Self-harm                                                                                                                              

 
 


Responding helpfully and safely to a child or young person who is
self-harming

 Video clips on self-harm

 

Never look down on anybody unless you are going to help them up...

 
 
Rev Jesse Jackson
 

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About self-harm                                                                                                       printable pdf

Self-harm is an issue for a lot of children and young people and many workers find it challenging to deal with.  Self-harm describes a wide range of behaviours that people sometimes use to cope with difficult feelings and distressing life experiences.  These behaviours may include cutting, burning, scalding, banging or scratching one’s own body, pulling one's own hair or swallowing poisonous substances or objects.  The majority of people who self-harm have no intention of ending their life. Most people who self-harm do so to manage their feelings.

Suicide can be viewed as a way of ending all feeling, whereas self-harm is often more about coping with and living with difficult feelings.  To help us understand how self-harm works for people, it is useful to view it in a broader context.  In the same way that some people may cope with stress and its associated feelings of anger and frustration by having a glass of wine or smoking cigarettes, others may manage similar feelings by cutting or burning themselves.

It is estimated that one in fifteen young people in the United Kingdom have deliberately harmed themselves, suggesting that around two people in every secondary school classroom have self-harmed at some time.  Self-harm amongst young people is more common between the ages of 11 and 25, although occasionally it can occur in children younger than this.

Around four times as many girls as boys self-harm. Young men with similar problems are more likely to get into fights and get into trouble with the police.  Whilst self-harm is reported as common throughout society, it is recognised that it is more prevalent among certain groups, e.g. young people with learning disabilities, young people who are lesbian, gay, bisexual and transgender, young Asian women and young people in residential settings.

Other associated risk factors include a history of self-harm, unemployment and alcohol- and drug-related problems.


How self-harm works for people                                                                        top of page

However negative and self-destructive it may be to hurt one’s own body, for some children and young people it can serve many important functions.  Self-harm is primarily a way to cope and in some cases it may feel like the only way to deal with feelings that are so distressing that the only alternative would be suicide.

Young people say self-harm works for them in the following ways:

Relief of feelings

Through hurting themselves, a person may be able to release feelings that feel unbearable when held inside.

Distraction

Self-harm can help a person cope by providing a distraction.  The physical pain and injury take the focus away from an emotional pain that feels much worse.

Self-punishing

Some people carry feelings of self-hatred or self-blame.  When such feelings are very powerful, people may use self-harm to punish themselves.  This may help reduce their guilt.

Cleansing

For people who see themselves as dirty, often as a result of abuse, self-injury may be a way of symbolically ridding themselves of the contamination they feel.

Control

It is likely that most of the reasons for self-harm are underpinned by a desire for control.  Self-harm is a way of regaining control, by controlling the injuries to their own bodies.  Determining the nature, site, timing and severity of the self-injury is a way of staking claim to one’s own body.

Communication

Self-harm is primarily carried out to regulate feelings rather than to gain a response from others. Some people never show or tell anyone else about their injuries.  However, self-injury may also be a way of trying to communicate something without using words.

Comfort and nurturing

Self-harm can be experienced as calming or comforting.  This can come from the release of tension, but also by providing an opportunity to seek care and nurture from others.

Making one’s body unattractive

Sometimes people harm themselves to make their bodies unattractive in the hope this will keep others away, particularly when they fear someone who abuses them sexually.

Feeling real or alive

Sometimes people’s life experiences leave them feeling numb, dead or unreal.  Hurting one’s body is one way of breaking through these feelings and actually experiencing something that makes them feel alive again.


Things to think about                                                                                            top of page

The experiences that lead to self-harm can generate many difficult feelings and emotions in children and young people.  Young people who self-harm often carry feelings of shame, guilt, self-hatred, anger, frustration and isolation.  However, there is a common belief that young people who self-harm are 'attention-seeking'.  In reality, most young people who self-harm tend to do it in secret, and labelling someone as attention-seeking only serves to further feelings of shame and guilt. This, in turn may exacerbate self-harming behaviour.

Young people self-harm for many different reasons.  In trying to understand why a child or young person may be self-harming, ask yourself the following:

  • Do you know if the child/young person is being bullied at school?

  • Do you know if they have suffered sexual, physical and/or emotional abuse?

  • Do you know if they have lost a parent through death or separation?

  • Do you know if they are in conflict with parents or other family members?

  • Do they have a chronic illness or disability?

  • Are they being subjected to excessively high expectations?

  • Are they worried about school work and exams?

  • Do they have problems to do with race, culture or religion?

  • Are they afraid or ashamed about their sexuality?

  • Is there a possibility they have an unwanted pregnancy?

  • Have they recently experienced bereavement?

  • Have they experienced self-harm or suicide of someone close?

  • Are they feeling isolated?

  • Do they have low confidence or sense of self-worth?


Think about yourself                                                                                             top of page

Self-harming behaviours or thoughts of self-harm in young people can lead to strong feelings of anxiety, fear and frustration in the people who surround them and in those who are trying to support them.  The containment and management of these feelings is an important factor in supporting young people who self-harm.  To help you do this, try not to focus too much on the self-harming behaviour; ensure that you engage with the person and the issues underlying the self-harm.

Offering what support you can, being there for the person and their feelings and problems can be very helpful but it is important to be aware of your own limitations and not offer more than you cope with.

For more information, see section on being aware of yourself and your own response.


What you can do                                                                                                    
top of page

  • It is always advisable to seek the advice of a mental health specialist if you discover a young person is self-harming.  In many cases this can be done in the first instance without giving the young person's name.  If you and the specialist feel the self-harm is not a major threat to the young person's safety, it may be appropriate to support the young person within their present situation.
      
  • Listening and caring is the most important thing you can do to help.  It might not seem much, but showing that you want to know and understand can make a lot of  difference.

  • Seeing the person behind the self-harm is important to show that you care about the whole person and not just the self-harm.  The person may find it much more helpful for you to focus on their feelings, rather than dwelling on the self-harm.   Accepting the self-harm helps them cope and can help to show that you understand that at the moment, self-harm works for the person when nothing else can.

  • Accepting mixed feelings is very helpful.  The young person might hate their self-harm, even though they might need it.  It helps the person a lot if you accept all of these changing and conflicting feelings.

  • Help the young person find further support.  They may need help in addition to what you can give - you can support and encourage them in finding this.

  • Show concern for the young person's injuries.  By offering the same compassion and respect you would show for any other sort of injury, you are showing the person that their body is worth caring about.  If the person shows you a fresh injury, offer the appropriate help in the same way as if it was an accidental injury.   There is no need to overreact just because it is self-inflicted.  Voice any concerns you may have but listen to the person’s feelings about what they want to happen. Work out, together, a way of taking care of their health and safety.

  • It is important to recognise how hard it may be for the young person to talk to you.  It may take a lot of courage for a person to discuss their self-harm and their feelings, and it may be difficult for them to put things into words.  Gentle, patient encouragement can help.

  • Help the young person find alternatives to self-harm.  Some young people find it helpful to develop a list of alternatives to their self-harm.  Young people have said that their most successful alternatives are:

- Hitting a punch bag to vent anger and frustration.

- Hitting pillows or cushions and having a good scream.

- Going outdoors for a walk.

- Any form of physical exercise.

- Writing down thoughts and feelings on paper and possibly ripping them    up.

- Keeping a diary.

- Calling and talking to a friend.

- Creative alternatives like art.

- Looking at self-help websites.

- Using a pen to draw on their skin in the place they might usually cut.

- Holding an ice cube against their skin instead of cutting.

 

"You shouldn't be ashamed of who you are. That was something the workers told me"

 
 
Young Person
 


What not to do                                                                                                       top of page

  • Don’t tell the person off or punish them in some way.  This can make the person feel even worse, so could lead to more self-injury.

  • Don’t blame the young person for your shock and upset.  You have a right to feel these things but it will not help if you make the person feel guilty about it.

  • Don’t jump in with assumptions about why the young person is self-harming.  Different people have different reasons and it is best to let the young person tell you why they do it.

  • Don’t avoid talking about it.  Avoiding talking about it won’t make the self-harm go away, but will leave the person feeling very alone.

  • Don’t try to force them to stop self-harming.  Doing things like hiding razor blades or constantly watching the young person doesn’t work and is likely to lead to harming in secret, which can be more dangerous.

  • Don’t ask a young person to promise not to self-harm.  This will not work, but is likely to put a lot of emotional pressure on the person and can set them up to feel guilty.

  • Don’t treat the young person as mad or incapable.  This takes away their self-respect and ignores their capabilities and strengths.

  • Panicking and overreacting can be very frightening for the person.  It is better to try and stay calm and take time to discuss with them what should be done next.


Managing risk and confidentiality                                                                      top of page

It is usually best not to make decisions about risk on your own but rather in consultation with senior colleagues.

Self-harming behaviours can present a threat to a young person’s safety.  In addition, young people who self-harm may also have suicidal thoughts.  In order to develop a judgement about the level of risk they are at, it is important to take time to talk to the person and to respectfully enquire about their intentions.  The assessment of risk should also consider the young person’s strengths and resources alongside coping strategies and support networks that are available to them.

The issue of confidentiality should be openly discussed with the young person and jointly understood.  Where confidentiality needs to be compromised in relation to risk, it should be done respectfully and openly.  Normally a worker's duty to protect a young person from serious harm will outweigh the worker's duty to keep confidentiality, although every case should be considered in its own right and taking account of your organisation's policy on confidentiality.


When to contact a mental health specialist                                                    top of page

It is always advisable to seek the advice of a mental health specialist if you discover a young person is self-harming.  In many cases this can be done in the first instance without giving the young person's name.

  • If there is sufficient concern around the young person’s safety, either through concern about the extent of injuries or suicidal thoughts.

  • If you feel there is evidence of depressive symptoms, e.g. sleep disturbance, loss of appetite, poor concentration, sense of hopelessness. 

  • If you feel you are not experienced enough to discuss any issues underlying the self-harm, e.g. sexual abuse.


How to contact a mental health specialist

You should get in touch with your local health centre or hospital to obtain a contact number for the appropriate children and young people's mental health specialists.

Remember - you can contact your local mental health specialists for a number of reasons, for example:

  • For advice on how to make a referral about a named child.

  • For advice about whether or not to make a referral (it is normal practice to seek this advice without naming the child in the first instance).

  • For advice about what to do (once again there should be no necessity to name the child).

By not naming the child you are protecting their right to confidentiality. This method of seeking advice also has the advantage that you do not need to get anyone’s consent in advance of your contact phone call.


Quotes from young people - Why do I harm myself?                                    top of page

I’m in control
     
  "I’ve always had to do what suited other people – different foster parents, children’s homes, schools.  Nobody ever asked me what I wanted."  
     
  "It’s like a control thing.  How deep, how often, where I cut – it’s all down to me. It’s my body and I’ll decide what to do with it."  
     
Time-bomb ticking inside me
     
  "I get mad about things, it all knots up inside me and I just want to scratch myself and slash at myself."  
     
  "I hit myself because I’m so angry with myself – for being so stupid and pathetic, for being the sort of person bad things happen to."  
     
  "After I cut myself I feel good, like I’ve punished them, secretly.  I can be talking to them and I can feel my arm and it’s like ‘stuff you’, like I’ve got one over on them."  
     
Getting out the badness
     
  "The badness I feel becomes unbearable. I can’t take it any more so I cut.  The relief is instant. It’s like I’ve got what I deserve.  The badness just drains away."  
     
  "Washing doesn’t work, however much I do it.  I cut myself where I was touched.  It gets rid of the dirt."  
     
An excuse for some comfort
     
  "When I feel empty it’s like there is nothing inside me.  I’d do anything to fill that gaping hole. I used to stuff myself with food but it was never enough.  But when I cut it just goes."  
     
  "I like looking after my cuts. It’s the one time I can be really nice to myself.  Then I curl up in bed and just snuggle down and go to sleep."  
     
 

"It gave me an excuse to go to the nurse and be bandaged up and taken care of."

 
     
Showing there’s something wrong
     
  "I thought if I had bruises on me, someone would realise that things weren’t all right at home, and would make it stop, somehow."  
     
  "People always think I’m happy and together. Even if I say that I’m down they think it’s not serious. In the end I took tablets – not to die but to prove I wasn’t OK."  
     
  "I wanted my Dad to feel bad, to realise that it mattered what he’d done to me. That I was screwed up by it. I wanted him to be sorry."  
     
Something that’s mine – This is me
     
  "Self-harm – it’s something special I do for myself, it’s mine, my secret. Like a friend, just for me."  
     
  "Cutting is like part of me, my identity. Sometimes when people are having a go at me about ‘looking nice’ or getting a good job or something (and I’m keeping my mouth shut), I think about my arms and my scars and then I don’t care."  
     
Stopping the pain
     
  "Sometimes my emotional pain is so strong that I don’t feel I can take it and that it’s going to destroy me. I just know I need to stop it. Cutting my arms seems to help me do that. The physical sensation ground me somehow – it brings me back to reality away from the overwhelming feelings. After hurting myself, I can care for and bandage the wounds and therefore feel justified in looking after myself. When feeling the physical hurt that it causes, I am numb to the emotional pain which is a million times worse and so much harder and scarier to deal with."  

 

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