Self-harm: a Management Toolkit for Educational Settings

This toolkit is to support those working with school age children and young people under 18 in educational settings and aims to:

• Increase understanding and awareness of self-harm

• Support staff in being aware of risk factors and signs that are associated with self-harm

• Provide a toolkit for educational settings (and staff within them) for responding to students who self-harm

• Raise awareness in educational settings of what support is available locally in responding to self-harm, and when/how it can be accessed

This toolkit includes information about responding to self-harm, however, as usual, in the event of a medical emergency, call 999.

If you would like the complete leaflet, and other leaflets designed for parents and children, please contact Katie Cowling.

Healthwatch research on self-harm

Toolkit

The term “self-harm” is used to describe a wide range of behaviours. Self-harm is often understood to be a physical response to an emotional pain. Some of the well- known forms of self-harm include cutting, burning or pinching, but there are many forms of self-harm, including abusing drugs and alcohol or struggling with an eating disorder. Some people use the same type of self-harm all the time, others hurt themselves in a variety of ways at different times. It’s usually a way of coping with or expressing overwhelming emotional distress. Although some people who self-harm are at a higher risk of suicide, many people who self-harm don’t want to end their lives

To deal with distressing experiences and difficult emotions

Young people may use self-harm as a way of coping with distressing thoughts or emotions. Self-harm can occur at times when they feel overwhelmed, exposed, anxious, stressed, angry, unable to cope and/ or unable to express themselves. Self-harm can lead to feelings of relief, calmness and of being in control. Some young people also self-harm to deal with feeling unreal, numb, isolated, or disconnected. Self-harm in these circumstances may lead to feelings of being more real, more alive, functioning and able to cope in the short term. Some young people may self-harm because physical pain seems more real and therefore easier to deal with than emotional pain.

To keep people away

Some young people self-harm with the intention of making themselves unattractive to others or to prevent others from getting close.

To enlist help or concern

For some young people, self-harm is a way of expressing their distress non-verbally. Self-harm should not be assumed to be “attention seeking behaviour” - however superficial it appears. It is almost always a sign that something is wrong and needs to be taken seriously. Avoid making judgements or assumptions about why someone has self-harmed.

 

Risk factors may mean some young people are more at risk of self-harm, particularly if they have a number of risk factors. Children and young people with fewer protective factors listed may be less at risk of self-harm. However some who self-harm may not have any of these risk factors, and may self-harm despite having protective factors (e.g. supportive adult relationships etc.).

Risk Factors: Characteristics of the Individual Child

  • Low self esteem
  • Poor coping, communication or problem solving skills
  • Difficult temperament
  • Mental distress or illness, e.g. anxiety/depression
  • Alcohol/substance misuse
  • Impulsivity
  • Stress or worries about school work or peers
  • History of similar behaviour in the past
  • Past or current experience of abuse
  • Feeling isolated
  • Recent bereavement or loss
  • Worries around sexuality
  • Gender dysphoria
  • Chronic illness/disability

Protective Factors: Characteristics of the Individual Child

  • High self esteem
  • Higher ability/attainment
  • Outgoing personality
  • Good coping skills
  • Positive school experience
  • Secure attachment
  • Resilience
  • Knowledge of where to seek support

Risk Factors: Features of the Immediate Context

  • Access to means of causing self-harm
  • Being alone
  • Social exclusion
  • Alcohol and drugs

Protective Factors: Features of the Immediate Context

  • Access to social support
  • Social inclusion

Risk Factors: Family Factors

  • Family members who self-harm
  • Family conflict
  • Parental separation and divorce
  • Single parent family
  • Parental illness
  • Parental alcohol/drug misuse
  • Sexual/physical/emotional abuse or neglect
  • Poverty/low socio-economic status
  • Domestic violence
  • Pressure from family to achieve at school/unreasonable expectations

Protective Factors: Family Factors

  • Supportive adult relationship
  • Harmonious family relationships
  • Low level of material or social hardship
  • Good role models within family

Risk Factors: Peer Groups

  • Arguments with friends
  • Bullying
  • Friends who self-harm
  • Loneliness/social isolation

Protective Factors: Peer Groups

  • Stable and secure friendship group

Risk Factors: School/College

  • Pressure to perform well or to work outside ones comfort zone.

Protective Factors: School/College

  • Supportive and understanding adult
  • Inclusive/incorporative ethos
  • Strong commitment to PSHE mental health promotion
  • Establishment of peer support systems

Risk Factors: Wider Culture and Community 

  • Minority status
  • Problems in relation to race, culture or religion
  • Problems regarding sexual orientation or identity
  • Media portrayals glamorise self-harm or suicide ‘victims’ and elicit ‘copy-cat responses by vulnerable children and young people

Protective Factors: Wider Culture and Community

  • Community support

 

It may be hard to know if someone is self-harming as there may not be any warning signs. However some changes in behaviour that could occur include:

  • Changes in eating/sleeping habits
  • Increased isolation from friends/family
  • Changes in activity and mood e.g.more aggressive or less engaged than usual
  • Lowering of academic grades
  • Talking about self-harming or suicide
  • Drug or alcohol abuse
  • Expressing feelings of failure, uselessness or loss of hope
  • Giving away possessions
  • Risk taking behaviour (substance misuse, unprotected sexual acts)
  • Unusual desire to dress to cover the body

Of note, the relevance of individual signs and risk factors may vary according to the age of the child or young person

 

Every child or young person is an individual and their experience of self-harm is going to be unique.

Talking about self-harm is not easy, however the below prompts give some suggested phrases for guiding the conversation. The language, wording, choice of questions asked and general approach to the conversation may need to be adjusted according to the age and understanding, capacity and special educational needs of the child or young person. For example, an older student may prefer a more direct or upfront approach. The level of detail asked may need to be adjusted according to the individual situation and this may take place across several conversations.

Possible Prompt Questions

Confidentiality 

  • “I appreciate that you may tell me this in confidence but it is important that I let you know that your safety will always be more important than confidentiality. If I am sufficiently worried that you may be feeling unsafe or at risk of hurting yourself, part of my job is to let other people who can help you know what’s going on. BUT I will always have that discussion with you before and let you know what the options are so that we can make these decisions together”

Starting the conversation/ establishing rapport

  • “Let’s see how we can work this out together…… I may not have the skills to give you the help you need, but we can find that help for you together if you would like…”
  • Use active listening e.g. “Can I just check with you that I have understood that correctly?”

The nature of the self-harm

  • “Where on your body do you typically self-harm?”
  • “What sort of self-harm are you doing…?”
  • “What are you using to self-harm?”
  • “Have you ever hurt yourself more than you meant to?”
  • “What do you do to care for the wounds?”
  • “Have your wounds ever become infected?”
  • “Have you ever seen a doctor because you were worried about a wound?”

Reasons for self-harm

  • “I wonder if anything specific has happened to make you feel like this or whether there are several things that are going on at the moment…..?” E.g. peer relationships; bullying; exam pressure; difficulties at home; romantic relationship breakup; substance misuse; abuse

Coping strategies and support

  • “Is there anything that you find helpful to distract you when you are feeling like self-harming….? Perhaps listening to music, playing on your phone, texting a friend, spending time with your family... reading, going for a walk…. etc.”
  • “I can see that things feel very difficult for you at the moment….. and I am glad that you have felt able to talk to me. Is there anyone else that you have found helpful to talk to before?....... Is there anyone else that you think maybe good to talk to? How would you feel about letting them know what’s going on for you at the moment?”
  • “How could we make things easier for you at school?”
  • “What feels like it is causing you the most stress at the moment?”
  • “What do you think would be most helpful?”

Speaking to parents (where appropriate)

  • “I understand that it feels really hard to think about telling your parents… but I am concerned about your safety and this is important….. would it help if we did this together?...... Do you have any thoughts about what could make it easier to talk to your parents?......”

Ongoing support

  • “Why don’t we write down what we have agreed as a plan together… then you have a copy that you can look at if you need to remind yourself about anything. Sometimes when you are feeling low or really want to self-harm it is difficult to remember the things that you have put in place- this can help remind you….”

Do

  • Make time. Talk to the child or young person about their self-harming showing an understanding and empathy towards the behaviour. Talking will not increase the chance that the child or young person will self-harm BUT not talking about it may make them feel unheard or alone
  • Listen to what is being said and check your understanding, try to get to know exactly what is being communicated (see p11 for examples of conversation prompts under ‘starting the conversation’)
  • Respond with concern rather than anxiety or distaste. Keep body language open. Try not to give specific emotional responses
  • Be interested in them as a person not just as someone who self-harms
  • Find out how they are feeling – are there ups and downs?
  • Are there underlying difficulties? e.g. bullying, difficulties in peer relationships, stress from exams, conflict at home
  • Ask about coping strategies - when are they most likely to self-harm? What have they found helpful in managing them?
  • Ensure that the individual is given the opportunity to direct the conversation, express their thoughts about self-harm and be involved in jointly agreeing plans for keeping safe and for further support
  • Act appropriately in line with policy of confidentiality – inform child or young person first before informing others
  • The child or young person may wish to have new strategies to manage some of their difficult feelings. Talking to someone or distracting themselves e.g. by listening to music, are common strategies 
  • Speak to other agencies or nominated people within the school as appropriate and within the parameters of confidentiality
  • Look after yourself- ensure that you have someone to support you and talk things through

Don't

  • Tell them to stop self-harming or give them an ultimatum
  • Do not ignore self-harm however superficial it may seem to you, or assume someone else is already helping them
  • Do not make judgements or promises you can’t keep

Replacing self-harm with safer coping strategies can be a helpful way of responding to difficult feelings. Which coping strategies are appropriate for which children/young people are likely to vary by age and personal preference. Talking to the child or young person about what coping strategies work for them may be useful. Different strategies may work for different individuals and may require time to become effective.

Examples of Activites

Calming/ stress relief/ distraction

  • Going for a walk, looking at things and listening to sounds
  • Create something: drawing, writing, music, cooking, sculpture, painting, crafts
  • Going to a public place, away from the house
  • Keeping a diary or blog (the child/young person should consider how to protect themselves online)
  • Stroking or caring for a pet
  • Watching TV or a movie
  • Getting in touch with a friend
  • Listening to soothing music
  • Having a relaxing bath
  • Breathing exercises/ 5,4,3,2,1 Grounding technique (https://copingskillsforkids.com/deep-breathing-exercises-for-kids)
  • Plan an activity or trip e.g. volunteering, cinema, park
  • Popping bubble wrap
  • Having a stress ball or finger fidget toy Blowing bubbles


The 30 Day What’s Up Challenge is a resource for young people in Suffolk. It is 30 simple challenges which includes ideas and activities they can try to support their emotional wellbeing. The challenges are inspired by the ‘five ways to wellbeing’ which are known to support your emotional health. These are – ‘Be Active’, ‘Give’, ‘Keep Learning’, ‘Take Notice’ and ‘Connect with others’. For further information go to
www.thesource.me.uk/health/30-day-whats-up-challenge/

Releasing or managing emotions e.g. aggression and anger

  • Clenching an ice cube in the hand until it melts
  • Snapping an elastic band against the wrist
  • Drawing on the skin with a red pen or red paint instead of cutting
  • Sports or physical exercise, kick a football against a wall, go for a run.
  • Using a punch bag/pillows or other soft object
  • Listening to or creating loud music
  • Tearing up newspaper
  • Repetitive counting or writing

Restlessness

  • Take some exercise e.g. walking, sports, gardening, bike ride
  • Sing or shout loudly

Resources and Services

Staff should be aware that when generally searching about self-harm online, some sites that come up may be pro self-harming. Therefore care is required with online sites. The resources below are recommended for further help and resources.

PMHW Service Primary Mental Health Worker based on your school’s area. You can contact the PMHW Service on 01473 296110 if you wish to discuss support for your school.

Emotional wellbeing Hub

The emotional wellbeing Hub provides access to children and young people’s mental health support services, up to the age of 25, for families, professionals and young people in East and West Suffolk. Refer or get advice about wellbeing and mental health services call 0345 600 2090 or visit www.emotionalwellbeinggateway.org.uk or www.thesource.me.uk/hub (for young people)

Ormiston Families Point 1 Service

Point 1 provides an advice and referral service for young people experiencing mental health and emotional wellbeing problems for those based in the Lowestoft and Waveney area. Call 0800 977 4077 or visit www.ormiston.org

Wellbeing Service

The Wellbeing Service provides a range of support and self-help advice to people with common emotional wellbeing and mental health issues, such as low mood, depression or stress. Call 0300 123 1503 https://www.wellbeingnands.co.uk/suffolk/

School Nursing Team

School Nursing Team provide advice and support for any concerns that you may have about your child’s/children’s health and wellbeing. Monday to Friday 9am -5pm call on 03456 078866 or email on childrenshealth@suffolk.gov.uk.

ChatHealth texting service

ChatHealth is available for young people aged 11 to 19 years old. Texts are responded to by a member of the school nursing team between 9am and 4:30pm Monday to Friday. (excluding bank holidays). You can text them on 07507 333356.

Suffolk Safeguarding Partnership

Suffolk Safeguarding Partnership website has policies, including prevention of youth suicide. Visit, https://www.suffolkscb.org.uk/safeguarding-topics/self-harm/

Suffolk: MASH Social care team

Suffolk MASH receives and processes all safeguarding referrals of children and adults at risk of harm and abuse. Contact Customer First on 0808 800 4005 or the MASH Consultation Line on 0345 606 1499

 

Staff should be aware that when generally searching about self-harm online, some sites that come up may be pro self-harming. Therefore care is required with online sites. The resources below are recommended for further help and resources:

Emotional Wellbeing Gateway/Infolink families Directory

The Emotional Wellbeing Gateway website provides information, advice and guidance pages on common mental health issues. It is also an online directory of local services and community groups to support professionals, young people and families. Visit www.emotionalwellbeinggateway.org.uk

Psychology & Therapeutic Services

The Psychology & Therapeutic Services offer an ELSA training programme to schools. Call 01473 264700 or visit https://www.suffolk.gov.uk/children-families-and-learning/pts/elsa/

Kooth

Kooth provides free, safe anonymous online counselling for 11 to 18-year olds. They also have a range of self-help materials for young people. Visit, www.kooth.com

The Source

The Source and Emotional Wellbeing Gateway website both provide information, advice and guidance pages on various emotional health and wellbeing issues.Visit, www.thesource.me.uk/wellbeing and www.emotionalwellbeinggateway.org.uk