Finding out that a young person is self-harming can be difficult and upsetting. However, teachers and other school staff can play a very important role in helping young people who self-harm
Who is vulnerable to self-harm?
Self-harm is common among young people – at least 10 per cent report having self-harmed – and it is more common in girls than boys, especially in early adolescence. Examples of ways in which a person might intentionally injure themselves include self-cutting, taking an overdose, swallowing objects or poisons, hitting or bruising, self-strangulation and burning.
Some young people are particularly vulnerable to self-harm, especially if:
- They have depression, anxiety, low self-esteem, ADHD or an eating disorder, or are on the autistic spectrum.
- There are family issues such as mental health difficulties in parents/carers, poor parental relationships, conflict with parents, or abuse or neglect.
- They experience difficult social relationships – peer rejection, bullying, have friends or family who self-harm, or are influenced by social media that encourages self-harm.
Self-harm can be a way of coping with life stresses – for example, to manage emotional upset, to reduce tension, to provide a feeling of physical pain to distract from emotional pain, or to express emotions such as hurt, anger or frustration – but in some cases self-harm may reflect a wish to die.
Recognising self-harm
Young people often hide their self-harm, but you may see unexplained cuts, burns or bruises, or you may notice that they keep themselves covered, for example avoid swimming or changing clothes around others. However, the signs are not necessarily only physical.
You may notice that the young person has become withdrawn or isolated, or is experiencing low mood and a lowering of academic grades. Or you may see sudden changes in behaviour – becoming irritable, angry or aggressive – or excessive self-blame for problems and expressing feelings of failure, uselessness or hopelessness.
As a staff member, you may be the first to notice that a young person has been self-harming. This can be distressing and it can be hard to know what to do.
However, it is important that you do not ignore the signs of self-harm. Let the young person know that you have noticed a difference in their behaviour and be open about your concerns, while remaining calm, non-judgemental and understanding.
For example: “I’ve noticed that you have become (state the changes you have observed in their behaviour, for example withdrawn, irritable, angry) and I’m wondering if maybe things are difficult for you at the moment?”
If you have explicit concerns around self-harm, move on to more specific questions, such as: “I’ve also noticed that you’ve (voice your observations, for example ‘got some scars’ or ‘have been covering up’) and I know that sometimes this can be a sign that someone has harmed themselves. Can I ask if you’ve self-harmed?”
What you can do
To understand why a young person may be self-harming, it is important to have an open conversation with them. It can be helpful to convey that you understand some of the functions of self-harm to encourage them to open up.
For example: “Sometimes people self-harm as a way of managing strong and difficult feelings or emotions. I’m wondering if that might be why you hurt yourself?”
If the student has self-harmed at school, there are steps you can take to manage the physical injuries:
- Keep calm and follow first aid guidelines for cuts, wounds and burns.
- If you have immediate concerns about the effect of an overdose or if there is serious physical injury, call the emergency services.
- Always ask the student if they are in pain – they may have needed to feel physical pain at the point of self-harm, but this does not mean they want to feel pain afterwards.
- Involve the school nurse where possible, they may be able to give pain relief.
Confidentiality
Confidentiality is very important to the young person and, while you should respect their wishes around confidentiality where possible, their health, safety and welfare are paramount. If you become aware that a student is self-harming, you are obliged to share this with your school’s designated safeguarding lead. This information would usually be shared with the parents or carers too, but you should discuss the need to do this with the young person and listen carefully to any fears they may have.
Students should be informed when the school contacts their parents or carers, in particular because self-harm can be a way of feeling in control – by not involving the student, the school may exacerbate their level of distress. It may be helpful to invite the parents or carers into school to talk with staff and the student together, to try and make sense of the self-harming behaviour and think about ways of supporting the young person.
Supporting the young person
There are possible strategies that you can discuss with the student to help them manage the urge to self-harm. Not all of these will work for every student but with time and practice the young person can usually develop positive ways of coping. These strategies may include:
- Building support networks, which might be friends, family or a member of staff.
- Replacing self-harm with other safer activities. It is important to find things that the young person is interested in, but these could include physical exercise, taking a dog for a walk, watching television or having a relaxing bath.
There are also strategies that can help to manage the extreme tension in the body that the young person may feel, such as:
- Clenching ice cubes in the hand until they melt, hitting a pillow or other soft object, breathing exercises (breathing in to the count of four and out to the count of six), counting (which allows the body to slow down, for example by counting 10 films, 10 animals, etc), and engaging in physical exercise.
- Using resources such as relevant helplines and websites (for example, Childline and YoungMinds).
Given that the young person is likely to be experiencing difficult emotions, it is important that they can find a way of expressing them. If they do not feel able to talk to others about their feelings, you could suggest that they write a letter expressing their feelings (which need not be sent), keep a diary, or write about or draw their feelings.
It may also be helpful to try and encourage the student to think about some positive things about themselves and their life and develop a “hope box”, where they can store things that make them feel better, such as photos, memories, nice things people have said and so on. They could do this on their phone, too.
On a practical level, encourage the young person to make sure that they do not have razors, medication or other means of self-harm in their room. You can also suggest that they write down a practical safety plan, which includes actions they can take and people to contact if they have the urge to self-harm.
Levels of concern
While all self-harm is of concern, it is important to establish what level of concern there should be about the student’s self-harming in order to decide appropriate action, such as contacting mental health professionals. There may be a higher risk of self-harm or on-going mental health problems if the student has self-harmed and any of the following are present:
- Low mood – particularly a recent change in mood.
- Behaviour change – some students may become withdrawn and isolated, others may become disruptive.
- Expressing hopelessness, for example saying that they cannot see a future.
- Low self-worth or self-hatred.
- Lack of family support or distant family relationships.
- Expressing suicidal feelings, explicitly – “I want to kill myself” – or more subtly – “I don’t want to be here anymore”. It is important to note that it is okay to ask students about suicidal thoughts and that doing so will not “put the idea into a young person’s head”.
- Previous self-harm.
- Bullying, including cyber-bullying.
- Serious difficulties around gender or sexual identity.
- Excessive use of drugs or alcohol.
- Recent history of self-harm or suicide in a friend or family member.
- Bereavement, especially recent loss.
Listen to your intuition. If you have a hunch that a student may be at risk, you may well be right. If you are concerned about a high risk, or are not sure about the level of concern, it may be helpful to consult with your local Child and Adolescent Mental Health Service (CAMHS), as well as the school nurse, head of year, school counsellor or safeguarding lead.
If you are worried that self-harm or other behaviours may be due to abuse or exploitation, this should be managed as a safeguarding concern and referred to children’s social care.
Supporting other students
In schools, one student’s self-harming behaviour can sometimes affect other students. This can occur particularly with self-cutting and is more common among girls. If a student comes to you with concerns about a friend’s self-harm, reassure them that telling you is the right thing to have done and that they have been a good friend. Offer them the opportunity to speak to the school counsellor too, if possible.
If more than one student has self-harmed, it is important not to panic (self-harm can be “contagious” in social groups). Be observant and raise awareness of how students can get help when they are struggling with difficult emotions. Continue to provide support, separately, for young people who are self-harming – this is preferable to raising the issue in large school groups such as school assembly.
Taking care of yourself
Finally, it is important to recognise that self-harm can be distressing for school staff. Be honest with yourself about your emotions – it is common to experience sadness, shock, anger, fear, disgust, frustration and helplessness. And because self-harm is self-inflicted, it can be more difficult to empathise with the person. Discuss your feelings with colleagues or managers, seek support and make sure that you prioritise your own health and wellbeing.
Supporting students who may have self-harmed: Five things to remember
- Building a positive school culture that encourages resilience and promotes help-seeking is the most important thing schools can do in relation to enhancing mental wellbeing.
- If you suspect self-harm, do not ignore the signs. Let the person know you have noticed a difference in their behaviour and be open about your concerns.
- Create a supportive and non-
judgemental atmosphere that will make it easier for pupils to seek help.
- Involve parents and carers wherever possible.
- Support is always available.
- Charlie Waller Memorial Trust (CWMT) is a charity that provides fully funded mental health training to schools.
Further information & resources
This article has been compiled by the CWMT and is based on the booklet Young people who self-harm: A guide for school staff, which was developed by researchers at the University of Oxford. It is available to download or order from the CWMT. Visit www.cwmt.org.uk/schools-families-resources