‌Self-harm

What is self-harm?

Self-harm is an expression of personal distress, not an illness, and there are many varied reasons for a person to harm him or herself. Self-harm describes a wide range of behaviours that someone does to themselves, usually in a deliberate and private way, and without suicidal intent, resulting in non-fatal injury.

In the majority of cases, self-harm remains a secretive behaviour that can go on for a long time without being discovered. Many children and young people may struggle to express their feelings and will need a supportive response to assist them to explore their feelings and behaviour and the possible outcomes for them.

Self-harm is common, especially among younger people. Approximately 1 in 10 young people report having engaged in self-harm. A wide range of psychiatric problems, such as emerging borderline personality disorder, depression, bipolar disorder, schizophrenia, and disorders related to drug and alcohol use are associated with self-harm. However many young people will not have a mental disorder.

Studies use different definitions of self-harm and cover different age ranges. This makes it very difficult to understand how many young people are affected. However, it is reasonable to conclude that:

• self-harm becomes more common after the age of 16, but is still prevalent among teenagers and younger children from the age of eight
• young women are up to three times more likely to self-harm than young men
• rates amongst young Asian women can be even higher but other than this, there is no reported difference in prevalence between young people from different ethnic backgrounds
• lesbian, gay, bisexual and transgender (LGBT) young people are more likely to self-harm. 

Triggers to self-harm

Vulnerabilities increase the likelihood that a young person might self-harm, one or more additional factors, or 'triggers', make this more likely to occur. These may include:

• family relationship difficulties (the most common trigger for younger teenagers)
• difficulties with peer relationships, eg break up of a relationship (the most common trigger for older adolescents)
• bullying, especially homophobic or cyber-bullying/mobile phones
• significant trauma eg bereavement, abuse
• self-harm behaviour amongst the young person’s peer group (contagion effect)
• self-harm portrayed or reported in the media
• difficult times of the year, eg anniversaries
• trouble in school or with the Police
• feeling under pressure from families, school or peers to conform/achieve
• exam pressure
• times of unwelcome change, eg parental separation/divorce.

A young person discloses or you have concerns

What matters for many young people is having someone to talk to who will take them seriously.

• Depending upon the setting and circumstances, find somewhere private to talk with the young person.
• Tell a colleague what you are doing.
• Listen attentively - just being listened to can be a brilliant support and bring great relief to the young person, particularly if they have never previously spoken to anyone about their self-harming before.
• Encourage them to talk about their feelings.
• Do not ignore or dismiss the feelings or behaviour nor see it as attention-seeking or manipulative.
• Stay calm - it may be uncomfortable listening but try not to let your own emotional response prevent you from hearing what the young person is saying and what their body language is telling you.

If they have taken any substances or injured themselves.

• Take all mention of self-harm or suicidal thoughts seriously - listen carefully and keep detailed notes.
• Clarify whether or not there are immediate needs for medical attention especially with regard to cutting or possible overdose, or to keep the young person safe and respond accordingly.
• In the case of an overdose of tablets, however small, the young person should be taken to a hospital as they may have taken more tablets than stated. If the incident took place over 72 hours ago, advice must be obtained from medical practitioners (or Hospital Emergency Department).
• Provide first aid if necessary and always take medical advice if a possible overdose may have occurred.

Having dealt with any immediate medical needs, explore with the young person what is going on in their life that has caused them to feel/behave like this - the feelings, thoughts and behaviours involved. This can help the young person to makes links between feelings and behaviours, begin to make sense of the self-harm and to think about other ways of coping.

Multi-agency guidance

There is a reference guide for all agencies and practitioners to help support children and young people who have expressed thoughts about self-harm or who are about to or have self-harmed. The guidance outlines:

• what self-harm is
• the triggers for self-harm
• guidance about what to do when working with young people and children who self-harm.

Single Point of Access 

• Derbyshire Healthcare Foundation Trust Child and Adolescent Mental Health Service (CAMHS) provides comprehensive and targeted treatments to support the emotional and psychological wellbeing of children and young people in Derby city and south Derbyshire.
• You can use the online referral form to make a referral for services to help children and young people with behavioural and emotional problems.
• For emergency referrals, please contact the CAMHS duty worker on 0300 1239164 to discuss the referral.
• Chesterfield Royal Hospital Child and Adolescent Mental Health Service (CAMHS) supports young people's mental health and wellbeing in North Derbyshire. If a situation requires a quick response, please contact the Urgent Care Team on 0790 1330724. 
• In all cases if life is at imminent risk please contact the emergency services on 999. 

What should I do if I have concerns about significant harm and abuse?

If there are immediate medical concerns for the welfare of the child or young person, medical attention must be obtained. If you are concerned about self-harm you can find more information in the Derby and Derbyshire Safeguarding Children Procedures about making a referral to Children's Social Care. Always discuss your concerns with the senior person in your organisation who is responsible for safeguarding and child protection. If you are a young person, parent or carer, you can contact Children's Social Care to discuss your concerns.

Resources

• MindEd for Families, a free online resource developed as part of the MindEd project to enable parents and families to intervene earlier in their children and young people’s mental health issues.
• The Samaritans is a national charity that can help people of all ages with whatever is getting to them. Samaritans are available free to phone at any time on 116 123.
• Papyrus is a national charity that helps to prevent young suicide. 
• Young Minds and the Royal College of Psychiatrists have created a series of films and digital resource packs on self-harm. These have been created with the help of children and young people, parents and professionals. There are three digital packs (young peoples’, parents and professionals) to go with the films, these include personal stories of young people, parents and professionals, common questions and what to do next, and information on how to find help. The Royal College of Psychiatrists have also published a self harm leaflet.
• Partnership for Mental Health and Well-being in Schools - has published a whole school framework for emotional wellbeing and mental health: a self-assessment and improvement tool for school leaders and a range of accompanying resources.