Self-harm describes a wide range of behaviours that people use to cope with difficult feelings and distressing life experiences. The majority of people have no intention of ending their life, most do so to manage their feelings. It is estimated that 1 in 15 young people in the UK have deliberately self-harmed at some point, and the most common age is between the ages of 11 and 25. Around four times as many girls as boys self-harm. Young men with similar problems are more likely to get into fights or trouble with the police.
Think about yourself
Self-harm in children and adolescents can lead to strong feelings of anxiety, fear and frustration in the people who are trying to support them.
The management of these feelings is an important factor in supporting the child or adolescent. To help you do this, try not to focus too much on the actual self-harm behaviour; ensure that you engage with the person and the issues underlying the self-harm. Offering what support you can, being there for the person and their feelings and problems can be very helpful, but it’s important to be aware of your own limitations and not offer more than you can cope with.
How self-harm works
What young people have said:
- Distraction - the physical pain takes the focus away from the emotional pain.
- Self-punishing - some experience self-hatred or blame and use self-harm to punish themselves.
- Cleansing - may be a way of symbolically ridding themselves of contamination, often as a result of abuse.
- Control - may be a way of regaining control, by being in charge of their injuries.
- Communication - as a means of letting people know something without using words.
- Comfort - a release of tension, or a means of seeking care and nurture from others,
- Making themselves unattractive - to keep someone away, fear of sexual abuse.
- Feeling real or alive - pain can be a way of breaking through feelings of numbness and of actually experiencing something.
Things to think about
- Is the child/adolescent being bullied?
- Do you know if they've suffered any other abuse?
- Do you know if they've experienced a bereavement?
- Are they in conflict with parents or other family members?
- Do they or their parents/carers have a chronic illness, disability or mental health problem?
- Are they subject to high expectations?
- Are they worried about school work?
- Do they have problems with race, culture or religion?
- Are they afraid or ashamed of their sexuality?
- Is there a possibility they are pregnant?
- Have they experienced the self-harm or suicide of someone else?
- Are they feeling isolated or low in self-esteem?
What can you do?
Listening and caring is the most important thing you can do to help - showing that you want to know and understand, can make a lot of difference.
Seeing the person behind the self-harm is important to show that you care about the whole person and not just the self-harm. Acknowledge that self-harm is a symptom of other problems, it is not the problem to focus on. Accepting the self-harm helps them cope and can help to show that you understand that at the moment, self-harm works for the person when nothing else can, the goal is to find alternatives to self-harm.
Accepting mixed feelings is very helpful - one of the conflicts may be that they hate their self-harm, even though they might need it. It helps if you accept all of these changing and conflicting emotions.
Help the child/adolescent find further support – they may need help in addition to what you can give and you can help support and encourage them in finding this. Remember though that if the young person has began to talk to you, you are well-placed to continue to work with them.
Show concern for their injuries - by showing the same compassion and respect you would show for any other injury, you are showing them that their body is worth caring about. It is important to recognise how hard it is for them to talk - gentle, patient encouragement may help. Some children/adolescents find it helpful to develop a list of alternatives to their self-harm.
Some successful alternatives are:
- hitting a punchbag to vent anger
- going out for a walk
- writing down thoughts and feelings and possibly tearing this up
- keeping a diary
- talking to friends
- self-help websites
- draw on skin with a pen where they would cut
- holding an ice cube against skin instead of cutting
Useful websites include:
When to consider Child and Adolescent Mental Health Services (CAMHS)?
It is usually best not to make decisions about risk on your own, but rather in consultation with a senior colleague, or with a CAMHS worker (see below). In order to make a judgement about the level of risk, it is important to take time to talk to the child/adolescent and to enquire about their intentions.
- If there is a risk of serious self-harm or suicide, treat as a medical emergency i.e. emergency GP or A&E. CAMHS will become involved thereafter.
- If you feel there is evidence of depressive symptoms e.g. sleep disturbance, loss of appetite or sense of hopelessness.
How to contact CAMHS:
If it's non-urgent:
Contact Derby City and South Derbyshire CAMHS single point of access (SPOA). This online referral form is for professionals to contact the SPOA team to request support for children and young people with emotional and behavioural problems in the Derby City and South Derbyshire area only.
Alternatively, call the main CAMHS service on 0300 7900 264
If it's urgent:
Contact CAMHS RISE (Rapid Intervention Support and Empowerment) on 0300 123 3124. If the young person is already known to CAMHS it would be best to talk things through with the relevant worker at the locality team.
The team is working to ensure that children and young people who are in urgent need of care due to self-harming or suicidal thoughts get the support they require.The CAMHS RISE team will speak with the GP and the young person and provide specialist advice. Where the team recommends that a young person goes to the children’s emergency department at Royal Derby Hospital, the team (based at the hospital) will make every effort to meet with that young person, maximising the continuity of care. Where a visit to hospital is not required, but a more detailed mental health assessment is needed, the team will arrange that with the GP and the young person. The end result should be that young people get the care and support that meets their needs – and there should be fewer young people being admitted unnecessarily to hospital.
That reflects the key aims of the ‘joined up care in the south of Derbyshire’ programme – meeting the demand for quick access to complex care and for care close to home.
Please call the team on 0300 123 3124. The team is available from 8am to 11pm every day. It is important to note though that though the team members are around at these times, they cannot guarantee to answer the phone immediately because of other pressures and expectations as part of their role.
Please note - the CAMHS RISE team are here to help you when young people who present themselves are experiencing acute mental distress – such as when they have seriously self-harmed or are experiencing suicidal feelings. In addition to this CAMHS and partner agencies use SPOA as the referral process, this is on the CAMHS webpage if you follow this link.
Samaritans has produced resources providing information about the emotional health of young people aged 16-24.
Sources of help and further information can be found here.
Harmless is a user-led organisation that provides a range of services about self-harm including support, information, training and consultancy to people who self-harm, their friends and families and professionals.
Find out more here.
Many young people prefer to turn to other young people when they have a problem.
Peer support approaches are intended to equip school students with the skills to support each other effectively. It is not an alternative to professional counselling and other interventions or treatments, but it is an important intervention in its own right.
Papyrus HOPELINE UK
HOPELINEUK advisers want to work with you to understand why these thoughts of suicide might be present. They also want to provide you with a safe space to talk through anything happening in your life that could be impacting on your or anyone else’s ability to stay safe.
- For children and young people under the age of 35 who are experiencing thoughts of suicide
- For anyone concerned that a young person could be thinking about suicide
Young People - Our advisers are all trained to help you focus on staying safe from suicide. Their training enables them to provide advice and support that may help you to move forward and stay alive.
Concerned Others - Our advisers are all trained to help you focus on staying safe from suicide. Their training enables them to provide advice and support that may help you to move forward and stay alive.
Contact HOPELINEUK: If you are having thoughts of suicide or are concerned for a young person who might be you can contact HOPELINEUK for confidential support and practical advice.
Opening hours: 9am – 10pm weekdays, 2pm – 10pm weekends, 2pm – 10pm bank holidays
Self-Harm Practice Guidance
This guidance has been developed by Derby and Derbyshire Safeguarding Boards. It includes information, useful websites, incident report forms etc. and should be read in conjunction with the Derby and Derbyshire Safeguarding Children procedures via the DSCB's website here.