CHARLOTTE LEVENETRAINING AND CONSULTANCY

YOUNGMINDS

Mental health and self-harmA risk and resilience approach to helping young people.

AIMS FOR THE SESSION...

To enable participants to better understand why young people might self harm and to explore ways in which you can respond positively in order to help

To give participants some knowledge as well as practical tools which you can use to assess risk and promote resilience

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’

YoungMinds 2006

CHILD MENTAL HEALTH

• 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

DEFINING AND UNDERSTANDING SELF HARM

What comes to mind when you think about self-harm?

DEFINING SELF HARM

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

The most common form of self-harm is cutting the arms or the back of the legs with a razor or knife, but it takes many forms, including burning, biting, hitting and taking overdoses.

NICE Guidance on Self Harm (2004)

TRUTH HURTS

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

IS THERE A LINK BETWEEN SELF HARM AND SUICIDE?

While studies have shown that young people who self-harm are more at risk of suicide, people don’t necessarily self-harm because they want to take their own lives.

The young people we work with describe self harm as a coping mechanism to manage overwhelming feelings; and young people who took part in this survey (TASH) describe it as a diversion of painful feelings.

HOW COMMON IS IT?

In every secondary school classroom there will be two young people who have self-harmed

HOW COMMON IS IT?

• 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)

WHY DO YOUNG PEOPLE SELF HARM?

“

“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.”

“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.”

“I cut myself when I’m angry, it hurts but it

helps my anger.”

Cutting takes my mind off

things, when I’m unhappy

about myself, the way I am.”

BIOLOGICAL EFFECTS OF SELF HARM

Self harm can bring its own physical release. Neurochemicals can play an important role

in self-harm. Endogenous opioids and serotonin may

bring about a very positive feeling of calm and well-being.

These chemicals are released particularly when the body is injured in any way.

They produce insensitivity to pain which help the individual survive when faced with danger.

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

THE ONS REPORT ‘MENTAL HEALTH OF CHILDREN AND YOUNG PEOPLE IN GREAT BRITAIN, 2004’ FOUND THAT:

28% of children aged 11-16, with an emotional disorder reported that they have self-harmed. This compares to 6% without an emotional disorder.

21% of children aged 11-16, with a conduct disorder reported that they have self-harmed. This compares to 6% without a conduct disorder.

18% of children aged 11-16, with a hyperkinetic disorder reported that they have self-harmed. This compares to 7% without this disorder.

25% of parents, who had a child with an autistic spectrum disorder, reported that their child had self-harmed, compared to 2% whose children did not have the disorder.

YOUNG PEOPLE WITH LEARNING DISABILITIES

Why might young people with learning disabilities be at particular risk of self harm?

Also consider young people with physical disabilities

A BIO-PSYCHO- SOCIAL MODEL

NATURE

NURTURE

EVENTS

WHAT ARE RISK FACTORS?

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 IS RESILIENCE?

RESILIENT CHILDREN

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

Newman, T (2002)

RESILIENCE

• 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)

• Ordinary magic .. In the minds, brains and bodies of children, in their families and relationships and in their communities (Masten)

RESILIENCE IN THE CHILD

• being female• secure attachment experience• an outgoing temperament as an infant• good communication skills, sociability• planner, belief in control• humour• problem solving skills, positive attitude• experience of success and achievement• religious faith• capacity to reflect

RESILIENCE IN FAMILIES

• At least one good parent-child relationship• Affection• Clear, firm consistent discipline• Support for education• Supportive long term relationship/absence

of severe discord

RESILIENCE IN COMMUNITIES

• Wide supportive network• Good housing• High standard of living• High morale school with positive policies

for behaviour, attitudes and anti-bullying• Schools with strong academic and non-

academic opportunities• Range of sport/leisure activities• Anti-discriminatory practice

HARM MINIMISATION

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

WHAT CAN WE DO TO HELP?

Listen non-judgement

ally

Show care and respect

Acknowledge

emotional distress

Explain what is going to happen

next

Help to them to get

help to address the problems (referral)

Be aware of your own

capacity to help and

make sure you have

the opportunity

to reflect

ADVICE FOR YOUNG PEOPLE

Prepare yourself with knowledge about self-harm before you talk to your friend.

Stay calm and don’t over react. The person you are talking to is clearly upset or stressed. Being shocked or angry could make it worse.

Talk it through with someone confidentially beforehand. This could be a parent or teacher, or even an organisation like ChildLine. 

Offer advice about where to go. They could speak to a teacher, their GP or one of the organisation at the bottom of this page.

Accept that they might not want to talk, but it’s important though for you to try and encourage the person to open up. This might take more than one

conversation.  Accept that they might not want to talk,

but it’s important though for you to try and encourage the person to open up. This might take more than one conversation.

If you are concerned that they might really hurt themselves consider explaining the situation to a teacher, parent or ChildLine so that you have support. It might feel like you are ‘telling’ on your friend but it’s important that they get support. 

Sometimes you will say the wrong thing. Don’t worry about it or let it stop you having a conversation. The most important thing is you show you care and keep talking to your friend.

“Wait till I’m finished and calmed down...” Don’t try stop someone in the middle of self-harming as they will be in an agitated state. Be there for them to listen.

Look out for signs and clues that someone is self-harming.

Stay loyal. It’s important that your friend knows they can trust you, so don’t gossip about the situation your friend is in.

Recovery takes time; so don’t hold yourself solely responsible for helping. Be there as a consistent support mechanism for them.

Talk about thoughts and feelings rather than what they’re doing.

DEVELOPING A SELF HARM POLICY

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?

YOUNGMINDS

Parents Helpline: 0808 802 5544 Tel: 020 7089 5050 Website: http://www.youngminds.org.uk and

Publications Training & Development: charlotte.levene

@youngminds.org.uk