Early identification &

effective support for those

pupils who self-harm

Zoë Dale Consulting

2

considering effective management of deliberate self-

harm in the school environment

proactive strategies focusing on early identification and

intervention for pupils who resort to self-harm

consider proactive interventions that build emotional

resilience and reduce the risk of pupils resorting to self-

harm

how schools can provide effective support for staff in

managing the emotional and mental health needs of

pupils

Zoë Dale Consulting

Focus of presentation

3

‘Emotional wellbeing lays the foundation for

adulthood, and ensures young people are able to

participate fully as adults. It is vital that schools

feel confident to play their part in both pastoral

support and early intervention activities.’ Sarah Teather

Minister of State for Children

and Families 2010-2012

Zoë Dale Consulting

Current policy context

Listen to this short

audio clip

Working in pairs

consider the key

reasons why this pupil

resorted to self-harm

Why self-harm?

A young person may self-

harm to help them cope

with negative feelings, to

feel more in control or to

punish themselves. It can

be a way of relieving

overwhelming feelings that

build up inside, when they

feel isolated, angry, guilty

or desperate.

About self-harm

In every

secondary school

classroom there

will be two

young people

who have self-

harmed

6

How Common is it?

Between 1 in 12 and 1 in 15

young people self-harm

The Truth Hurts 2005

Over the last ten years

inpatient admissions for

young people who self-

harm have increased by

68%. In the last year alone

these hospital admissions

for under 25s increased by

10%.

Among females under 25,

there has been a 77%

increase in the last ten

years.

Current incidence

8

Estimated 19,000 suicide attempts by

adolescents in the UK per year Hawton and Van Heeringen 2002 (equals more than one every 30 minutes)

At least 2 suicides every day by young people 15-24 in the UK and Ireland ONS 2002

Suicide accounts for 18% of all deaths of young people ONS 2003

Self-harm & suicide

pressure to perform at school

poorer job prospects/economic

recession

pressure to keep up with

consumer trends

isolation and additional

pressure of online social

networking

concern that adults don’t

realise how serious bullying is

– especially online

Why the current escalation?

10

Methods of self-harm

methods

cutting

scalding

hair pulling

breaking bones

banging

ingesting

restrictive eating

11

Early identification – where to focus?

Reasons for self-harm cited by young people:

bullying at school

conflict with parents

stress - academic performance

parental divorce

bereavement

unwanted pregnancy

abuse in earlier childhood

sexuality

problems with race, culture or religion

low self esteem

feelings of being rejected

Zoë Dale Consulting

Truth Hurts 2005

12

Early identification

– the cycle of low self-esteem

Zoë Dale Consulting

low self-esteem

poor self-image

negative

thoughts

resort to self-harm

temporary

raise in

self-esteem

vulnerable

to

Stress

13

Early intervention – breaking the cycle

of low self-esteem

Zoë Dale Consulting

low self-esteem

poor self-image

negative

thoughts

resort to self-harm

temporary

raise in

self-esteem

vulnerable

to

Stress

build

self-esteem

peer

support

build

resilience

anti-bullying

policy

staff who

listen &

support

CAMH

support

challenge

stigma

educate

key messages from research What staff notice in

schools…

externalising behaviour

rather than signs of

inward distress

acting out distress maybe

a desperate way of

engaging adults

teacher’s need support

about what they can say

Zoë Dale Consulting Talking Self Harm 2012

15

Key messages from children and

young people

give us time to talk and build trust

try and understand why

don’t label us ‘self harmers’

be honest – who will need to be told and why

don’t be offended if we don’t want to handle things your way

we value professionals with clear roles and boundaries

• teachers focusing on education

• mental health professionals/counsellors addressing emotional

distress/mental health needs

Zoë Dale Consulting Talking Self Harm 2012 & Truth Hurts 2005

positive

relationships

& shared

language

trust & respect

behaviour &

boundaries

Effective relationships in schools

17

Qualities that characterise individuals who

help young people resist stress, i.e.

‘turnaround people’:

a caring relationship

high expectations

opportunities for contribution and

participation

Bernard (2002)

Resilient staff

Managing disclosure

non-judgemental stance

acknowledge emotional distress

explore at the child’s or young person’s

pace

establish trust and respect – who will be

told and why

acknowledge strength and courage in

disclosure

consider when and if parents should be

informed

is the young person fraser competent?

take care with decision making – make

key decisions with colleagues

Assessing risk and resilience

Find out more

Are there worries they would

like to talk about?

How do they feel?

What helps them not hurt

themselves?

What are there dreams/hopes

for the future?

Are the parents/families under

pressure themselves?

Consider risk

Does the child/young person

present a risk to themselves or

others?

How is the child/young person

harming themselves?

Are there difficulties in a number

of different aspects of a child’s

life?

Does this situation require

additional support?

20 image: insiderhondashead.blogspot.com

Challenges to identification

21 image: solidersofdestiny.org

Challenges to intervening

22

Developing a school policy

staff need clear guidance - define roles and responsibilities for

all staff

build ‘time to talk’ into the school day/culture

consider designated staff with specific responsibilities relating

to self-harm

risk assessment guidance for pupil and peers

include strategy for containing spreading of self harming

behaviour

define threshold for seeking specialist help

on going training and support of staff is key

Developing effective strategies

Working in pairs consider your current role and

consider a goal for your work that:

helps with early identification, or

prevention, or

support for a child/young person/family

relating to self-harm

24 Zoë Dale Consulting

consultation • treatment • training

Zoë Dale Dip COT, MA, Cert Ed

Registered Occupational Therapist

Specialist in Child and Adolescent Mental Health

enquiries@zoedaleconsulting.co.uk

www.zoedaleconsulting.co.uk