To support professionals, Hampshire Safeguarding Children Partnership (HSCP) has developed some practical tools that can be used when working with children and young people who may be at risk of self- harm. Select a topic below:
All professionals should know what to do if a child tells them he/she is self-harming. Staff should know how to manage the requirement to maintain an appropriate level of confidentiality. This means only involving those who need to be involved, such as the designated safeguarding lead (or a deputy) in a school/college and children’s social care. Staff should never promise a child or young person that they will not tell anyone about a report of self-harm, as this may ultimately not be in the best interests of the child. It is also important to take into account 16- and 17-year-olds who have chosen not to have their information shared.
Good Practice Points
- Listen actively to the child/young person and seek to understand the situation from their point of view in a non-judgemental, respectful and empathic way. It is important to try to validate the feelings of the child/young person and understand their experience.
- It is important to have some understanding of the risk presented, and access to guidance on assessing risk.
- Learn about self-harming behaviour, and the difference between suicide and self-harm. Encourage staff to attend training in self-harm to support their understanding and capacity to respond to self-harm in appropriate ways.
- It is important to remember that if someone tells you that they self-harm, it could be a sign that they trust you and are willing to share this very personal problem with you. Respond to this trust in a thoughtful and reflective way.
- An important part of beginning to manage self-harm effectively is feeling heard and understood by another person. Some people just want to be heard and empathised with. You may need to balance this with gently asking some important questions.
- Self-harm is not the only way for people to deal with emotional distress. Try to encourage the child/young person to seek alternative coping mechanisms. However, do not expect them to be able to stop self-harming, or develop new coping strategies immediately or in the short term.
- If the disclosure is made in a school/college, you may be able to put the child/young person in touch with your in-house counsellor as a first step to getting additional support.
- Be aware that social media is sometimes used by children/young people to enquire about ways to self-harm or to share details or images of their self-harming with their peers.
- Be aware that supporting children/young people who harm themselves may evoke feelings of anxiety, frustration, repulsion, bewilderment and helplessness. It is important not to convey these feelings to the young person who self-harms. But staff need to take care of themselves – seek support when they need it; be aware of their own feelings and limitations and not offer more help than can be coped with.
Managing Disclosures for 16- and 17-Year-Olds
A young persons safety is paramount but they may not wish to tell their parents about their self harm, a balance needs to be found between the young person’s rights and the need to keep them safe. Young people are deemed Gillick Competent when they have the intelligence and understanding to make their own decisions and fully understand the consequences of that decision. Young people over the age of 16 will come under the Mental Capacity Act 2005 and if they have capacity to make decisions for themselves they can choose not to share information with their parents.
Young people should always be encouraged to talk to their parents about their self harm if appropriate. A young person should always be told if you are planning to share information with parents or other professionals. When talking to parents:
- Give factual details, be non-judgemental.
- Ask if they had any knowledge of the self harm behaviour.
- Have resources to sign post parents to for information and support.
- Be prepared for varying reactions from the parents, they may be cross, in denial or completely shocked.
- Expect to have a further phone call to give more information and support once the parents have had time to process the information.
The examples below provide an outline of conversations, please also consider the following factors and think about how they may influence your conversation:
- Choice of language – are the words appropriate for the child’s age and comprehension.
- Tone of voice.
- Body language.
- Non-judgemental approach to ensure the child does not feel stigmatised.
- ‘I appreciate that you may tell me this is in confidence but it’s important I let you know that your safety will always be more important than confidentiality. If I am sufficiently worried that you may be feeling unsafe or at risk of hurting yourself, part of my job is to let other people who can help you know what’s going on but I will always have that discussion with you before and let you know what the options are so that we can make these decisions together’.
Starting the conversation / establishing rapport
- Let’s see how we can work this out together. I may not have the skills to give you the help you need, but we can find that help for you together if you would like?
- Use active listening – for example: can I just check with you that I have understood that correctly?
The nature of self-harm
- Where on you body do you typically self-harm?
- What are you using to self-harm?”
- Have you ever hurt yourself more than you meant to?
- What do you do to care for the wounds?
- Have your wounds ever become infected?
- Have you ever seen a doctor because you are worried about a wound?
Reasons for self-harm
- I wonder if anything specific has happened to make you feel like this or whether there are several things going on at the moment? For example, peer relationships; bullying, exam pressure, difficulties at home, romantic relationship break-up, substance misuse or abuse.
Coping strategies and support
- Is there anything that you find helpful to distract you when you are feeling like self-harming? Perhaps listening to music, playing on your phone, texting a friend, spending time with your family, reading, going for a walk etc?
- I can see that things feel very difficult for you at the moment and I am glad that you have felt able to talk to me. Is there anyone else that you have found helpful to talk to before or is there anyone that you think maybe good to talk to? How would you feel about letting them know what’s going on for you at the moment?
- How could we make things easier for you at school?
- What feels like it is causing you the most stress at the moment?
- What do you think would be most helpful?
Speaking to parents/carers (where appropriate)
- I understand that it feels really hard to think about telling your parents, but I am concerned about your safety and this is important. Would it help if we did this together? Do you have any thoughts about what could make it easier to talk to your parents
- Why don’t we write down what we have agreed as a plan together, then you have a copy that you can look at if you need to remind yourself about anything. Sometimes, when you are feeling low or really want to self-harm, it is difficult to remember the things that you have put in place – this can help remind you.
When working with children/young people, it is essential to develop an understanding of the level of risk that they present to themselves and to remember that this can change over time. It is okay to talk with young people about these issues; it will not make things worse.
Factors that increase the risk
- The use of alcohol or drugs when self-harming (this can increase recklessness and impulsiveness).
- Feelings of hopelessness about life (whether it be not caring about themselves or actively wanting to die).
- Methods of self-harm where there is a higher risk of accidental or unanticipated severe harm (e.g. frequent small overdoses may cause long-term harm).
- An increase in the frequency of self-harm or a feeling of having to do more to feel what they perceive to be the benefits.
Unless the child or young person is in obvious emotional crisis, kind and calm attention to ensuring that any immediate physical wounds are treated (by an appropriate member or staff) should precede additional conversation with them about the nonphysical aspects of self-harm.
The Self-Harm Pathway applies to all children under 18 years who present with self-harm behaviour in the community including those who are actively suicidal (i.e. continues to state that they will commit suicide and needs to be prevented from doing so).
Questions of value in assessing severity of the injury
- Where on your body do you typically self-harm?
- What do you typically use to self-harm?
- What do you do to care for your wounds?
- Have your wounds ever become infected?
- Have you ever seen a doctor because you were worried about a wound?
Where in doubt or if concerned, seek medical attention as appropriate.
In general, children and young people are likely to fall into a spectrum of risk:
- Lower risk: Little history of self-harm, a generally manageable amount of stress and at least some positive coping skills and external support.
- Higher risk: More complicated profiles, report frequent or long-standing self-harm practices, use of high lethality methods, younger age, parental mental health problems and/or students who are experiencing chronic internal or external stress with few positive supports of coping skills.
These risk factors and questions serve only as a guide to support staff and are by no means exhaustive. Assessing risk should be in collaboration with the young person and your organisation’s safeguarding lead.
- Where a child or parent is unwilling to engage with support services, a referral to Children’s Services should be considered, as refusal to engage may constitute a safeguarding issue. Professionals should complete the online Interagency Referral Form.
- After assessing immediate risk, gaining further information from the child or young person may take place over a number of conversations and should occur at a pace comfortable for them.
- Remember, if you a concerned that the child or young person has experienced or is at risk of experiencing significant harm then it is necessary to follow your organisation’s child protection procedures.
- Establish if any other adult is aware of the self-harm.
For further information and guidance refer to the HIPS Procedures 3.9 Self-harm and Suicidal Behaviour.