Mental Health and Growing Up
Factsheet
Self-harm in young people: information for parents, carers
and anyone who works with young people
About this factsheet
This is one in a series of factsheets for
parents, teachers and young people entitled Mental Health and
Growing Up. The aims of these factsheets are aim to provide
practical, up-to-date information about mental health problems
(emotional, behavioural and psychiatric disorders) that can affect
children and young people. This factsheet looks at the reasons
behind why people self-harm, and offers advice about what to do to
help.
What is self-harm?
Self-harm is a term used when someone injures
or harms themselves on purpose rather than by accident. Common
examples include `overdosing' (self-poisoning), hitting, cutting or
burning oneself, pulling hair or picking skin, or
self-strangulation. Self -harm is always a sign of something being
seriously wrong.
Why do young people harm themselves?
Unfortunately some young people use self-harm
as a way of trying to deal with very difficult feelings that build
up inside. This is clearly very serious and can be life
threatening. People say different things about why they do it.
- Some say that they have been
feeling desperate about a problem and don't know where to turn for
help. They feel trapped and helpless. Self-injury helps them to
feel more in control.
- Some people talk of feelings
of anger or tension that get bottled up inside, until they feel
like exploding. Self-injury helps to relieve the
tension that they feel.
- Feelings of guilt or shame
may also become unbearable. Self-harm is way of punishing
oneself.
- Some people try to cope with
very upsetting experiences, such as trauma or abuse, by convincing
themselves that the upsetting event(s) never happened. These people
sometimes feel 'numb' or 'dead'. They say that they feel detached
from the world and their bodies, and that self-injury is a way of
feeling more connected and alive.
- A proportion of young people
who self-harm do so because they feel so upset and overwhelmed that
they wish to end their lives by committing
suicide. At the time, many people just want their problems
to disappear, and have no idea how to get help. They feel as if the
only way out is to kill themselves.
Who is at risk?
An episode of self-harm is most commonly
triggered by an argument with a parent or close friend. When family
life involves a lot of abuse, neglect or rejection, people are more
likely to harm themselves. Young people who are depressed, or have
an eating disorder, or another serious mental health problem, are
more likely to self-harm. So are people who take illegal drugs or
drink too much alcohol.
Many young people who self-harm with a wish to
commit suicide also have mental health or personality difficulties;
often the suicide attempt follows a stressful event in the young
person’s life, but in other cases, the young person may not have
shown any previous signs of difficulty.
Sometimes the young person is known to have
long standing difficulties at school, home or with the police. Some
will already be seeing a counsellor, psychiatrist, or social
worker. There has been an increase in the suicide rate in young men
over recent years.
The risk of suicide is higher if the young
person:
- is depressed, or has a
serious mental illness
- is using drugs or alcohol
when they are upset
- has tried to kill themselves
a number of times, or has planned for a while about how to die
without being saved
- has a relative or friend who
tried to kill themselves.
How can I help?
- Notice when the young person
seems upset, withdrawn or irritable. Self-injury is often kept
secret but there may be clues, such as refusing to wear short
sleeves or to take off clothing for sports.
- Encourage them to talk about
their worries and take them seriously. Show them you care by
listening, offer sympathy and understanding, and help them to solve
any problems.
- Buy blister packs of
medicine in small amounts. This helps prevent impulsive overdoses.
Getting pills out of a blister pack takes longer than swallowing
them straight from a bottle. It may be long enough to make someone
stop and think about what they are doing.
- Keep medicines locked
away.
- Get help if family problems
or arguments keep upsetting you or the young person.
- If a young person has injured
themselves, you can help practically by checking to see if injuries
(cuts or burns for example) need hospital treatment and if not, by
providing them with clean dressings to cover their wounds.
As a parent, it's really hard to cope with a
child/young person with self-harming behaviour or who attempts
suicide. It's natural to feel angry, frightened or guilty. It may
also be difficult to take it seriously or know what to do for the
best. Try to keep calm and caring, even if you feel cross or
frightened; this will help your child/young person know you can
manage their distress and they can come to you for help and
support.
This may be difficult if there are a lot of
problems or arguments at home. Or, you may simply feel too upset,
angry or overwhelmed to effectively help your child/young person.
If so, you should seek advice from your GP.
If you are a teacher, it is important to
encourage students to let you know if one of their friends is in
trouble, upset, or shows signs of harming themselves. Friends often
worry about betraying a confidence and you may need to explain that
self-harm is very serious and can be life threatening. For this
reason, it should never be kept secret.
Where do I get specialist help?
Everyone who has taken an overdose, or tried
to kill themselves, needs an urgent assessment by
a doctor as soon as possible even if they look OK.
Usually, this means an examination at the
nearest Accident and Emergency Department (A&E). If you are
unsure whether the young person was suicidal or not, it is best to
act cautiously and take them to hospital. With overdose, the
harmful effects can sometimes be delayed, and treatment with
medication may be needed. Paracetamol is the most common medicine
taken as an overdose in Britain. It can cause serious liver damage,
and each year this leads to many deaths. Even small overdoses can
sometimes be fatal.
If the young person is self harming by cutting
themselves or other ways, it is still important that they have
help. Do speak to your GP who can refer you to your local child and
adolescent mental health services (CAMHS).
How is it treated?
All young people who attend hospital following
attempting suicide or harming themselves should also have a
specialist mental health assessment before leaving.
It is often difficult to work out what
prompted the young person to self-harm or whether they actually
wished to commit suicide or not; mental health professionals have
the expertise to make sense of these complicated situations.
It is usual for parents or carers to be
involved in the assessment and any treatment. This makes it easier
to understand the background to what has happened, and to work out
together whether more help is needed.
Assessments in A&E which include a short
‘talking therapy’ session have been shown to help young people come
back for ongoing help and support. A lot of young people
self-harm or make another suicide attempt if they do not receive
the help they need.
Usually, treatment for self-harm and attempted
suicide, other than any immediate physical treatment, will involve
individual or family 'talking therapy' work for a small number of
sessions. They will need help with how to cope with the very
difficult feelings that cause self-harm.
Clear plans on how to help and how to keep the
young person safe will also be made. Some people who find it very
difficult to stop self-harming behaviour in the short term will
need help to think of less harmful ways of managing their
distress.
Families often need help in working out how to
make sure that the dangerous behaviour doesn't happen again, and
how to give the support that is needed This is something your local
CAMHS should have on offer.
If depression or another serious mental health
problem is part of the problem, it will need treatment. Some young
people who self-harm may have suffered particularly damaging and
traumatic experiences in their past. A very small number of young
people who try to kill themselves really do still want to die.
These two groups may need specialist help over a longer period of
time.
Further information
Childline
Provides a free and confidential telephone service for children.
Helpline: 0800 1111.
Firstsigns
An online, user-lead voluntary organisation to
raise awareness about self-injury and provide information and
support to people of all ages affected by self-injury.
National Self-Harm
Network
UK charity offering support, advice and advocacy services to
people affected by self harm directly or in a care role.
NHS Direct
Health advice and
information service. Tel: 0845 4647
The Samaritans
Provide a 24-hour service offering
confidential emotional support to anyone who is in crisis. Helpline
08457 909090 (UK), 1850 609090 (ROI); e-mail: jo@samaritans.org
YoungMinds
Provides information and advice on child
mental health issue and a Parents'Helpline:0800 802 5544.
Further reading
Understanding NICE guidance: They are versions of all
guidance for patients, carers and the public and summarises, in
plain English, the recommendations that the National Institute for
Health and Clinical Excellence makes to health and other
professionals.
A CD-ROM designed for 13-17 year-olds on
mental health, which looks at health, which looks at depression,
and self-harm: 'Changing
Minds' A Multimedia CD-ROM about Mental Health'.
References
National Institute for Health and Clinical
Excellence: CG16 Self Harm: NICE Guideline
(2004).
National Institute for Health and Clinical
Excellence: CG133 Self-harm: Longer term
management): of Self Harm: NICE Guideline 2011.
Hawton K, Harriss L. Deliberate self harm in
young people: characteristics and subsequent mortality in a 20 year
cohort of patients presenting to hospital. Journal of Clinical
Psychiatry 2007 68:1574-83
Ougrin D et al. Trial of therapeutic
assessment in London: randomised controlled trial of Therapeutic
Assessment versus standard psychosocial assessment in adolescents
presenting with self-harm. Archives of disease in
childhood 2011 96 148-153
- Revised by the Royal College of
Psychiatrists’ Child and Family Public Education Editorial
Board.
- Series Editor: Dr Vasu Balaguru
- With grateful thanks to Dr Mona Freeman.
This leaflet
reflects the best possible evidence at the time of writing.
© March 2012. Due for review March 2014. Royal
College of Psychiatrists. This leaflet may be downloaded, printed
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