concerned that an episode is a serious attempt to end their life,

and they are known to CAMHS:

Contact the relevant team’s duty line

If they are not known to CAMHS:

Contact CAMHS Single Point of Access (SPA) on 01865 902515 (8am-6pm Monday-Friday)

Out of hours- call 111/ Out of hours GP

In immediate danger, always call 999

Questions to consider when

responding

Is your young person a danger to themselves?

Listen Remain calmAsk how you

can help

Questions to consider when

responding

What message do you want to give to your

child/ young person?

Showing you’re

not afraid to talk

about the specifics

of self-harm can

feel very

supportive to your

young person

Telling them

that self harm

is wrongGiving a

negative

reaction

Agreeing to

unrealistic

plans

Giving ultimatums

or applying

pressure

Seeing them as

‘just a self-

harmer’

What can be

unhelpful

Assuming that

every episode of

self harm is for the

same reason

Overview

Understanding self-harm

(including common

misconceptions)

Conversations with young

people

Offering practical support

Explore alternatives

ways of coping

Identifying your young person’s

safety net…

Confide in

family and

close friends

Speak with a

favourite

teacher

Access to

appropriate

information or

helplines

Identifying

other ways

of coping

with

difficult

feelings

Help your young person to identify less risky ways to cope with difficult emotions…

Write or draw about feelings

Talk to a person or helpline

Go to a quiet place and

scream / scream silently

Hit a pillow / soft object

Listen to musicLook after an

animal or sibling

Draw red lines on the skin

Clench ice cubes

Snap elastic band on wrist

Alternative coping strategies

Pick one or two initially,

try them out and review:

Was it helpful? Did it

work?

Would you use it again?

What else could you try?

Summary:

How you

can help

Arrange appropriate medical care

Listen to the young person and be mindful of your reactions

Provide access to information

Tell other people/seek support (where appropriate)

Talk about other coping strategies and offer practical advice

If you remember 3 things…

Self-harm is

a coping

mechanism

Trust your

gut. If

you’re

worried,

follow up

LISTEN

1 2 3

Overview

Understanding self-harm

(including common

misconceptions)

Conversations with young

people

Offering practical support

Any questions?

Useful apps for young people

who self-harm Calm Harm (distractions and support around self-

harm)

For me-Childline (live chat for mental health support)

Stay Alive (suicide prevention)

Catch It (support with mood)

Stop, Breathe, Think (meditations and mindfulness)

Think Ninja

https://charliewaller.org/resources/coping-

with-self-harm/

No Harm Done: Information for young people, parents and staff

https://youngminds.org.uk/youngminds-professionals/our-

projects/no-harm-done/

Further Sources of

Information

www.selfharm.co.uk

www.charliewaller.org

www.youngminds.org.uk

www.mind.org.uk

www.nshn.co.uk/downloads

.html

www.barnados.org.uk

www.minded.org.uk