In this edition we consider self-harm and discuss what teachers can do to help young people who are vulnerable to self-harm

What is self-harm?
Until recently the subject of self-harm hasn’t been the focus of much publicity. However, this doesn’t mean that it was not already a significant yet hidden feature of the lives of many young people. As with bullying, until the 1980s, schools infrequently achieved excellence in terms of policy development, knowledge or productive intervention in this area. This situation has changed significantly in recent years, since the October 2009 Safeguarding Vulnerable Groups Act, which required a centralised vetting system and raised awareness of the need to develop pro-active interventions and implement policy in these areas. However, self-harm still remains a major public health issue amongst young people in the United Kingdom; it affects at least one in 15, making their lives extremely difficult and seriously affecting their relationships with friends and family.

Self-harming behaviours are secretive by definition, and parents and carers will often be unaware of what is happening. In fact, whilst some young people might talk in school to a trusted professional, they may well insist that parents or carers are not told. School staff need to make sure that they can make useful reference to ‘Gillick competence’ and the circumstances under which young people may receive help without parental consent or knowledge. It is difficult to know whether or not to take this route, and responsibility for taking it should be that of a line manager who can make the appropriate explanatory notes and records.

Self-harm describes a range of things that young people do to themselves in a deliberate and usually very hidden way. These might involve the following:

  • taking too many tablets
  • burning
  • cutting
  • banging or scratching their own bodies
  • breaking bones
  • pulling hair
  • swallowing toxic substances or other inappropriate objects.

It is important to remember that these behaviours are not done in any calculated way, as some people might think. There are many myths around self-harm; most significantly the one that behaviours are simply attention-seeking. This is totally wrong and needs to be challenged persistently. People who self-harm do this because they are in a state of very genuine and real distress and unbearable emotional pain – self-harm is one way of releasing and controlling such pain. Some people may only self-harm on a few occasions, whilst for others it will become a regular thing – almost like an addiction. A second myth that needs to be dispelled is that young people can stop self-harming if given the right support or if simply told to do so by a significant adult. Again this is totally untrue. If it were that easy to stop, then these young people would certainly cease such behaviours.

Who self-harms?
The average age for young people to begin self-harming is approximately 12 years and the majority of self-harmers are between 11-25 years. It is more common in young women than men and the majority of those who self-harm are likely to have experienced some significant physical, emotional or sexual abuse during childhood. The reasons for self-harm are many and varied, but may include the following: feelings of isolation or depression; problems in relationships with partners, friends and family; academic pressures; low self-esteem and feelings of hopelessness; sexual or physical abuse; bullying; feeling powerless as if there’s nothing that they can do to change anything in their lives; inappropriate use of alcohol or drugs. Another possible cause is the need to show another person who distressed the student in order to punish them; however, this is not the norm as most people are extremely private about the whole process and wouldn’t engage in self-harming behaviours to meet this objective.

Can self-harm be prevented?
There are ways of preventing self-harm amongst young people, and there is an increasing amount of evidence to show that this is the case.

  • School initiatives to tackle self-harm causes: There are many initiatives in school, for example anti-bullying strategies and whole-school approaches to promote emotional health and wellbeing. These appear to help, though there is no real evidence as yet that these initiatives have any real or long-lasting impact upon self-harming behaviours.
  • Educating individuals about self-harm: One thing that does remain a key factor for many young people is the sense of social isolation that they experience. Self-harmers tend to think that they are the only people who engage in these behaviours – this is why educating young people in this area, and providing opportunities to gain appropriate information and increase understanding, can help prevent or reduce such behaviours in both the short and long term. What is important is that any increased awareness is shared by parents or carers and teachers and others who come into contact with young people who self-harm.
  • Developing a self-harm policy: This is a big undertaking, but it is vital for school-based staff to develop their own self-harm policies, and be very clear that these need to be shared and owned by all involved (parents, students and those in the wider school community). (See below for this)
  • Bringing the issue of self-harm into the curriculum: It is also vital that schools ensure that mental health education is made a broader part of the school curriculum. Mental Health Foundation report of 2006 clarified why many young people who self-harm were prevented from seeking support. This was primarily because they didn’t feel that the professionals they dealt with or the services on offer were actually meeting their needs.
  • Peer support: What young people did report positively upon was that school-based programmes were deemed to be more effective because they offered young people the opportunity to develop peer support schemes, and ensure that school based staff can and do provide an appropriate emotional and social context in which to give and receive such support. Such programmes need to ensure that they teach successful distraction techniques.

What help is there?
Some of the most popular tried and tested techniques identified by the Mental Health Foundation (Truth Hurts, 2006) were as follows:

  • using a red water-soluble felt tip pen to mark instead of cut
  • hitting a punch bag to prevent anger and frustration
  • rubbing ice instead of cutting
  • physical exercise
  • making lots of noise either with a musical instrument or just banging on pots and pans
  • writing negative feelings on a piece of paper and then ripping it up
  • scribbling on a large piece of paper with a red crayon or pen
  • putting elastic bands on wrists and pulling and releasing them instead of cutting
  • writing a diary or journal
  • talking to a friend, not necessarily about self-harm
  • completing a collage or artwork
  • going online and looking at self-harm websites.

Developing a self-harm policy
What is vital is that, alongside any intervention, the school-based staff develop a self-harm policy which meets the needs of their own students. The policy is necessary because, frequently, self-harm isn’t taken seriously enough in an educational context. Many believe it’s a passing phase, attention-seeking or simply that it’s not happening in their own school. However, we can now no longer deny the fact that as one in 10 teenagers is self-harming, which could be as many as three in every tutor group – there’s a real and genuine need to have a standardised and consistent approach to supporting those who engage in these behaviours in our schools.

Policies need to clarify:

a) the purpose – setting out clear guidelines on procedures for dealing with those who self-harm, whilst identifying support systems for staff who are dealing with these students
b) the content of the policy – this needs to be personalised to reflect each institution’s ethos and procedures, as a way of clarifying school staff’s understanding of self-harm and explaining the roles and responsibilities of those who respond to self-harming individuals. All staff and teachers need to be provided with systems, in terms of responding to individual disclosures. The school should also nominate a designated staff member who should be informed of every case of self-harming. The policy also needs to make clear that confidentiality is not promised to students if their behaviours are putting that at severe risk. If self-harm occurs on the premises, medical attention may be necessary, and staff need to clarify how this is conducted within their policy.
c) a member of staff needs to have responsibility for recording all incidents of self-injury and also for determining the most appropriate courses of action. It is the headteacher’s responsibility to appoint the designated member of staff and, together with the governing body, should ensure that the policy in place is communicated to all staff and implemented across the school.

Preventing the spread of self-harm within a school
The policy also needs to highlight the ways in which cases of self-harm can trigger others to engage in these behaviours and the ways in which they must attempt to prevent such escalation or spread. For example, wounds, injuries and scars should never be openly displayed, and students who self-harm should agree to this rule. Long sleeve PE kits may be necessary for those who self-harm. The designated member of staff should try and identify peers who may be self-harming who are ‘high status’; mapping out a sociogram can be useful in this respect. Where deliberate coercion is found to be present, for example providing a penknife for another to try self-harming, the policy needs to state that disciplinary action may be necessary and will be taken in appropriate circumstances.

The policy can be reviewed in-line with all related polices on a regular/annual basis. It is important that parents or carers work in partnership with the school when supporting those who self-harm, and endorse the school’s approach to the education of students regarding self-harm.

Overall, when considering addressing self-harming behaviours in the school context, teachers and those supporting young people need to ensure that any support programme or intervention is truly meaningful for adolescents in schools. From my own experience in the London Borough of Hillingdon, young people themselves have been very clear about what they did and did not want in terms of mental health support. They did not want to visit mental health workers in a clinical setting, but rather wanted a programme including coping strategies, support systems and techniques, and peer group support within the school context. They wanted the topic of self-harming to be demystified so that they were more likely to illicit the support that they needed – and know what it is that they might need – and when to seek this support. Developing school-based interventions, within a context in which whole-school policy is simultaneously developed, should hopefully meet such an objective.

Useful websites and organisations
The most useful websites to look at both for professionals, carers and young people are as follows:

www.selfharm.org.uk
www.selfharm.net
www.mind.org.uk
www.vpsyc.ac.uk
www.nice.org.uk

A telephone support is also given by Childline – free national helpline for young people. Free confidential advice on a range of problems 0800 1111.

NHS direct – a helpline with health advice provided by NHS nurses 0845 4647

Samaritans – a telephone helpline and e-mail service for anyone who is feeling upset, worried or suicidal. Ring 08457 909090.

References

  • Brunner, R. et al Prevalence and Psychological Correlates of Occasional and Repetitive Deliberate Self-harm in Adolescents Archives of Pediatrics and Adolescent Medicine July 2007 161 (7) pp. 641-649
  • Hawton, K. & Harriss, L. How Often Does Deliberate Self-harm Occur Relative to Each Suicide? A Study of Variations by Gender and Age Suicide and Life-Threatening Behaviour December 2008 Vol/is 38/6
  • Palmer, L. et al Helping people who self-harm Emergency Nurse June 208 Vol/is 16/3
  • Rae, T. & Smith, E. (2008) Self-harm & Suicide: The Professional Development File London: Optimus Education
  • Slee, N. et al Emotion Regulation as Mediator of Treatment Outcome in Therapy for Deliberate Self-harm Clinical Psychology and Psychotherapy January 2008 Vol/is 15/4

This e-bulletin issue was first published in March 2010

About the author: Tina Rae, a senior educational psychologist in the London Borough of Hillingdon and the emotional literacy co-ordinator for Chantry SEBD school in West Yiewsley. Tina has extensive experience of teaching, research, programme development and consultancy across the country