by AboveThePen

Information For Schools & Other Professionals

Prevention

Work in schools can significantly reduce and help prevent self-harm and suicide attempts.  Many young people prefer to turn to other young people for support and many have said that all they want is to be able to talk to someone who will listen and respect them, not specifically about self-harm but about problems and issues in their daily lives. Some say that had this been available to them they may never have started to self-harm. Research suggests that peer support can be helpful but works best when it is used alongside a whole school approach to mental health and reducing social isolation, which includes strategies such as anti-bullying ones. Focussing on the reasons young people self-harm is crucial.   Encouraging a healthy diet and lifestyle can play a significant part in positive mental health. Seaton (undated) suggests the following strategies are helpful in encouraging young people feel good:

  • Emotionally healthier schools, colleges.
  • Encouraging young people to talk openly and ask for help early on.
  • Ensuring access to people who can help and offering a quick response.
  • Removing shame and stigma.
  • Reducing poverty/inequality.
  • Increasing awareness/understanding among public and professionals and the media.
  • Making sure children and young people feel safe and secure.

lifecenterli

All professionals working with young people need to adopt the following principles:

  • Adolescents do not really want to die but they do not want to go on in pain.
  • Suicide threats must always be taken seriously.
  • Eventually suicide may not be prevented.
  • After a suicide, all involved will have to deal with feelings of guilt.

Responses to disclosure of self-harm

 ‘The key to working with young people who self-harm is acceptance, care and interest. …having the opportunity to discuss what she does without the other person being embarrassed or shocked. It has helped her tremendously to read articles on self-harm and learn that she is not the only one in the world who does it – I think this is a very common feeling among harmers.’  (Brophy pg. 69)

 It can be hard for family, friends, and professionals to handle a young person’s disclosure of self-harm but the reaction a young person receives when they disclose their self-harm can have a critical influence on whether they go on to access supportive services.  For some, it can be the only way that they can ask for help and yet many avoid it because of their fear of how they will be treated. Many experience dismissal, judgemental attitudes and accusations of being attention seeking when they disclose (Truth Hurts).  Many feel that they lose control of another aspect of their lives and others that more attention is drawn to their self-harm because others constantly watch them.  Others feel as though adults in their lives see the self-harm as a failed suicide attempt, engage in it as part of a “cult” or to be manipulative: these are usually myths linked to society’s taboos.  In addition, they may be worried that if they do disclose their future may be compromised and some worry that they will not be able to work in professions such as teaching, nursing, or childcare because of the public perception that people who self-harm are ‘dangerous.’

Young people need preventative measures that are respectful: they also need school staff and others to provide opportunities for them to discuss problems before they turn to self-harm as a way of coping.  It may be important to consider whether young people have access to a male or female supporter. Adults who may be involved in supporting a young person who has self harmed needs to have excellent communication and listening skills but they are also advised to be aware of confidentiality policies within their setting, appreciate Gillick competence (i.e. whether a child under 16 years of age is capable of giving consent to her or her own medical treatment without parental permisssion), and be alert to other legal guidance.  Individual practitioners and services should be able to demonstrate  that they have followed the advice of other professionals and that they have undertaken an appropriate assessment of the risk to the young person and considered the least invasive interventions.

Seaton (undated) advises being direct with young people, so:

Avoid: “You’re not thinking of hurting yourself, are you?”

Better is the question “Are you thinking of harming yourself?”

Best is “Sometimes when people have had your experiences and feelings they have thoughts of suicide. Is this something that you’re thinking about?”

‘The most important thing is not to tell people to stop, but to listen to them, find out what they need to stop and help them find ways of achieving that. This way people heal in their own time. Telling people to stop makes them more secretive, more dangerous, and more dishonest about it. People need to not feel threatened by people that are ultimately trying to help them.’  (Brophy pg 70)

Schools also have a responsibility to:

  • Assess the risk and involve more than one teacher.
  • Reassure and supervise staff working with children who might be at risk.
  • Keep safe (suicide-proof the environment).
  • Warn parents.
  • Refer to other professionals (CAMHS, Primary Mental Health Team, Children’s Services Professionals).
  • Keep records of referrals, incident/action logs.

Identifying students at risk

 Signs to look out for

  • Unexplained cuts, burns, scars or markings on the skin.
  • Arms, hands and forearms opposite the dominant hand are common areas for injury. However, evidence of self-injurious acts can and do appear on any body part.
  • Inappropriate dress for the season (consistently wearing long sleeves or trousers in summer
  • Constant use of wrist bands or other coverings
  • Unwillingness to participate in events or activities that require less clothing (such as swimming or other sports)
  • Frequently wearing bandages
  • Unusual or inexplicable paraphernalia (e.g. razor blades or other implements, inappropriate medication)
  • Any sudden or dramatic change affecting a child’s or adolescent’s performance, attendance or behaviour should be taken seriously. This might include:
  • lack of interest in usual activities;
  • an overall decline in grades;
  • decrease in effort;
  • misconduct in the classroom;
  • unexplained or repeated absence or truancy;
  • excessive tobacco smoking or drinking, or drug (including cannabis) misuse;
  • incidents leading to police involvement and student violence.

If a staff member has reason to believe that a student is an immediate suicide risk they should:

  • Keep the student under continuous adult supervision: do not leave the student alone.
  • Notify head teacher, counsellor, school worker or school psychologist or CAMHS professional.
  • Contact parents and request information sharing between professionals.
  • If parent is unavailable or uncooperative regarding emergency services contact social services to intervene on behalf of student (potentially a child protection medical neglect referral).
  • Do follow-up check with family, student or treating agency to ensure that adequate care has been given.
  • In line with any treatment plan meet with the student’s teachers to alert them of the risk and ask them to help monitor student’s behaviour.
  • Document all actions on behalf of the student (referrals, contacts, follow-up activities).

In the event of a suicide attempt:

 In the event of an actual suicide attempt staff will

  • notify head teacher
  • ensure short-term physical safety of the student

The head teacher must

  • call 999, local support services, Children’s Services,
  • keep student under constant supervision at all times,
  • communicate with appropriate school personnel, parents / guardians, counsellors to establish immediate plan of action,
  • ensure that school psychologist, counsellor or social worker refers parent(s) / guardian(s) to CAMHS or other appropriate professional for implementation of long-term plan of action for student (in follow-up to immediate physical needs),
  • ensure documentation of all actions taken on behalf of student (referrals, phone contacts, follow-up activities),
  • offer support to any staff or students who are affected

Communicating with students about a suicide:

If a suicide does occur:

  • Release information in a small setting (not assembly)
  • Be truthful, avoid too much detail
  • Attempt to stop rumour
  • Dis-identify with victim
  • Acknowledge grief and loss
  • Respond to individual needs, views and opinions
  • Advise that there is no right way to feel
  • Without going into excessive detail provide students with facts about the suicide
  • State that the only one ultimately responsible for the suicide is the victim
  • Acknowledge that the suicide was an avoidable act
  • The student made a poor choice – other choices were available
  • Portray the act as a permanent solution to temporary problems
  • Discuss how survivors are different from the suicide victim.
  • Portray the suicide victim as very upset, disturbed, and as
  • someone who had not found an effective way to work out problems.
  • Help survivors to dis-identify with the victim without abusing the victim’s character.
  • State that there is no ‘right way’ to feel after a suicide
  • Point out that painful reactions to the suicide will be alleviated with
  • time and talk
  • Acknowledge that people may have suicidal thoughts following the
  • suicide of a significant other
  • Provide information about the warning signs of suicidal behaviour
  • and available mental health / support resources inside the school
  • and outside the school
  • If appropriate prepare students for the funeral

Leaflets, guidance and supporting information

The above information for children and families from the Child Bereavement Charity will be helpful: http://www.childbereavement.org.uk. Tel:01494 446648 . In addition the site also contains helpful information for schools, including the following:

  • Support for schools
  • Children’s understanding of death
  • How schools can help
  • Breaking sad news
  • Supporting a bereaved pupil
  • How to put together a school policy
  • Special educational needs
  • Lesson plans
  • Resources for staff

Information for other professionals includes the following:

Ordinary Days & Shattered Lives: This 50 page report includes a year’s research on sudden death and the impact on children and families. From interviews with families, the report provides vital information for all professionals, whether in healthcare, visit at: http://www.childbereavement.org.uk/Portals/0/Shop/Free%20Downloads/Ordinary%20Days%20-%20Shattered%20Lives%20W%20Cover.pdf.

The World Health Organisation (2000): Preventing Suicide: A Resource for teachers and Other School Staff.  This includes sections on protective factors, risk factors, how to identify students at risk, managing suicidal students and recommendations. Available at:

http://whqlibdoc.who.int/hq/2000/WHO_MNH_MBD_00.3.pdf.

A report by the Samaritans and The Centre for Suicide Research, University of Oxford (2002):

http://www.samaritans.org/pdf/Samaritans-YouthSelf%20HarmPerspectives.pdf.

NICE guideline, Self-harm: the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care, which has been issued to people working in the NHS. Available at: http://www.nice.org.uk/CG16.

Truth Hurts: Report of the National Inquiry into Self-harm among Young People.  This reports uses the views and comments of young people to raise awareness of issues linked to self-harm and suicide attempts.  It quotes from them and highlights what they see as helpful. This is free to download and available at:

http://www.mentalhealth.org.uk/publications/truth-hurts-report1.

Winston’s Wish have a number of helpful leaflets, for example one linked to bereavement through suicide. This is available at:

http://www.winstonswish.org.uk/page.asp?section=0001000100020025&pagetitle=Bereavement+through+suicide.

The Self-harm in Children and Young People Handbook (2011) published by the National CAMHS Workforce Programme, National CAMHS Support Service (NCSS) is designed to provide basic knowledge and awareness of the facts and issues behind self-harm in children and young people, with advice about ways staff in children’s services can respond. Available at

http://www.chimat.org.uk/resource/item.aspx?RID=105602

Contributor: Sue Sanderson, Cumbria County Psychological Service 2012