Why we need to promote self-care to avoid self-harm
A recent headline from the BBC News reads:
"Fifth of 14-year-old girls in UK self-harm"
It is generally considered that around 5th of young people may try to hurt themselves on purpose at some point between the ages of 11 and 16, though many experts say the actual figure could be much higher and they may be right. The Children's Society estimates that 109,000 children aged 14 may have self-harmed across the UK during the 12-month period in 2015 - 76,000 girls and 33,000 boys. In addition to this, the NHS data released this month that showed the number of admissions to hospital of girls aged 18 and under for self-harm had almost doubled in two decades, from 7,327 in 1997 to 13,463 in 2017.
Most experts and mental health campaigners do agree on one thing: Self-harm is one of the fastest growing mental health issues in young people.
So what is self-harm?
In a nutshell, self-harm can be described as any behaviour where a young person causes harm to themselves. It usually means cutting but can also include burning and non-lethal overdoses. Some experts are also starting to include repeatedly over-eating or consuming dangerous levels of alcohol as self-harm. Others are including any type of high-risk behaviour.
It is probably best to take the stance that any unhealthy behaviour by a young person that causes them harm or injury as a way to deal with difficult emotions is self-harm.
So why do young people self-harm?
The Royal College of Psychiatrists sees self-harm as communication by young people who are in distress. 'Self-harm’ they say, ‘is a coping mechanism.’ Of course, it is not a healthy coping mechanism and indeed is better described as a ‘toxic coping mechanism’ in the same way as substances and alcohol are. They have a lot in common. According to behavioural change and addiction expert, Shahroo Izadi, self-harming is no different to other toxic coping mechanisms and therefore can become highly addictive.
All young people cope differently with things that cause them stress and worry. Some cope by talking to teachers, friends and family, while others might not feel they have anyone to talk to or might bottle it up until the pressure builds up and becomes unbearable. Those that self-harm then turn this in on themselves and use their bodies as a way to express the thoughts and feelings they can’t say aloud. When they feel angry, distressed, worried or depressed, the urge to hurt themselves increases.
Girls are thought to be more likely to self-harm than boys, but this could be because boys are more likely to engage in behaviours such as punching a door or a wall, which is less likely to require A&E treatment and isn't always recognised as self-harm.
Mental health campaigner, Natasha Devon MBE, has devised 13 reasons why she believes young people are feeling greater levels of anxiety and emotional distress that might, in turn, lead them to self-harm:
- Academic pressure from a narrowed but more demanding curriculum.
- Exam stress and an increased culture of testing.
- Worries about future prospects, employability and/or student debt.
- Worries about world issues and current affairs.
- Parents working longer hours, and reduced family time.
- Peer pressure and worries about not fitting in.
- Appearance-based bullying.
- Worries about sexuality and gender.
- Racism and racist attitudes
- Lack of access to sport and exercise.
- Lack of access to arts and music.
- Lack of mandatory PSHE, meaning little access to reliable information on mental health.
Note that none of Natasha Devon’s 13 reasons includes a direct link to social media. That said, Natasha does agree that social media and pro-self-harm websites are teaching young people how to self-harm, but in order to seek this information, young people had a pre-existing reason for looking. In other words, their emotional and mental wellbeing had already been negatively affected and, whether consciously or not, they were actively looking for ways to manifest distress. She believes it highly unlikely that young people would be induced to self-harming behaviours if they were perfectly happy and content.
What can we do to support a young person who is self-harming?
The first thing to do is avoid the inevitable urge to immediately persuade the young person to stop the self-harm without getting them some professional help. Accordingly to Mental Health First Aid England, taking away self-harm as a coping mechanism without addressing the underlying causes can increase the young person’s risk of suicide. Simply gaining the agreement of the young person to stop leaves them with the uncomfortable and painful feelings but has no means of expressing them.
Of course, you do need to know your limits. If you believe they are in immediate danger or have injuries that need medical attention, you need to take action to make sure they are safe.
Support websites for young people include:
How to spot self-harm:
Look for physical signs such as cuts, bruises, burns and bald patches from pulling out hair. These are commonly on the head, wrists, arms, thighs and chest.
Possible warning signs:
- tearfulness and low motivation
- becoming withdrawn and isolated, for example wanting to be alone in their bedroom for long periods
- sudden weight loss or gain
- low self-esteem and self-blame
- drinking or taking drugs
Talk to someone:
Case studies have shown that talking to someone is the first step towards recovery and feeling better for many young people. While it might be a conversation in the middle of a busy day for a teacher, it might have taken days, weeks or even months of planning for a young person who has been self-harming and will have taken huge strength and courage.
Again and again, in all sorts of surveys and studies, young people say one of the most important things to them is being listened to. Whilst there is a need to secure professional help for a young person who is self-harming, accepting the responsibility of listening is crucial to building a bridge for them towards that help.
Try to ensure the conversation is focused on the underlying thoughts and feelings why the young person self-harms rather than how or where they are self-harming. Many young people will have little visible signs of self-harming but will need to be believed. Try not to react shocked or disgusted even though you might not understand what they are going through or why they do it but remind them you are there for them regardless and they can get better.
Finding new ways to cope:
In advance of professional help, supporting young people to recognise when they self-harm and developing distraction techniques to ‘ride the wave’ of emotions can help them to overcome the urge to self-harm.
These can include techniques such as:
- Get them to write down distressing thoughts and feelings, crumple up the page and throw it away
- Tell them to scream into a pillow
- Be understanding and listen
- Help them to discover the triggers
- Show you trust them and don't pass judgement
- Only tell those who you can trust.
Speak to a professional:
Professional help for young people who are self-harming can include therapy, counselling, cognitive behavioural therapy (CBT) which focusses on building coping strategies and problem-solving skills, and psychodynamic therapy, which helps with identifying the problems that are causing the distress and leading to self-harm. The young person’s GP or other trusted health professional are the usual gatekeepers to such treatment.
For further professional information and support visit:
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