Help someone who self-harms
At least 1 in 10 young people will self harm before the age of 16. That makes it a huge issue and yet one that is often misunderstood by parents, teachers and those working with young people. This guide outlines some of the key reasons why young people self-harm, how to support a young person who is harming and where to go to find more information and advice.
You've been mentoring Katy for a while now, and as you sit in that cold one to one room she starts to tell you what's really been going on. Slowly she opens up about how she sits alone at night feeling so low she carves at herself with a razor blade until she can no longer hold the blade or the tears back. Katy tells you she feels unattractive and unwanted, that at every argument at home she feels in the way, and that at school she lives in fear of attention being drawn to her and is relieved when the day is over. She worries so much about everything that she doesn't enjoy anything anymore and wishes, just wishes she could be like other people, but knows she never could be. And you want to cry as you hear all this young person's fear and pain come tumbling out, and wish you could tell her that what she felt wasn't true, but this girl is hurting so much she couldn't hear you even if you tried.
Then there's Justin, he's in year eleven now, you've known him for a few years, when he makes it to school he gets in trouble all the time and many are amazed he hasn't been permanently excluded yet. You see him in a weekly anger management group, along with six other lads. Justin's an entertainer, always quick with the jokes, and seems to be the centre of any group banter. As they are larking about you notice burn marks on his arms, his shirt mostly covers them, but when he reaches out your heart sinks. You realise they could only have been deliberate, and you think how can he be the life and soul of this group yet be in so much pain when he's alone. You wonder how to begin talking about it.
Maybe you've been there when a young person tells you they are self-harming and you find yourself feeling helpless, not knowing how to respond for fear of dong the wrong thing. Maybe this is a completely new area, but one in which you want to be prepared for. The good news is that understanding just a little more about self-harm stops it being a scary subject and enables you to act with confidence as you support the young people you work with.
- What is self-harm?
Self-harm is essentially a physical response to an emotion or psychological pain of some kind. When we feel overwhelmed it can sometimes be unbearable, and we long for a release from how we feel, especially if we don’t necessarily have the words to describe what’s going on or lack opportunities to talk to someone we trust. People continue to assume that self-harm is all about someone cutting themselves, and while many young people will harm in this way, it’s important to remember that self-harm encompasses a whole range of behaviours.
- Why do young people self-harm?
Every young person will have their own reason for turning to self-harm, although they may not be able to articulate why it is. Trauma in childhood such as abuse, bereavement or family breakdown can all be underlying causes of self-harm, as can bullying, poverty and exam stress. Research suggests one of the biggest risk factors is seeing self-harm in someone else, be it a parent, friend or sibling. Sometimes, young people don’t think they have a good enough reason to be self-harming, and this can make it harder for them to ask for help.
- Helping someone who self-harms
Self-harm is often termed as addictive, both because of the chemical aspects of harming, but also because it can become highly habitual with routines and rituals, and can also become a reflex reaction to emotions that cause anxiety. The upshot of this is that a young person who self harms is likely to feel trapped by the behaviour at the same time as being scared of how they would cope without harming.
When supporting someone who self-harms it is essential to understand the emotional dependency that people place on harming. If the focus is solely placed on helping them to stop harming, or changing their habit, the reality is that they will be no better equipped to handle the emotions that led them to harming in the first place.
One of the first places to start is by exploring the feelings they have immediately before harming and then exploring with them different ways of expressing those emotions. For example if people feel things are out of control at work, they may tidy their desk, if they feel angry, they may go to the gym and pound it out on the treadmill, or, if they feel low they may ring one of their closest friends. They can be very simple, but highly effective and invite young people to think about hope, where before there was only destructive behaviour.
Central to anybody overcoming self-harm, the young person needs to feel they have autonomy and control. What helps along the way is lots of affirmation of their positive choices and encouragement of them as a person.
It is common for people who self-harm to rotate their harming mechanisms to other negative behaviours masking the harming itself. For example stopping cutting, but starting drinking pints of vodka instead, then moving onto having lots of unprotected sex. Although these do not all have the physical effect of harming, the patterns and habitual needs in their lives are similar and something for those supporting harmers to be aware of.
Common questions about self-harm
- What do I do when a teenager confides in me (initial disclosure)?
1. Listen. Hear what they have to say and give them the space to talk freely – this could be the first time they’ve ever shared this with someone.
2. Don’t judge. You don’t have to understand and they’re not looking for approval, so try to refrain from giving too many opinions.
3. Be led by them. What do they think they need? What do they want from you? You may have an organisational responsibility to pass information on to other professionals or parents, but make sure they’re involved in that as much as they want to be, and have an opportunity to feel in control of what’s happening.
4. Document everything.
- How do I stop someone from self-harming?
The short answer is: you can’t. Your role may be to walk with them while they deal with the reasons that cause them to feel the way they do. The only person who can stop self-harm is the person who’s doing it; everyone else is there to provide the support network to help get there.
- Should I see them more often now they have told me they self-harm?
Not necessarily, but you might like to touch base with them more often initially, especially if they’re navigating the reality of school and parents being told for the first time. Just make sure you manage expectations of when you can be available and in what capacity.
- What do I do if I think someone is self-harming?
Ask them. It can be incredibly difficult to tell someone that you struggle with self-harm. A lot of sufferers feel overwhelming shame and fear of how others may react yet deep down want some support and someone to talk to. If you know the person well and can cope with them telling you to mind your own business, then go for it and gently explain that you’re worried and why. You never know – they may have been waiting months – or even years – for someone to just ask them.
- Do people recover from self-harm?
Absolutely, yes. It’s not easy, and can involve having to deal with some painful thoughts and feelings, but with the right support (and a desire to recover) self-harm does not have to be an enduring issue. Some young people may take self-harm into adulthood with them, but that still doesn’t mean they can’t overcome it later on.
- Do I need to tell the school?
Ideally, yes. If the young person tells you on the school premises then you need to inform the pastoral lead as in the same way any other member of school staff or volunteer would. If they tell you outside school then it’s good practice to share that information (ideally with the young person’s consent and/or knowledge) so everyone can be working together to support the young person, especially if school work has been suffering as a result of the self-harm.
- Should the parents be informed?
There will always be exceptions, e.g. where telling parents may make things much worse, or because the self-harm stems from a difficulty at home, but where possible parents should be informed when their child is self-harming. It’s important to remember that parents often react badly to the news of a child self-harming, they feel panic and shock, fear that people will think it is their fault and anxiety that their child has not come to them earlier. Many people know very little about self-harm and fearful of what they don't understand. It’s important to prepare the young person for this, so they understand where any reactions may be coming from.
- Can I do group work with young people who harm?
Yes, absolutely. It’s commonly assumed that putting young people who self-harm together will turn into a tip sharing competition that sees little benefit for those involved. However the reality is it can give a safe environment to discuss the issues and responses of others who can empathise, taking the sting out of the feeling that many young people have that they are the only ones to feel like this. In fact peer group work, especially in schools, has been long thought of as the most effective intervention for young people who self-harm.
- On the web
www.selfharm.co.uk - Established in 2010, selfharmUK is a project of Youthscape and provides information, advice, resources, and training for any young person affected by self-harm and those working with them.
http://alumina.selfharm.co.uk - Alumina is a free online 6-week recovery programme for young people aged 14-18. It’s run by selfharmUK and is accompanied by workbooks that may later act as disclosure aids.
www.freedomfromharm.com- Information, blog and training aimed particularly at those aged 18+ who continue to struggle with self-harm and eating disorders into adulthood.
- In print
Alumina - User guide and workbooks available for anyone wanting to run the Alumina programme with young people either in a group or 1-1 mentoring situation.
Parent’s Guide to Self-Harm – Helpful booklet for supporting parents to understand what self-harm is and why it may be happening to their child. Contains practical advice.
These, and a number of other resources such as postcards, posters and books are all available from the Youthscape store.
selfharmUK run frequent training events. Find out when and where here.
Feel free to use and distribute this guide but please acknowledge schoolsworkUK as the source.