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 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 themselves, and offers advice about what to do to
help.
Introduction
What is self-harm?
Self-harm is a term used when someone injures
or harms themselves on purpose rather then by accident. Common
examples include `overdosing' (self-poisoning), hitting, cutting or
burning oneself, pulling hair or picking skin, or
self-strangulation. It can also include taking illegal drugs and
excessive amounts of alcohol. Self-harm is always a sign of
something being seriously wrong.
Why do young people harm themselves?
Self-harm is a way of dealing with very
difficult feelings that build up inside. 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 suffer from
feelings of 'numbness' or 'deadness'. 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 by difficulties that they wish to end
their lives by committing suicide. Often, the decision to
attempt suicide is made quickly without thinking.
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 other serious mental health problem are at
greater risk. So are people who take illegal drugs or excessive
amounts of alcohol.
Many young people self-harming 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 your child 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 and
your child.
- If your child or adolescent 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 extremely hard to cope with
a child with self-harming behaviour or who attempts suicide and
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 remain calm and caring, even if you feel cross or frightened;
this will help your child 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. If so, you
should seek advice from your general practitioner.
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 can endanger their lives. For this reason, it should
never be kept secret.
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 Casualty Department. If you are
unsure whether your child 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 necessary. Poisoning with paracetamol is the most common type of
overdose in Britain. Overdosing with paracetamol causes serious
liver damage, and each year this leads to many deaths. Even small
overdoses can sometimes be fatal.
All young people who
attend hospital following attempting suicide or harming
themselves should, in addition, have a specialist mental health
assessment before leaving. The aim is to discover the causes of the
problem. 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 help is needed. A lot of young
people 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. Individuals will need help with how to cope with the very
difficult feelings that cause self-harm.
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. There is recent evidence
that young people who self-harm can be helped by being treated
alongside other young people with similar difficulties in a group
setting. This may be something your local Child and Adolescent Mental Health
Service may have on offer.
If depression or anxiety, or other serious
mental health problems are part of the problem, these will need
treating. 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.
References
Sources of further information
Or you may like to look at these websites:
The Mental Health and Growing Up series contains 36
factsheets on a range of common mental health problems. To order
the pack, contact Book Sales at the Royal College of Psychiatrists,
17 Belgrave Square, London SW1X 8PG; tel. 020 7235 2351, ext. 146;
fax 020 7245 1231; e-mail: booksales@rcpsych.ac.uk, or
you can download them from this website.
© Revised November 2009.
Due for review November 2001. Royal College of Psychiatrists.
This factsheet may be downloaded, printed out, photocopied and
distributed free of charge as long as the Royal College of
Psychiatrists is properly credited and no profit is gained from its
use. Permission to reproduce it in any other way must be obtained
from the Head of
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Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.
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