Residential Staff Responses To Adolescent Self-Harm: The Helpful And Unhelpful

Self-harm in residential care

Self-harm is an intentional act of self-injury regardless of the motivation or degree of suicidal intent. Research suggests that children in local authority care are at a heightened risk of self-harm compared to non-looked after children. There is also evidence that the prevalence of self-harm within residential settings is higher than in other care settings.

There is a myriad of complex reasons for the high prevalence of self-harm among these young people. It is thought to arise from the high levels of adversity, trauma and difficult attachment relationships that many of these children have experienced. These experiences can lead to difficulties in regulating and coping with strong emotions, which can trigger self-harm.

Consequences of self-harm

Young people who self-harm experience immediate and potentially long-term physical injury. Strong negative emotions (e.g. shame and regret) can also be triggered and perpetuate a cycle of self-harm. The consequences of self-harm can also result in distress for family members, friends and staff supporting the young person. There is also an association between exposure to the self-harm of others and adolescent self-harm.

It is important that young people who self-harm receive support that is helpful to them. Fortune et al (2008) and McAndrew and Warne (2014) define helpful support as including being listened to; not being judged; confidentiality; trust; and having opportunities to talk to someone independent of family, friends or school. A study by Piggot et al (2004) of young people who had previously lived in residential care found that "good relationships" and empathic listening were crucial for helpful support. Being listened to and having a non-judgmental attitude increases the chances of young people engaging with support services.

The study findings

This study used purposive sampling to select young people who had self-harmed in residential settings. Seven young people aged 14-16 were interviewed (three boys and four girls). Five of the young people were in secure care and two were in residential care and all had been in the care setting for over six months.

Analysis identified the following key themes: