Skills for the Job: Dealing with self-harm

Being able to identify the warning signs that a young person may be self-harming can help save their life, says Dr Mona Freeman

What is self-harm?

Self-harm is a term used when someone injures or harms themselves on purpose rather then by accident. It is estimated that seven to 14 per cent of adolescents self-harm at some point in their lives.

The most common methods of self-harm in young people are self-cutting or self-poisoning (taking an overdose) but other examples include self-hitting or burning, pulling hair or picking skin, or self-strangulation.

Other young people may self-harm in less obvious ways, for example the use of alcohol or illicit drugs, or even in indirect ways, like exposing themselves to harm from others.

Hearing that a young person has self-harmed should always prompt those working with them to explore the issue further, as it is serious and can be life threatening.

Who self-harms?

Self-harm tends to be more common in young women than young men. There are often difficulties in the young person’s life, affecting themselves, family or friends.

This could include having a mental health problem like depression, or a problem with alcohol or illicit drugs. Their family may no longer be intact, or they could have experienced abuse.

There are links with knowing others who self-harm or have committed suicide, both within the family and among peers. Some minority ethnic groups have also shown increased rates of self-harm.

Why do young people self-harm?

An act of self-harm is usually triggered by an argument or an unpleasant event or experience. This could even be an incident that occurred online or via a text message.

Only a small proportion of young people who self-harm actually want to die. Most self-harm to communicate distress, to "punish" themselves in some way, to relieve tension or cope with difficult thoughts or feelings and in some cases to feel more "connected" or "grounded" if they are usually "cut off" from their emotions.

Whatever the intent, all self-harm should be taken seriously; it is an important risk factor for future suicide, even if that is not what the young person intends.

What should you look out for?

Notice when the behaviour of a young person has changed; they may start to isolate themselves from family and friends. Self-harm is often kept secret, but you might pick up on a young person who refuses to wear short-sleeved clothing, or change in front of others for sport at school.

Just letting a young person know you have seen a difference in them recently and asking if they’re okay can be enough for them to start to open up.

If a young person has taken an overdose they must be assessed in a hospital, even if they appear well.
Paracetamol, which is the most common drug taken as an overdose in the UK, can cause serious liver damage which can be fatal without treatment.

Other forms of self-harm may need urgent intervention; cuts may need stitching and burns can become infected.

What specialist help is available?

It can be difficult to judge risk and intent in young people who self-harm; mental health professionals who work with young people in child and adolescent mental health services (CAMHS) have the expertise to do this and to think about how best to help.

All young people who are seen in hospital after self-harm should be reviewed by a mental health professional before they leave. Those not requiring hospital treatment may still benefit from having a CAMHS assessment from a local service.

If additional mental health difficulties are uncovered, these will also need treatment and it is particularly helpful for the thinking between health, education and social care to be joined-up around these young people.

Dr Mona Freeman, consultant child and adolescent psychiatrist



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