Introduction to self-harm

A risk and resilience model

Charlotte Levene

Mental health: A definition

‘the strength and capacity of our minds to grow

and develop, to be able to overcome difficulties and challenges and to make the most of our

abilities and opportunities’

• Understand why some young people might self harm

• Explore risk factors• Explore helpful responses• Consider what young people have told us• Develop strategies to build resilience in young

people

Aims for the session...

• A capacity to enter into, and sustain, mutually satisfying and sustaining personal relationships

• Continuing progression of psychological development

• An ability to play and to learn so that attainments are appropriate for age and intellectual level

• A developing moral sense of right and wrong• A degree of psychological distress and

maladaptive behaviour within normal limits for the child’s age and context

Child Mental Health

Mental health problemA disturbance of function in one area of; relationships, mood, behaviour or development, of sufficient severity to require professional intervention.

Mental disorder

A severe problem (commonly persistent) or the co-occurrence of a number of problems, usually in the presence of several risk factors

Problems & Disorders

A bio-psycho-social model

EVENTS (what happens to us)

NATURE (what we are born with)

NURTURE (what we grow up

with)

• When some people feel sad, desperate, angry or confused, they can hurt themselves. This is called ‘self-harm’.

• People can do this in a number of ways and for different reasons.

• People who harm themselves on more than one occasion may do so for a different reason each time. They may also harm themselves and not tell anyone about it

NICE Guidance on Self Harm (2004)

Defining Self harm

Young people who self-harm do so because they have no other way of coping with problems and emotional distress in their lives…. It provides only temporary relief and does not deal with the underlying issues.’

Truth hurts

Truth Hurts, Mental Health Foundation (2006) http://www.mentalhealth.org.uk/publications/truth-hurts-report1/

Methods of self harm

Methods

Excessive risk taking

Cutting

Scalding burning

Hair pulling

Breakingbones

Banging

Ingesting

Restrictive

eating

• 3 in 4 young people don’t know where to turn to talk about self-harm…most seek information online

• A third of parents would not seek professional help if their child was self-harming

• Almost half GPs feel that they don’t understand young people who self-harm and their motivations

• 2 in 3 teachers don’t know what to say to young people who self-harm

Talking self harm YoungMinds/Cello (2012)

http://www.cellogroup.com/pdfs/talking_self_harm.pdf

YoungMinds & Cello Research research

How common is it?

Approximately 2 children in every classroom will have self-harmed

• Between 1 in 12 and 1 in 15 young people self-harm (truth hurts 2008)

• 7% of young people aged 15-16 in England self-harm (Hawton, et al., 2002)

• 37,000 young people presented to hospital in 2010/11 and many report previous episodes when they did not go to hospital (hospitals admissions statistics 2010)

• Inpatient admissions of young people under 25 for self harm have increased by 68% in the last 10 years (hospitals admissions statistics 2010)

How common is it?

• 318 out of 1000 young people in young offenders institutions report that they have self-harmed (ONS 2010)

• 18% of children aged 11-16, with a hyperkinetic disorder (similar to severe ADHD) reported that they have self-harmed. This compares to 7% without this disorder. (ONS 2004)

• 25% of parents, who had a child with an autistic spectrum disorder, reported that their child had self-harmed. (ONS 2004)

• Looked After Children and care leavers are between 4 and 5 times more likely to self harm in adulthood than those not Looked After (Annual Report of the Chief Medical Officer 2012)

Increased Vulnerability

• What do you think are the main myths that surround self-harming behaviour in young people?

Self Harm Myths

Self harm myths

Myths associated

with self harm

Attention seeking

Just about cutting

Copying others

Associated with

specific sub

cultures (Emo, goth)

Fashionable-didn't

happen in my day

Is a suicide attempt

Its because of the

internet

Consider what the effect of this stigma is

• Increase feelings of shame and guilt• Encourage likelihood of hiding self-harm• Reduce willingness for open discussion/disclosure• Increase judgement• Add to risk• Reduce likelihood of adults identifying young people• Increase angry responses• Increase in panicked responses• Increase in “not taking it seriously” responses• Inaccurate and inappropriate referrals

What is the effect of this stigma?

Why do some people self-harm?

What young people have told us…

“I don’t really like school and nick off as much as I can. There’s

always arguments at home so I go out and hang around with a group of lads

and lasses. We all drink a bit; sometimes I cut my arm with a bit of

broken glass. It feels good, but then I regret it the next day

when I see the scar.”

Cutting takes my mind off things, when I’m unhappy about myself, the way I am.”

“I cut myself when I’m

angry, it hurts but it

helps my anger.”

“The thoughts are in my head every day, I can’t take it. Cutting myself is the only way I can deal with him being around

Release of unbearable pressure

“Cutting for me releases all the built up anger and frustration and pain I feel inside. There are many things that happen to me in my life which cause the pain I feel and how I release it. Mostly the feelings of isolation like being outcast pretty much from relationships altogether. I don’t feel like I am a very stable person and I hate myself a lot of the time. I think body image also has a lot to do with my cutting. School is stressful, home life I can’t handle sometimes.”

Jolt back to reality (when disassociating)

“Sometimes when I felt numb and empty, scratching myself helped me to feel emotions again. Brought me back to life in a way”

Young person

“Why do kids hurt themselves? Because they can’t feel anything else. Why can’t they feel anything else? Because a previous pain has scarred them, just like scar tissue that you might have now, it doesn’t tan in the sun because it’s dead! If you hurt inside for whatever reason, your inside will die. And then you don’t feel anything. But your brain still works you are still physically alive and the only way to bring those feelings back is to physically feel something”

To physically feel something

Escape from the unbearable emotional present

For some young people, there are times when the present is just too painful. Something may trigger a past memory or a current situation may be too difficult to bear.Self-harm is a way that the young person can escape from the unbearable emotional present.

It’s a deflection of emotional to physical pain

“My emotions can vary rapidly and be very intense. If in an emotionally charged situation, I will either during or shortly after harm myself. I’m not good at dealing with emotions or communicating mine to others.”

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.

(HandsonScotland)

Self-punishment

“I would just like to mention the adrenalin rush that one experiences with the pain. When I feel numb and like I don’t really exist, I cause myself harm and it brings this rush that brings you back to earth”

Physical release and feeling of calm and well being

• Self-harm can bring its own physical release. Neurochemicals, such as serotonin, are released when the body is injured in any way and these may bring about feelings of calm and well-being. They produce insensitivity to pain which help the individual survive when faced with danger.

• Some people say that self-harm gives them this feeling of calm

• It is likely that the body grows to expect a higher level of these chemicals.

...and some people won’t be able to tell you why they self-harm.... they might not know or they may not be able to express it in words

Self harm and suicide

“Pain works. Pain heals. If I had never cut myself, I probably wouldn’t still be around today. My parents didn’t help me, religion didn’t help me, school didn’t help me but self-harm did. And I’m doing pretty well for myself these days. Don’t get me wrong, not in a heartbeat do I think that self-harm is a good or positive thing, or anything besides a heart-breaking desperate act that saddens me every time I hear about it. But there is a reason why people do it.”

Conditions, events or circumstances that are known to be associated with emotional or behavioural disorders and may increase the likelihood of such difficulties

Risk is cumulative

Risk is not causal but can predispose children to mental health problems

What are risk factors?

• Being Bullied• Not getting on with parents• Stress about school• Divorce• Bereavement• Unwanted pregnancy• low mood/anxiety• difficulty communicating• poor problem solving skills• Impulsivity• Experience of abuse

• Difficulties associated with sexuality

• Problems to do with race, culture and religion

• Low self esteem• Feeling rejected• an existing psychological or

developmental difficulty • Hopelessness• drug or alcohol abuse

Individual Factors

• unreasonable expectations

• Religious, ethnicity, cultural identity dilemmas or conflict

• young carers’ role within the family

• domestic violence

• neglect or abuse (physical, sexual or emotional)

• poor parental relationships and arguments

• depression, deliberate self harm or suicide in the family

Family Factors

• difficulty in making relationships/ loneliness

• persistent bullying or peer rejection

• Racism

• homophobic attitudes or bullying of children who think they may be gay, lesbian or bisexual

• easy availability of drugs, medication or other methods of self harm

Social Factors

Listen non judgementally Acknowledge emotional distress

Encourage young person to identify their own support

network and encourage them to access other support

Recognise your limitations and refer to appropriate service for

clinical assessment

Explain what is going to happen next Show care and respect

What can you do to help?

Assessing Risk

• Ask the young person to explain in their own words, why they have self-harmed

• Remember- people self-harm for different reasons at different times.

React with

horror or

discomfort

Ask abrupt

or rapid questions

Threaten or get

angry

Engage in

power struggl

es; deman

ding ‘just stop’

Accuse

them of

attention

seeking

Get frustra

ted

Ignore other

warning

signs

Promise to keep things secret

Don’t….

“can resist adversity, cope with uncertainty and recover more successfully from traumatic events or episodes”

Newman, T (2002)

Resilient Children

•Normal development under difficult circumstances. Relative good result despite experiences with situations that have been shown to carry substantial risk for the development of psychopathology (Rutter)

•The human capacity to face, overcome and ultimately be strengthened and even transformed by life’s adversities and challenges .. a complex relationship of psychological inner strengths and environmental social supports (Masten)

Resilience

Sarah’s film...

Taking control of their lives (helping to reduce risk

taking behaviours)

Developing more

healthy ways of coping

Increasing their self esteem

Increasing their

assertiveness in a

positive way

Harm minimisation

What do you think an effective policy would look like?

1. Who would it target?

2. What would it need to contain?

3. How will you know that its having an effect?

4. Which local services need to be involved in?

Developing a self harm policy

• Defined self harm and explored methods• Recognised that the myths and stigma surrounding self-harm lead

to numerous adverse affects for those young people who do self-harm

• Recognised that there are many different reasons why a young person may self harm and they may be different on different occasions

• Most young people are secretive about self-harm• Those who disclose must be listened to, cared for, taken seriously

and be assessed by professionals• There are many ways you can help a young person reduce risk and

build resilience

So what have we learned..?

Parents Helpline: 0808 802 5544 Tel: 020 7089 5050 Website:

http://www.youngminds.org.uk Training & Development:

matthew.daniel@youngminds.org.uk

YoungMinds