1. Vandhna Sharma
December 2016
Image: MS Word

2.  “…self-mutilation is distinct from suicide…A
basic understanding is that a person who
truly attempts suicide seeks to end all
feelings, where as a person who self-
mutilates seeks to feel better” (Favazza,
1998).
 Intention
 Understanding

3.  Defining self-harm
 Causes of self-harm
 Assessing self-harm
 Managing self-harm - Strategies
 Break
 Suicide risk assessment & crisis plan
 Suicide interventions
 Advice parents/carers
 Support services

5.  Self injury is the intentional harm of one’s
own body without conscious suicidal intent
(Alderman, 1997; Favazza, 1998).
Types of SH – this is not an exhaustive list
 Cutting
 Scratching
 Burning
 Biting
 Swallowing foreign objects e.g. drawing
pins/glass
 Interfering with wound healing
 Swallowing toxic substances e.g. bleach
SELF-HARM DEFINITION & FORMS

6. Muller, 2005

7. SH alone is not a MH diagnosis. Is a symptom
associated with a number of mental health
disorders:
 Anxiety
 Eating difficulties
 Depression
 Post Traumatic Stress Disorder
 Personality Disorder
 Substance Use

8.  Can only be based on what is reported
 13% of young people may try to hurt
themselves on purpose at some point
between the ages of 11 and 16
 In past 4 years has been 70% increase in
10-14 year olds attending A&E for self-
harm.
 One in twelve children and young people are
said to self-harm
- www.nice.org.uk/guidance/cg16/evidence/cg16-selfharm-
full-guideline-2
- http://www.hscic.gov.uk/media/14858/Self-
HarmAreaTeamagegender2011-
2014/xls/SelfHarm_AreaTeam_age_gender_2011-2014.xlsx

9. Case study: You are working with 16 year old
Max for cannabis use. Lives at home with family
and attends school. He discloses to you that a
few days ago he cut his leg.
1/ What is your response? (what do you say? How do
you feel? What is the look on your face?)
2/ How do you assess the risk? (What questions do
you ask? What advice do you give?)
-Discuss in groups of 3 for 20 mins
-Feedback together, 10 mins

10.  Calm
 Eye contact
 Thank them for sharing
 Ask about it.
 Show you care.
 Acknowledge the distress
 Don’t discourage self-injury
 If appropriate, ask to see injury
Helping: What to Do (Alderman, 1997)

11.  Their account
 Intention and understanding
 When did they cut
 What did they cut with
 Where did they cut
 Deep or superficial cuts/scratches
 Has the cut healed
 Signs of infection
 Have they done it before
 Are they ok to show you the cut/s
 Are they planning on cutting again

12.  try not to cut over old cuts
 Clean area
 bandages and plasters
 If you cut an artery or bleeding won’t stop:
ambulance
 Don’t cut with glass
 Give crisis numbers and websites
 Alternatives to SH docs (handout)
 My Plan -crisis doc (handout)

13. STRATEGIES TO MANAGE DISTRESS
Chill Out Techniques
 Music
 Bath
 Call friend
 Punch pillow
 Hug
 Funny film
 Run
 Breathe

16.  Preparing yourself
 Can be scary and overwhelming
 Look after yourself
 Supervision
 Ask for help
 Use My Plan – on youself

17.  More than one million people commit suicide
annually across the globe.
 60-70 young people under the age of 18 die by
suicide in England each year.
 One in Four (26%) young people in the UK
experience suicidal thoughts
 ChildLine (UK) revealed that since 2010 there
has been a 116% increase in children talking
about suicide
 Only 14% of suicides aged under 20 have been in
contact with specialist mental health services
Youth Suicide – Young Minds Website

18.  LAC
 Young Offenders
 Disability
 LGBT
 BME
 Acting without thinking through consequences
 Having access to weapons/pills/rope etc..
 Chronic pain
 Money problems
 Little hope for future
 Thoughts/intent to hurt others
 Struggle to solve problems
 Perfectionist tendencies

19.  Someone has decided to kill themselves and
made a plan
 If they have sorted out responsibilities
 Completed a suicide note
 Said goodbye to people
 Given away belongings they love
 Announced it online

20.  told you
 support from family and friends
 pets
 plans for the future
 bright
 understand issues
 want help

21.  My Plan
 Professionals crisis plan (as per flowchart)
Share Info:
-parents/carers
-school
-GP
-social care
-any other relevant professionals

22.  See client more frequently
 Do crisis plan
 Practice coping strategies in sessions
 Look at social network
 Talk about future plans

23.  Lock up knives/pills/blades/bleach etc.
 Monitor young person
 Look at My Plan – what helps me feel better
 Encourage them to eat, rest, spend time
with family, do fun activities
 If concerns increase – ask YP directly “are
you having thoughts to kill yourself?”
 If immediate risk – ambulance / take A&E
 Get emotional support for self (professional
or friend/family), e.g. Young Minds Parent’s
Helpline 0808 802 5544

24.  Provide urgent assessments and treatment to young
people presenting at an A&E
 Once physically fit A&E contact CAMHS
 Mostly YP has self-harmed, are experiencing self-
harm/suicidal thoughts, have attempted suicide
 CAMHS see the YP at the hospital, and then again
within 2 weeks for a follow-up assessment.
 Then consider if further support required
If acutely unwell and/or unable to keep themselves
safe:
 arrange in-patient stay
 and/or
 CAMHS Outreach Team

25. Useful numbers
 -ChildLine 0800 1111
 -Papyrus hope line 0800 068 4141
 -Samaritans 116 123 number is available and free to call from
landline and mobile phones.
 -Dial House 0113 260938 - crisis centre open from 6pm to 2am for
people to visit (16+ years).
 -South CAMHS – 0113 8430804
 -West CAMHS – 0113 8432710
 -East CAMHS – 0113 8434468
Useful websites:
 - Papyrus: www.papyrus-uk.org
 -National Self Harm Network: www.nshn.co.uk/
 -ChildLine: www.childline.org.uk
 -Young Minds: www.youngminds.org.uk
 -Leeds CAMHS: www.leedscommunityhealthcare.nhs.uk/camhs

27.  Favazza AR: The coming of age of self-
mutilation.J Nerv Ment Dis. 1998
May;186(5):259-68.
 Alderman, T. (1997). The Scarred Soul:
Understanding and Ending Self-Inflicted
Violence. Oakland: New Harbinger .
Retrieved April 1, 2008, from Self-injury: A
struggle : http://self-injury.net/faq/