Self-Harm – Heads Above The Waves

The overall aim of this document is to ensure that all HATW staff are able to recognise and act appropriately to all cases of self-harm in young people that we are working with.

Objectives

To recognise any form of self-harm or harmful behaviours.
To help staff to understand and prepare for the fact that self-harming is almost always a symptom of some underlying emotional or psychological issue.
To put in place a framework for intervention.
For this document to be a practical way to help service users access support.

What is Self-Harm?

Self-harm is the act of deliberately causing harm to oneself either by causing a physical injury, by putting oneself in dangerous situations and/or self-neglect, and can include but is not limited to:

cutting
scratching
burning or scalding their skin
banging or bruising
scrubbing, picking or scouring their skin
deliberate bone-breaking
punching themselves
sticking things into their body
swallowing inappropriate objects or liquids
taking too many tablets
biting themselves
pulling their hair or eye lashes out
alcohol and substance misuse
controlled eating patterns- anorexia, bulimia, over-eating
indulging in any risky behaviours/ risky sexual behaviours
an unhealthy lifestyle (for example, not taking good physical care of oneself)
deliberately provoking aggressive reactions from others (intentionally getting into fights)

Things for us to Remember

Anyone from any background or of any age can self-harm, including very young children.
Self-harm affects people from all family backgrounds, religions, cultures and demographic groups.
Self-harm affects all sorts of people across a range of gender identities.
People who self-harm can often keep their problems to themselves which may mean opening up can be difficult.
You cannot just tell someone who self-harms to stop – it’s not that easy.

Links to Emotional Distress

Those who self-harm are usually suffering emotional or psychological distress and it is vital that all such distress is taken seriously to assist in alleviating it or to minimise the risk of increasing distress and potentially suicide.

Emotional/psychological risk factors associated with self-harm can include but are not limited to:

recent trauma e.g. death of a friend or relative, parental divorce
negative thought patterns and low self-esteem
bullying or being rejected by peers
difficulty in making relationships/loneliness
abuse- sexual, physical, emotional or through neglect
sudden changes to social situations and/or academic performance
relationship difficulties (with family or friends)
learning difficulties
school or work pressures to achieve (for example: from teachers or parents/guardians)
substance abuse (including tobacco, alcohol or drugs)
issues around sexuality or gender identity
depression/anxiety – though it may not be formally diagnosed
inability to express oneself
lack of positive coping mechanisms

Other casual or risk factors:

inappropriate advice or encouragement from internet websites or chat-rooms
experimentation, ‘dares’ or bravado, copycat behaviour
a history of abuse or mental health issues in a family
parental separation or family alienation or distancing/ poor parental relationships and arguments
neglect or domestic abuse and/or substance misuse in the home
media influence
issues surrounding religion or cultural identity

Warning Signs

Self-harm may present but not always visible. Therefore staff should be vigilant and should take any warning signs seriously. These may include but are not limited to:

visible signs of injury
a change in dress habits that may be intended to disguise injuries
changes in eating or sleeping habits
increased isolation from friends or family; becoming socially withdrawn
changes in activity or mood (e.g. becoming more introverted)
struggling in school or lowering of academic achievements
a withdrawal from out of school activities or after school clubs could be a sign of distress or isolation
alternatively, an increased amount of activities, workload and pressures leaving little time for the young person to relax or have any personal time
talking or joking about self-harm or suicide
drug and alcohol abuse
expressing, verbally or otherwise, feelings of failure, uselessness, loss of hope and low self-worth

All staff should take these signs seriously; however, we are dealing with young people who self-harm, on a daily basis. If it is already identified that a young person self-harms and they are discussing past or current behaviours in a group setting, one on one in mentoring or in a conversation, then a disclosure of self-harm shouldn’t necessarily cause serious concern for staff.

If they disclose that they are a serious risk to themselves or others then it should be escalated as a child protection and safeguarding issue.

If they disclose that the self-harming behaviour is a result of abuse or neglect (as defined in the Child Protection Policy) then it should be escalated as a child protection issue.

In the event of an escalation, the relevant organisations to be contacted would be the school contact, and also one of the following:

the police
social services
NSPCC

If you aren’t sure whether a disclosure should be escalated then talk to one of the Directors, as every young person’s case will be individual and will be handled as such.

Prevention

The risk of self-harm can be significantly reduced by the creation of a supportive environment in which an individual’s self-esteem is raised and healthy peer relationships are fostered. This can be achieved through respect, honesty and openness. Staff awareness of issues leading to self-harm is increased through accessing training, following the child safeguarding polices created by HATW and sharing stories of how people have overcome their issues on the HATW website (www.hatw.co.uk)

HATW doesn’t aim to necessarily enforce stopping self-harming, but rather, our aim is to introduce other, more positive alternatives, for service users to find their own way, and stop self-harming in their own time.

HATW will provide service users with a wide range of internal and external sources of help that can be contacted or used through a variety of methods. Staff will all have access to contact information for external agencies that can offer advice and/or assist with issues including self-harm.

Procedures for Dealing with Self-Harm

The first thing to remember is that if someone has chosen to tell you that they are self-harming then you will be someone that they trust and feel comfortable talking to. It is not easy to tell someone for the first time about something very private like self-harm. The person may have considered for a long time whether to talk about it or not and the fact that they have disclosed to you, even though it might be difficult, might be the first steps to finding help and changing their situation.

If a disclosure is made take it in your stride. Keep your body language open and remain emotionally neutral. They are not alone in self-harming and neither are you as someone trying to support them. Self-harm is a coping mechanism but it does not necessarily mean that the person is feeling suicidal or mean that they are at serious risk. However, staff should remain vigilant for signs that an issue is more serious.

If a young person discloses that they self-harm there are some initial key things to remember including:

Understanding Self-harm

Self-harm is a coping mechanism.
It is not about attention-seeking.
There is a difference between self-harm and suicide.
Understand that it is a long and hard journey to stop self-harming. Be aware that someone will only stop self-harming when they feel ready and able to do so.

Practical responses to self-harm disclosure

It’s OK to ask for time to let the news sink in
Take things at the young person’s pace
Ask what you can do to help
Don’t give a no-self-harm ultimatum
Encourage them to seek professional help.
Don’t worry about saying the wrong thing
Show them genuine concern
Be open and make time to listen to them
Encourage them to make their own decisions and ask what they want you to do, and how they want help
Be calm and patient with them
Give them a message of hope- that things will get better, for example, the stories shared through HATW.
Try not to show disappointment or distaste.
Don’t shout or demand answers
Don’t force anyone to talk about anything they aren’t ready to
Avoid confiscating equipment as it might mean that the young person will find something else to use that they may not be used to, and may cause more damage.
Do not force anyone to stop what they are doing. Instead talk about what triggers them, what things they think they might find helpful instead and if they want any further help or support.

When self-harming behaviours are being discussed remember to:

Let the person who self-harms know that you want to listen to them and hear how they are feeling when they feel ready and able to talk
Some people will just want to be heard and empathised with. If they’re comfortable talking, let them talk. If they’re not comfortable talking, try not to push them by asking questions that may overwhelm them.
Be clear about why they are discussing this with you, and what they are looking to get out of the conversation.
Be compassionate and respect what the person is telling you, even though you may not understand or find it difficult to accept what they are doing.
Self-harm is not the only way for people to deal with emotional distress. Try to encourage the young person to seek alternative and more constructive coping mechanisms. However, do not expect them to be able to stop self-harming immediately.
Be careful with your choice of language and keep your tone respectful. Discussing self-harm in graphic detail can be distressing and triggering. Do not use violent and/or graphic language or imagery (e.g. ‘slashing your wrists’ etc.)

Some Practical Things That You Might do While Supporting Someone Who Self-Harms

Ask them how they would like you to help them. It’s okay to ask questions and not know all the answers. The person who is self-harming is probably the one who knows best how they want to be supported, so just ask.
Don’t accuse the person of being attention seeking, there are common misconceptions that someone who self-harms does it because they want people to notice them but the reality is that many people self-harm but do everything they can to ensure that no one else finds out. Even if self-harm is being used by someone to get attention, that person is still struggling; self-harm is not a positive way to get the attention they are looking for and they need our support just as much as any other person.
While you are there for them and you will do your best to support the person who is self-harming, remember that you are not able to do everything alone. You can encourage the person to think about seeking help – perhaps from an understanding GP, parent, youth worker or teacher – but don’t force them to if they don’t want to. Just let them know that you are there for them and that there is more support out there when they are ready.
Don’t tell them to stop. Self-harm is a coping mechanism, it is something they have come to rely on to deal with difficult things at the moment. Other healthier coping mechanisms will need to be found before the person can stop self-harming and this process can take a long time, and can only happen when the person is ready.
Don’t focus only on the self-harm or ask the person to show you their scars/injuries. You should instead try to look at the underlying issues or the reasons behind the self-harm. By helping them to talk about the emotions/feelings/thoughts that are leading to them hurting themselves, you may be able to help them manage these things in a healthier way.
Some people may want further help with their self-harm and in this case you may be able to help by putting them in touch with organisations that that may be able to help further (see ‘Helplines’).
If they want to talk to their parents or Doctors about their self-harm it may be helpful for you to discuss with the young person what they expect, how they think it will go and how they hope it will go and put some action plans in place to achieve this, and talk about the best language to use or the best approach.
If they don’t want to stop self-harming immediately it may be best to make sure they stay safe and reduce the damage to their body e.g. Using clean utensils, not cutting too deep, keeping wounds clean and free from infection.

If physical harm occurs during a HATW session, the young person should be taken to the Health Centre or to A&E for medical assessment and care. If it is severe or life threatening, ring 999 immediately.

If a young person harms themselves in front of other service users, then all witnesses should be spoken to individually, and supported appropriately, to ensure that they’re not at an increased risk of self-harming as result of the incident.

Things to Suggest Instead of Self-Harm

There isn’t a “one size fits all” solution to self-harm. Try to help the young person come up with things that might work for them. If the young person cannot or will not find their own solution, some suggestions could be made like writing, screaming into a pillow, going for a really fast run or painting/listening to music really loudly.

They could also consider:

Talking to a family member, a friend or a helpline. If they are on their own perhaps phoning or emailing/texting/messaging a friend or helpline could be helpful.
Distract themselves by going out, singing or listening to music, or by doing anything (harmless) that interests them.
Relax and focus their mind on something pleasant or try some yoga poses or meditation techniques- creating their very own comforting place.
Find another way to express their feelings, perhaps through creative means.
Give themselves some ‘harmless pain’- eat a hot chilli, have a cold shower/holding ice cubes, or drawing red lines on their skin.
Focus their mind on positives eg. things they have to look forward to, things they have in their lives that they enjoy doing, things they are grateful for.
Write a diary/letter to explain what is happening- even if no-one else ever sees it.

Confidentiality and Reporting

While working on behalf of Heads Above The Waves, every conversation should be prefaced with the confidentiality guidelines, so that the young person is aware of what will and will not be disclosed outside of that conversation.

Confidentiality is about keeping things that you are told between the people involved, unless someone is at risk or in danger (this could be the person who is self-harming or anyone else). Be honest and tell them if you need to tell someone else.

While you listen and talk to the person about how they are feeling, you should never promise to keep everything they are telling you a secret.

If you believe that the person self-harming is in need of medical attention or has taken an overdose then you will need to tell someone. Primarily the child protection officer but also potentially a teacher, youth worker or parent.

If the person mentions that they are suicidal, you must take it seriously. Establish whether they have a plan in place to complete suicide, and if they do tell a responsible adult (primarily the child protection officer but also a teacher, youth worker etc.), even if they tell you not to. If there is no plan in place it is still worth discussing with one of the aforementioned people. Perhaps suggest that you go to talk to someone together.

In relation to confidentiality, where there is no child protection issue raised, although it is better if parents or a carer are notified and involved to support the young person, each individual case and approach needs to be handled carefully and sympathetically to support the well being of the young person. The decision about involving parents/guardians should be taken into consultation with the young person’s school. If a decision to contact parents/guardians is reached, then the school will make the contact, wherever possible.

In the case of severe self-harm requiring medical intervention/ A&E, parents will be informed immediately, unless it is known that self-harm is symptomatic of abuse in the home, at which point, you may take the decision to make a referral directly to the appropriate authority without informing the parents.

If a member of staff becomes aware of or is alerted to a new or escalated self-harming issue, or a young person discloses new or escalated self-harm, they should make a written report. This report should include the date of the event, what was disclosed, how concerned staff member is about it. A report should be made even if the incident eventually turns out to be an isolated one that was not indicative of a serious underlying emotional or abusive cause.

If a young person suggests there is evidence of self-harm beneath their clothing, a member of staff should accept such statements and must never ask the pupil to remove clothing to reveal wounds/bruises etc. A school nurse or a Doctor may investigate such evidence in a sensitive and appropriate manner in the Health Centre or A&E.

A Health Centre may be a school’s medical office, or a local/nearest Doctors’ surgery.

Regarding and Reporting Incidents of Self-Harm Disclosed to HATW Staff

A Self-Harm Report Form should be completed and will be kept as a record of all incidents in a private locked drawer that only the Directors will have access to.

The Directors may review this record to identify any trends or other areas of concern. They may also show the form to third parties such as the NSPCC, Police, School or Social Services but only in line with the Data Protection Policy.

Self-Care for Staff

Finally make sure that you take care of yourself. It is hard dealing with the fact that someone you know or are in regular contact with is self-harming. You shouldn’t be afraid of seeking some support for yourself. Remember, you will be able to better support the person who is self-harming if you are taking care of yourself too.

Should you require additional support or someone else to talk to, either contact an outside listening service, or get in touch with the voluntary counsellor for Heads Above The Waves, and request time to talk through your concerns. Conversations with the voluntary counsellor are bound by the same confidentiality and privacy guidelines as all Heads Above The Waves work.

Useful Resources and Helplines

National Self-Harm Network – 0800 622 6000 – nshn.co.uk – support@nshn.co.uk
The Mix – 0808 808 4994 – themix.org.uk
ChildLine – 0800 1111 – childline.org.uk
Samaritans – 116 123 – samaritans.org – jo@samaritans.org
NightLine – nightline.ac.uk/nightlines to find your local branch
SupportLine – 01708 765 200 – supportline.org.uk
CALL Helpline – 0800 132 737 – callhelpline.org.uk – Text “Help” to 81066
MIND Info Line – 0300 123 3393 – mind.org.uk
SANE – 0300 3047000 – sane.org.uk

Monitoring and Review

This policy will be reviewed annually (or earlier if necessary) by the Directors.