Self-harm is a concerning reality for teachers, parents and professionals working with children and young people today.
Recent statistics conclude that rates have increased in the UK and are now among the highest in Europe. According to the National Institute for Care and Excellence, the risk of suicide has also increased (NICE 2013).
Studies conclude that between 10 and 12 per cent of young people self-harm, but the true incidence is largely unknown as many young people do not present for help.
A recent poll commissioned by ChildLine, YouthNet, SelfHarmUK and YoungMinds revealed that of the 2,000 children and young people surveyed, over half of the 11 to 14-year-olds reported having self-harmed, or knowing someone who had. Equally, eight out of 10 18 to 21-year-olds say they have self-harmed or know someone who has (reported by NSPCC on Self Harm Awareness Day – March 1, 2015).
The predominant reason young people give for not reporting their self-harm is the concern that they will not be listened to or that they will be misunderstood.
Yet at the same time, self-harm is the one issue that all groups (young people, parents and professionals) feel least comfortable approaching. Parents tend to associate young people self-harming with failing as a parent, and teachers feel helpless and unsure about what to say. Other research has found that three in five GPs do not know what language to use when talking about self-harm with young people.
Children and young people’s general mental health continues to be a concern at both political, social and community levels.
Below are some key principles for school staff in how to understand and mange this complex psychological and social phenomenon.
Understand what self-harm is
How we understand self-harm will vary according to what we think it is. This will in turn affect what meaning we ascribe to it, and how we subsequently manage it.
For example, some definitions separate self-harm from “self-injurious behaviour”, where the latter attempts to capture young people who may harm themselves unintentionally due to their learning difficulties or disabilities. Some definitions have continued to separate intentionality and deliberateness from accidental or unconscious acts.
There are also instances of young people engaging in high levels of risk-taking behaviours which may not necessarily be associated with a traditional understanding of self-harm – for example, binge-drinking, heightened promiscuity, drugs, fights and/or body modifications.
Confusion may therefore exist for professionals in trying to tell apart normal manifestations of adolescent identity conflicts from more problematic mental health.
More recently, self-harm has been used as an umbrella term to include deliberate self-harm, self-mutilation, self-injury, self-poisoning, self-cutting, overdosing and attempted suicide (Hawton et al 2002).
Similarly, the Mental Health Foundation (2004) uses the following definition: “Self-harm or self-injury can be defined as a wide range of things that people do to themselves in a deliberate and sometimes hidden way, which are directly damaging to them.”
It is clear therefore that when faced with questions about self-harm, a one-size-fits-all approach will not do it justice.
It is perhaps preferable to view self-harm on a continuum between “good enough self-care” and “severe self-harm”, thereby avoiding the risk of pathologising young people and making situations worse for them (Turp 2002; 2003).
Know the child
There are many reasons why a young person may self-harm and trying to get to the bottom of this may prove challenging for anyone they choose to talk to. Stereotypes exist which may affect our reactions and responses to young people and staff need to be aware of their own feelings and thoughts, which may inadvertently be acting as barriers.
Many professionals, for example, assume that children who self-harm are provocative, angry and attention-seeking (Turp 2004). In other research, self-harm has been conceptualised as an issue affecting White, middle class, educated women (Sandoval 2006). Subsequently, children may not report their difficulties for fear of being judged according to these stereotypes.
It is important then for school staff to refrain from judgement or condemning the child. Giving advice or minimising the behaviour may be “unhelpful help” according to children who have experienced self-harm. They need adults around them to seek an understanding while keeping the behaviour separate from the child themselves.
Self-harm is generally understood as a way of coping with overwhelming emotional distress. While many serious cases of self-harm require medical attention or psychiatric support, schools can support their young people by ensuring they have psychologically healthy environments, which promote active listening and empathy.
One thing that children and young people who self-harm have in common is that they will have all had their own personal journey and experiences which may account for the position they find themselves in. What they often need from adults is not necessarily advice, but acknowledgement of their situation.
The tendency to self-harm tends to be linked to a multitude of factors which interact, and will be experienced differently for different children. The risk factors include low self-esteem, feelings of hopelessness, communication difficulties, problems with sexual orientation, and impulsivity. It can also be linked to a number of parent/family factors including history of abuse, substance abuse, parent separation or divorce, family history, and parent death.
School factors also play a part, including low achievement, bullying, having friends who have recently self-harmed, and stress and anxiety about school performance. The power of empathy should not be underestimated in our dealings with children and young people who are using self-harm to cope. It can make a situation more bearable just knowing that someone else understands.
School staff need to work together to understand and respond to concerns around self-harm. In order to do this, there needs to be openness and transparency from the outset about how the school views self-harm and what they will do about it.
Where possible, there also needs to be strong relationships with parents and carers so that there is an opportunity for joint problem-solving and support. Some schools find that writing a school policy helps staff teams to feel prepared.
Information in the policy might include referral pathways, scripts for talking to children, key personnel, support plans and other useful signposts. Information leaflets are useful to promote awareness for children as well as parents and should be built into PSHE lessons within school where possible.
School staff need to feel like they can help without doing harm. For this reason they need to be able to ask for help themselves when they are unsure what to do. Whole-school training can help to reduce myths and stereotypes, and provide staff with an increased sense of competence and understanding.
In more serious cases, an “emergency first aid” plan will help to clarify immediate responses and access to health professionals. Staff supervision will be important to contain and support any anxiety they themselves experience in relation to working with vulnerable children and young people.
Dr Joanna Mitchell is a child and educational psychologist and regional educational psychology manager at independent psychology service CPA.