When Rhiannon, 14, started cutting her arms with a craft knife from a kitchen drawer, she found it a form of release after her parents divorced. For two months she continued to hurt herself, always being sure to cover her scars with her sleeve.
But in her heart she knew she couldn’t carry on causing such painful physical damage in a bid to ease emotional hurt. She approached a member of staff from a student support unit at school to confide in. And the school’s action was swift.
Rhiannon’s mum Nickie explained: “I was called in for a meeting that day. A mentor was appointed for my child and a counsellor was directed to us as a family.
“Rhiannon was given unlimited access to spend time as and when needed in the student support unit. In the shock of everything that was happening and finding out our daughter had been self-harming, seeing that teachers knew exactly how to deal with the situation brought me peace of mind.
“They knew what to say and how to handle our reactions. They provided us with as much support as we needed and were extremely sympathetic to our situation. It was very reassuring to know they were there. We were advised of resources to read up on and made aware of support groups.”
Nevertheless, for Nickie, the start of the process to help Rhiannon was a daunting experience: “I felt like the school were involving other professionals without consulting me first.
“An out-of-hours emergency social services support team was called in at the start. I can understand now why things happened like they did, because they were concerned for my child’s welfare. But it’s very, very scary when you pick up the phone to someone like that without any warning.
“We were also referred to a child and adolescent mental health support unit at our local hospital in the very early stages of finding out about the self-harm; and they helped us to talk openly about what had happened and why.”
Rhiannon’s self-harm has now stopped. She continues to regularly see her mentor, as well as other professionals in her school’s student support unit. The family counsellor continues to work with Rhiannon and both her parents.
Rhiannon’s experience, for all its agonising beginnings, has been turned into a positive one. And, Nickie says, one that other schools may be able to learn from. She continued: “After hiding what she was doing from all of us, I am so glad Rhiannon sought help. Talking openly is the key to getting through this and making sure it doesn’t happen again. My child was self-harming not to intentionally harm herself, but as a way of relieving stress about a situation she was scared by.
“She never self-harmed with the intention of attempting to end her life. This would have been a far more serious situation to deal with. The self-harming occurred because she was deeply anxious about her future. Now that’s all out in the open that stress has gone.
“I do still keep a close eye on her, without being over-protective. Any signs of her feeling anxious about something and I need to be there and talking to her. She is very sensible and mature for her age. She’s also very sensitive to other people’s feelings, hence keeping her feelings in for the sake of upsetting or hurting others.
“Hopefully she understands now that speaking up is a better way of dealing with these feelings than self-harming.”
But, according to recent research by specialists in young people’s mental health, Rhiannon’s experience is not the norm.
Not only would most teenagers be reluctant to speak up, a third of parents would not seek professional help if their child was self-harming and two in three teachers don’t know what to say to young people who self-harm.
Research commissioned by the charity Young Minds and published in October 2012 concluded: “Many teachers feel unequipped to deal with the issue of self-harm and are much less comfortable discussing self-harm compared to other risky behaviours.
“Only one in three teachers believe that they are covering self-harm in lessons, despite the fact that
97 per cent of young people believe self-harm should be addressed in school.”
In response to the findings, Young Minds has compiled recommendations for parents, teachers, peers and health professionals on how to best identify and support at-risk and self-harming teens.
Lucie Russell, director of campaigns, policy and participation at Young Minds, said: “Young people often talk for the first time about self-harm to teachers, parents and GPs. It is vital that we increase the knowledge and capability of parents and professionals so that they are able to support the thousands of young people who are suffering intense internal pain that’s manifested externally.”
Trainer Zoe Dale has worked with Young Minds on research into self-harm. Zoe has delivered child mental health services in education for 13 years and currently delivers a child mental health service in a central London secondary school on behalf of the Tavistock and Portman NHS Foundation Trust.
In her report for Young Minds, she explained: “Secondary schools are increasingly facing levels of distress in young people and self-harm is an area that can generate great concern for staff.
“A young person deliberately hurting themselves may leave staff feeling de-skilled, concerned about how best to respond and uncertain of when and where to seek more specialist help. Levels of self-harm are increasing within the adolescent population and it is important we consider why.
“A school-based study of secondary age pupils highlighted that 6.9 per cent of pupils reported self-harm. Girls aged 13 to 15 present the highest risk of self-harm. However, it is also becoming an increasing issue for young men.
“Secondary staff need to be supported with how to effectively intervene. Schools have an important role to play in prevention and early intervention with young people’s emerging mental needs.
“In particular, educating young people and their families about emotional distress and self-harm, providing timely support in school and when necessary, support from specialist professionals.”
Zoe offers the following advice and pointers for teachers and other school staff who are working with students who confide to them that they have been self-harming:
-
Avoid being judgemental and acknowledge emotional distress.
-
Show care and respect – take it at the young person’s pace.
-
Acknowledge strength and courage in disclosure.
-
Respect how and what may be initially disclosed.
-
Establish trust and respect – who will be told and why.
-
What might a young person fear discussing?
-
Consider carefully when and if parents should be informed – would this increase or reduce risk to the young person?
-
Is the young person competent? Can they consent (understand the implications of) seeking help without their parents knowledge?
-
Take care in your decision-making – make key decisions with colleagues and record outcomes carefully.
-
Importantly, it is clear that self-harm is not an issue for school staff to manage alone, but one which needs additional professional support. A local child mental health service or educational psychology service should be approached where relevant.
It is also vital to consider risk. Zoe said that no matter how minor any physical injury may seem, there’s still a need for unique consideration and assessment.
What is self-harm?
When a young person is in so much distress they cannot put it into words or express it any other way, they may self-harm. This is their way of coping with what they see as unbearable feelings or thoughts. Young people who resort to self-harm can describe physical pain as preferable to their emotional distress.
What form can it take?
According to a report by trainer Zoe Dale for the charity Young Minds, it may include:
-
Banging/hitting.
-
Cutting.
-
Hair-pulling.
-
Pinching/picking at skin.
-
Restricting eating.
-
Ingesting objects.
-
Scalding.
-
Impulsiveness and risk-taking behaviour.
Why self-harm?
Reasons given by young people include:
-
Bullying in school.
-
Family difficulties and serious problems at home.
-
Parents who abuse alcohol/drugs.
-
Parental conflict/separation/divorce.
-
Abuse in childhood.
-
Shame/frustration.
-
Anxiety about attainment/performance.
-
Low self-esteem.
-
Loss/bereavement.
-
Being in care.
-
Learning difficulties /disability.
-
Mental health needs in wider family.
Further support
-
Young Minds Helpline for parents and professionals: 0808 802 5544.
-
For further support for children, their parents and school staff, visit www.youngminds.org.uk
-
Harmless is a national voluntary organisation for people who self-harm and their friends, family and professionals (includes training). Visit www.harmless.org.uk
-
Scar Tissue offers information, including personal accounts of self-harm and a guide for schools on writing a self-injury policy: www.scar-tissue.net
-
Linda Aitchison is a freelance writer.