Resources

No Harm Done: Recognising and responding to self-harm

Next steps for staff working with young people

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

We would like to acknowledge the Charlie Waller Memorial Trust (CWMT) UK for these resources and for allowing us to adapt this. For the original version of this resource, please refer to the CWMT website: www.cwmt.org.uk

INTRODUCTION

Self-harm describes any way in which a young person might harm themselves or put themselves at risk in order to cope with difficult thoughts, feelings or experiences. It affects up to 1 in 5 young people and spans the divides of gender, class, age and ethnicity. As such, many people find themselves in the position of wanting to support a young person who is self-harming. This can be difficult due to lack of confidence or uncertainty about what to say or do. Here we’ve provided simple guidance for taking those first steps – your support can be life-changing.

“I was so alone and lost and desperate. I thought no one cared until my [social worker] encouraged me to open up. I remember that day so vividly – it was the first day of the rest of my life.”

SELF-HARM WARNING SIGNS

There are many signs you can look out for which indicate a young person is in distress and may be harming themselves, or at risk of self-harm, the most obvious being physical injuries which:

  • you observe on more than one occasion
  • appear too neat or ordered to be accidental
  • do not appear consistent with how the young person says they were sustained

Other warning signs include:

  • secrecy or disappearing at times of high emotion
  • long or baggy clothing covering arms or legs even in warm weather
  • increasing isolation or unwillingness to engage
  • avoiding changing in front of others (may avoid PE, shopping, sleepovers)
  • absence or lateness
  • general low mood or irritability
  • negative self-talk – feeling worthless, hopeless or aimless

“At first we thought he was just accident prone, it was easy to miss, he always had an explanation as to how he’d got hurt.”

THE FIRST CONVERSATION

The sooner we encourage a young person to disclose their self-harm, the sooner we are able to provide or seek appropriate support to help them break the cycle. We can do so by passing our concerns on to a [trusted adult/teacher] or by providing a safe space for the young person to talk to us.

“It was the hardest conversation of my life, but every word I spoke made the load feel a little lighter and for the first time in a long time, I felt hope.”

The most supportive first conversation is one where:

  • the young person is the sole focus of your attention
  • you spend most of your time listening, not talking
  • the young person tells their story, you never guess or assume
  • there is a feeling of acceptance and support, not judgement
  • self-harm is not dismissed as attention seeking
  • unrealistic promises are not made about confidentiality
  • this is recognised as the first step of a difficult journey
  • clear next steps are identified and followed up promptly
  • you recognise how hard this conversation must be for the young person
  • you respond calmly – even if you don’t feel calm

“I’m not looking for attention, it’s just the only thing that helps me control the wayI feel.”

WHEN A YOUNG PERSON ISN’T READY TO TALK

When a young person is more reluctant to disclose or discuss their self-harm, three important questions to consider are:

  1. Who is the best person to have this conversation? You can use your knowledge of the young person, or ask them who they feel comfortable talking to.
  2. How can you help the conversation flow? An informal environment or talking whilst carrying out another activity such as walking or drawing can really help.
  3. Would another medium work better? Some young people feel happier talking via instant messenger, text or email – be creative and use your knowledge of the child.

“I tried several times to talk to him to no avail; it was only when I texted him that the conversation finally started.”

If a young person still isn’t ready to open up, provide them with details of anonymous sources of support and regularly revisit the situation.

“The [phone] counsellor helped me get more comfortable talking about things and next time my teacher tried to talk to me, I felt ready.”

NEXT STEPS

If you have any concerns about a young person’s immediate safety, this is an absolute priority and should be treated as an urgent safeguarding issue in line with your policies. If you think a young person is at risk, they should not be left alone.

All discussions should be recorded and shared with a trusted adult/teacher who will keep these details on file and can provide support and direction on appropriate next steps. These might include:

  • Informing adults who need to know in order to keep the young person safe. This will usually include parents or carers.
  • Visiting the GP to seek further support and guidance.
  • Providing access to a school counsellor.
  • Setting up regular meetings with a trusted adult such as a class teacher who can provide practical support and guidance.

It is important that all wounds are appropriately dressed and cared for as infection is common. Provide the young person with information about wound care or access to a trained first aider or medical professional who can assess and dress any wounds.

“He didn’t want to show me his wounds but he was happy to have the school nurse assess and dress them as long as I told her not to ask any questions.”

PROVIDING PRACTICAL SUPPORT

If you find yourself in the position of providing regular support to a young person, here are some helpful things you can do:

Listen – provide a safe space for non-judgmental, supportive listening. Even a few minutes of high quality listening can make a huge difference to how supported a young person feels.

Address stressors – work with the young person to understand their triggers and stressors. Working

through a typical day and highlighting the tough bits can be a great way to start and then think creatively of ways you might address these.

Make a self-soothe box – work with the young person to collect a range of different things they can use to distract or soothe themselves when they feel the urge to self-harm. This might include music, colouring, books, bubbles, photographs or inspirational quotes.

Provide safe sources of further information – highlight sources of further information such as those listed at the end of this resource.

Safeguarding your own wellbeing – It can be emotionally challenging to support a young person who is self-harming so it’s important that you too receive regular support and confidential listening. Keep in regular contact with a trusted adult/teacher and if, for any reason, you feel you are unable to continue to support the young person, discuss this at the earliest opportunity.

“Things changed for me at home and I felt unable to provide the level of support she deserved. I was honest with her and we identified a different adult she could regularly speak to.”

WHOLE SCHOOL APPROACH

Whilst there is much that proactive, supportive individuals can do to help a young person within their school or organisation, this support is best provided within the context of a whole school approach in order to keep both ourselves, and the young person as safe as possible. Simple steps that your school could take include:

1. Developing and implementing a mental health policy

Clear guidance can give staff the knowledge and confidence they need to respond to issues appropriately. It is important to develop a policy that feels relevant and achievable within your setting and to ensure that all staff know who to refer to with concerns.

2. Providing training for all staff

Providing basic training for all staff on how to recognise and respond to self-harm will increase the confidence of both staff and students in making and responding to disclosures.

3. Addressing self-harm as part of the curriculum

Your school curriculum can provide a great opportunity to tackle myths and misunderstandings surrounding self-harm and to provide students with an understanding of how to keep themselves and each other supported and safe.

4. Looking after staff wellbeing

Before we can look after others, we must first look after ourselves. Supporting young people who are in emotional distress can be physically and mentally draining for staff; this needs to be recognised and appropriate support put in place, both in terms of training and supportive listening.

“Most importantly, the [professional training] day got us talking about self-harm. It was uncomfortable at first but we all grew in confidence throughout the day. It was really empowering – we’re no longer scared of disclosures, we feel confident we can help.”

FURTHER INFORMATION (UK-only)

YoungMinds: youngminds.org.uk Parents Helpline 0808 802 5544 (Monday to Friday 9.30am – 4pm)

YoungMinds provides information and free resources to help implement a whole school approach and self-harm, mental health and resilience training for professionals.

Charlie Waller Memorial Trust provides free self-harm training to staff working with young people.

Factsheet from The Royal College of Psychiatrists Childline: childline.org.uk 0800 1111 (24hr)

Helpline (24 hr): 08457 90 90 90 UK & NI

Email: jo@samaritans.org The Site: thesite.org

Self-Harm Alternatives: over 130 ideas for use in recovery suggested by young people, collated by Dr Pooky Knightsmith

Self-Harm and Eating Disorders in Schools: A Guide to Whole-School Strategies and Practical Support by Pooky Knightsmith. Available as a paperback or Kindle

A Short Introduction to Understanding and Supporting Children and Young People Who Self-Harm by Professor Carol Fitzpatrick. Available as a paperback or Kindle

No Harm Done:    film &     resource pack for parents

No Harm Done:    film &     resource pack for young people

“There’s no denying that it’s a gruelling journey and there are downs as well as ups; but once you’re out the other side and you see a happy, healthy young person ready to head out into the world it is the best feeling ever.”