Self Harm

Self Harm Guidance Documents

The Educational Psychology Service, in consultation with CAMHS, has produced guidance for schools on assessing risk and supporting young people engaged in self-harming behaviours. There is also guidance for schools on self-harming behaviours exhibited by children with complex special needs.

One Minute Guide - Self Harm Guidance for School Staff

What is self-harm?

Self-harm is where someone does something to deliberately hurt themselves when they find things difficult to cope with.

It can include behaviours such as:

  • Cutting
  • Over-dosing
  • Hitting (self and others)
  • Burning or scalding
  • Picking or scratching skin
  • Pulling hair
  • Ingesting toxic substances
  • Eating disorders

Why do people self-harm?

People self-harm for lots of different reasons. Sometimes this is because they feel bad about something that has happened to them but often there is no known cause. Self-harming behaviours may have the following functions:

  • To communicate distress to others
  • To relieve unbearable feelings
  • To provide soothing and comfort by releasing tension and gaining care from others
  • To feel alive if they feel numb due to life experiences
  • To punish themselves as they feel shame and self-blame
  • To control things in their life when everything feels out of control

Who self-harms?

There is not a ‘type of person who self-harms. People who self-harm are of any age, religion, sex or background. Both girls and boys self-harm but may use different methods.

Is there a link to suicide?

People often think that there is a link between self-harm and suicide, however, most people who self-harm are not trying to kill themselves.

What do I do if I’m worried someone is self–harming?

  1. Pupil shows signs and symptoms of self-harming:
  • Stay calm – try not to panic or show you feel shocked, even though you may be.
  • Ensure all physical wounds are treated before any conversations around the non-physical aspects of self-harm.
  • Do not ignore, punish or criticise the behaviour.
  • You may want the young person to stop but telling them to stop is not helpful and can be dangerous as it takes away their coping strategy 
  • Listen to them non-judgmentally and try to understand
  • Explain about duty of care and confidentiality
  • Record concern and inform Designated Child Protection lead 
  • Have an awareness of your own feelings and need for safe support
  • Be aware of ‘social contagion’ – self-harm spreading between members of a group
  1. Undertake a risk assessment and create a ‘safety’ plan:
  • Designated Child Protection lead will work with available information to undertake risk assessment and safety plan – see Risk Assessment and Safety Plan for Young Person
  • Inform parents and carers unless clear reason not to.
  • Relevant course of action will depend on level of risk 
  • Seek support from other agencies 
  • Document concerns and actions to be taken – within whole school approach/policy/protocol
  1. Low/ medium risk
  • Identify key adult to work with young person.
  • Support them to stay safe if they continue to self-harm. Help them to minimise risks such as infection.
  • Support them to develop new coping strategies. Other strategies include distraction, flicking a band on their wrist, putting cold ice on their skin, going for a walk.
  • The Truth About Self Harm for young people and their families and friends by the Mental Health Foundation may be useful 
  • Seek further advice from other agencies
  • Ensure there is support for yourself. 
  1. High risk/Crisis
  • Seek immediate medical attention and administer first aid if required
  • Keep calm and give reassurance to pupil and others who may have witnessed the self-harm
  • Explain duty of care and confidentiality
  • Record concern and inform Designated Child Protection lead 
  • If child/ young person is taken to hospital, emergency protocols for treatment and care will be implemented
  • If child/ young person is not taken to hospital, discuss with CAMHS to mark pain if possible. Pain scales may also be helpful. 
  • Consider what might be going on for the child outside of school e.g. has there been a change or loss.
  • Speak to CAMHS if you need further support unpicking the ‘intention’ of the behaviour – is this self-harm or is the young person communicating an unmet need? Call the SPA and ask to speak to CAMHS clinician – 0330 0245 321.

Who can help in Devon?

CAMHS – 0330 0245 321
Call the pre-referral phone line at Single Point of Access to speak to a CAMHS Clinician regarding your concerns and they will advise on next steps and whether a CAMHS referral is appropriate. Have in mind FIDOS: Frequency, Intensity, Duration, Onset, Severity. 

School Nurse – contact your locality team

  • South – 0333 234 1901 southerenphnhub@nhs.net
  • Exeter – 0333 234 1902  exterphnhub@nhs.net
  • East – 0333 234 1903
  • North – 0333 234 1904

Educational Psychology Service - 01392 287 233
Speak to Babcock LDP Educational Psychology Service for support via consultation, staff supervision and training.

Further Support

  • Talk works Depression and Anxiety Service A support service people aged over 17.5 years with mental health concerns. Can provide face to face, group or online support. 
  • Pinpoint An online directory of local community services. 
  • Kooth A free online anonymous counselling service for children and young people.
  • Mood Juice Free and fast access to self-help resources for mental health concerns. 

Download this Self-Harm Guidance information in a printable format



 

One Minute Guide - Self-Harm and Children and Young People with SEND

Self-harm is: where someone does something to deliberately hurt themselves when they find things difficult to cope with.

It can include behaviours such as:

  • Cutting
  • Over-dosing
  • Hitting (self and others)
  • Burning or scalding
  • Picking or scratching skin
  • Pulling hair
  • Ingesting toxic substances 
  • Head banging
  • Biting own skin
  • Eating disorders 

Self-harm in children with Special Educational Needs and Disabilities (SEND) should be approached in the same way as for those without additional needs:

  • With compassion and non-judgement
  • Adults should seek to understand the purpose of the behaviour – it is usually a communication of distress
  • Do not assume that it is part of the child’s SEND

Why do people self-harm?

People self-harm for lots of different reasons. Sometimes this is because they feel bad about something that has happened to them but often there is no known cause. Self-harming behaviours may have the following functions:

  • To communicate distress to others
  • To relieve unbearable feelings
  • To provide soothing and comfort by releasing tension and gaining care from others 
  • To feel alive if they feel numb due to life experiences
  • To punish themselves as they feel shame and self-blame
  • To control things in their life when everything feels out of control

In addition children with SEND may have additional reasons:

  • Difficulty articulating feelings due to communication difficulties
  • Avoidance; trying to escape difficult feelings
  • To get attention: there may be an unmet social or emotional need. They may feel isolated and not able to communicate/engage
  • Frustration; difficulty in communicating their views and needs. Difficulties understanding the world
  • Sensory stimulation; seeking sensory stimulation or pain
  • Sensory avoidance: they may self-harm to manage feeling overwhelmed and seek relief from sensory overload.

Some self-harming behaviours in children and young people with SEND may be linked to sensory or environmental overload or communication difficulties, however, self-harming behaviours in these instances still serve to relieve unbearable feelings or communicate distress. Whilst the intent is the same (relief from difficult feelings) the thought process linked to this may be different. For example a young person with complex SEND may pick their skin if feeling overwhelmed by a learning task to gain some relief from uncomfortable feelings however, another young person may pick their skin to relieve feelings associated with self-loathing. Self-harming behaviours in these situations have the same intent, a relief from painful thoughts/feelings/ but they may be coming from a slightly different place.

What Can the School Do?

  1. Undertake a risk assessment and create a ‘safety’ plan:
  • Listen to the young person
  • Explain about duty of care and confidentiality
  • Have an awareness of your own feelings and need for safe support
  • Document concerns and actions to be taken – within whole school approach/policy/protocol
  • Ensure Child Protection lead is aware and work within Safeguarding frameworks
  • Refer to school policy regarding Safe Handling and be aware of Deprivation of Liberty guidance (DOLS)
  • Unless there is a good reason not to, discuss and share concerns with parents/carers
  1. Understand the behaviour:
  • Work with parents to identify patterns of when the child is hurting themselves and begin to recognise triggers. Learn to recognise urges and distract from the urge to self-harm in the short term.
  • Look and observe repetitive behaviours to break a pattern before it becomes a compulsive behaviour. It may help to keep notes or a diary around this. 
  • Rule out any medical or dental causes of pain in the body – use a body outline for the person to mark pain if possible. Pain scales may also be helpful. 
  • Consider what might be going on for the child outside of school e.g. has there been a change or loss.
  • Speak to CAMHS if you need further support unpicking the ‘intention’ of the behaviour – is this self-harm or is the young person communicating an unmet need? Call the SPA and ask to speak to CAMHS clinician – 0330 0245 321.
  1. Strategies/interventions:
  • Include sensory breaks if over stimulated/give sensory involvement if under stimulated.
  • Increase level of structure and routine to give stability to reduce anxiety. 
  • Timetables, including visual timetables may help. If a young person is feeling in control, the risk of harming decreases along with their anxiety.  Social stories, comic strip conversations also may be helpful.
  • Using communication tools maybe be helpful for some young people, but this will depend on their communication abilities. 
  • Rather than talking, sit alongside and be available/ present. For example, complete a puzzle together.
  • Young people with Autism may be able to communicate on their specialist subject extremely articulately but unable to express feelings and thoughts – increase emotional literacy and include feelings and thoughts in all visuals including (PECS).

Things that don’t help

  • Showing disgust or anger
  • Telling the young person what they are doing is wrong.
  • Telling them how dangerous it is/what a stupid thing to do.
  • Constantly asking if they have done it again.
  • Asking to see the self-harm/scars.
  • Asking lots of questions.

How can staff look after themselves?

  • Think about your own boundaries and responses.
  • Seek additional support from others and share safeguarding concerns.
  • Do not feel personally responsible for stopping the young person from self-harming. Stopping might not be the right thing for that young person at that moment.
  • Be mindful of the impact on yourself.

For further support and signposting see Babcock LDP short guide – Self Harm Guidance for School staff.

Download this Self-Harm and SEND information in a printable format

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