Understanding & responding to self-harm in young people

Dr Sarah Rowe, UCL

s.rowe@ucl.ac.uk

Self-harm – True or False?

1. The UK/Europe and the US typically use the same definition of self-harm?

Answer: FALSE

2. Rates of self-harm in adolescents are around 5-8% during their lifetime

Answer: FALSE

Self-harm – True or False?

3. Self-harm is one of the strongest predictors of death by suicide in adolescence

Answer: TRUE

4. Self-cutting is the most common method of self-harm

Answer: TRUE (and FALSE), community vs hospital

‘At risk’ groups

• Sex (female for self-harm, male for suicide) – most countries

• Low socio-economic status, young people in care or asylum seekers

• LGBT

Other risk factors for self-harm

• Individual negative life events & family adversity:

- history of physical and sexual abuse

- family history of suicidal behaviour

- bullying

- interpersonal difficulties

• Psychiatric & psychological problems:

- mental health problems e.g. depression, anxiety

- drug and alcohol misuse

- perfectionism, low self-esteem, impulsivity, poor problem-solving, hopelessness

Why do young people self-harm?

• It’s a sign of distress; a way of expressing emotions such as hurt, anger or frustration

• Reasons might include: - To manage emotions - To reduce tension - To use physical pain to distract from emotional pain - A form of escape - To regain control - To punish themselves or others - To identify with a peer group - To elicit care from others

Help-seeking for self-harm (1)

• Between ⅓ and ½ DO NOT seek help for their self-harm

• Sources of help are most

commonly informal sources

such as friends and family

• Fewer than 13% present to

hospital Hawton et al., (2012) The Lancet, 379 pg 2373-2382

Help-seeking for self-harm (2)

• Young people often use the Internet to disclose self-harm rather than ask for help

• Barriers to help-seeking – young people often don’t know how or where to get help (or what to expect from that help)

• Facilitators to help-seeking – few specific to self-harm have been identified.

Responding to self-harm (Parents/Carers)

• Qualitative study found most parents were bewildered or confused by their child’s self-harm (Ferrey et al., 2016 BMJOpen 6(1))

• Social isolation could be a problem due to perceived stigma

• The necessity of being available to their child often conflicted with the demands of full-time work

• Website for parents and carers http://www.healthtalk.org/peoples-experiences/mental-health/self-harm-parents-experiences/topics

https://www.tcat.ac.uk/wp-content/uploads/2016/02/Coping-with-Self-Harm-Guide.pdf

Responding to self-harm (Teachers/Schools)

• Recent research suggests:

- anxiety/stress related to study, and bullying may ↑ self-harm

- self-harm is “invisible” in schools except for the most severe acts

- it’s sometimes seen as ‘bad behaviour’ or disruptive

- structures and supports systems to equip staff are rarely provided

- escalating it to external experts may contribute to non help-seeking behaviour

(Evans and Hurrell, BMC Public Health (2016) 16:401)

Responding to self-harm (Teachers/Schools)

Contagion:

• Students should not be given explicit details about self-harm

• However, educating students about signs of distress in themselves and others, as well as teaching the use of positive coping skills, is appropriate and even suggested

• Treatment of self-harm within schools should be done on an individual basis not in a group therapy setting

Responding to self-harm (Teachers)

Useful links to self-harm policy for school & supporting students:

• https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=11&ved=0ahUKEwjN0a-H1_7SAhWkLsAKHVohBZs4ChAWCBswAA&url=http%3A%2F%2Fwww.erscb.org.uk%2FEasySiteWeb%2FGatewayLink.aspx%3FalId%3D325173&usg=AFQjCNGc-cANd36fj6tzwit95FoXohUpFg&sig2=rSYPKenk9bcKCbo_NU3Qbg

• http://www.rcpsych.ac.uk/pdf/Knightsmith%20Jodi%20-%20Self-Harm%20Policy.pdf

Responding to self-harm (Formal/Professional)

• GP

• Young people under 16 years should be admitted to paediatric unit overnight and assessed by CAMHS (NICE guidelines)

• Outpatient treatment

- crisis/safety plan

• Interventions

- evidence based treatments such as 2-12 sessions of talking therapy e.g. CBT, family therapy

Responding to self-harm (Formal/Professional)

• Survey by YoungMinds (2013) found: - Young people felt out of place on paediatric wards

- Lack of privacy, confidential matters were discussed in open areas in ED

- Severe self-harm more likely to be prioritised which led to feelings of not being taken seriously

- Young people valued collaborative working

- Young people thought emotional aspects were more important than medical and physical aspects of treatment

- Young people valued clear communication, a caring and sensitive approach

Responding to self-harm (Formal/Professional)

Links that may be of interest:

• https://www.psych.ox.ac.uk/research/csr/research-projects-1/copy_of_coping-with-self-harm-a-guide-for-parents-and-carers

(summary of research findings for clinicians)

• http://www.proceduresonline.com/kentandmedway/pdfs/manage_self_harm_yp.pdf

• http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)60322-5.pdf

Key challenges

• Better understanding of the effect of new media on adolescent self-harm and suicide

• Better understanding of the factors associated with adolescents stopping self-harm

• Development of innovative interventions and strategies that decrease stigma, promote adolescent help-seeking, and enhance meaningful engagement with health services

• Better management of the care pathway (aftercare) of vulnerable young people as they move from child or adolescent to adult services

• Tackling the stigma of mental illness and mental health problem

Thank you!