Hilary Cowdock Francesca Keynton Based on a presentation by Dr Tina Rae

Transcription

1 Hilary Cowdock Francesca Keynton Based on a presentation by Dr Tina Rae

2 What is deliberate self-harm? the act of deliberately causing harm to oneself either by causing a physical injury, by putting oneself in dangerous situations and/or self neglect intentional self poisoning or injury, irrespective of the apparent purpose of the act (NICE, 2004)

3 QUICK QUIZ True / False People who self-harm are attention seeking People who self-harm use it as a way of releasing pressure and feelings It is easy to stop selfharming People who self-harm are usually feeling suicidal People who self-harm typically hide it from others Self-harm is a failed suicide attempt Self-harm is a cry for help Self-harm is more common among girls than boys

4 Young Minds: Talking Self-Harm report 2,461 online interviews were conducted in August ,002 young people (aged between 14 and 24) 265 secondary teachers 994 parents of children between 11 and GPs

5 Self-harm among young people is the number one issue that young people themselves are concerned about among their peers, in a list that includes gangs, bullying, drug use and binge drinking

6 The Facts FACT 1: The rise in hospital admissions shows rates of self harm are going up FACT 2: The most common form is cutting, followed by overdosing, burning and strangulation FACT 3: Anonymous surveys show 1 in 10 young people have tried to hurt themselves at some point FACT 4: Most common reasons are family difficulties followed by body image and work or school pressure FACT 5: Most young people who self harm say they do it to cope with their emotions, not as a plea for help or a failed suicide attempt

7 So? Why is this issue not openly discussed?

8 Self-harm is the issue that all groups feel least comfortable approaching with young people Two in three teachers, parents and young people think that they would say the wrong thing if someone turned to them

9 What are the feelings that lead people to self harm? Feeling desperate about a problem and don t know where to turn for help. They feel trapped and helpless Feelings of anger or tension that get bottled up inside, until they feel like exploding Feelings of guilt or shame which are unbearable Self harm can make them feel more in control. Self harm helps relieve the tension they feel Self harm is a way or punishing oneself

10 Why do people self-harm? Paradoxically, the purpose of some acts of self-harm is to preserve life Parents and professionals sometimes find this a difficult concept to understand

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12 First and foremost, try to remain calm (even if you don t feel calm) If his or her wounds are fairly minor, provide basic appropriate first aid, and a dose of tender love and care

13 Try to be accepting and open-minded. Provide an ear to listen, a shoulder to cry on, a hand to hold, and focus on the person not the self-harm behaviour The reaction a young person receives when they disclose their selfharm can have a critical influence on whether they go on to access supportive services Young people who selfharm can find it very hard to talk about what has happened and are often afraid of how people will react

14 Talk to them when they feel like self-harming. Try to understand their feelings, and then move the conversation onto other things Take some of the mystery out of self-harm by helping them find out about selfharm perhaps by using the internet or the local library Offer to assist them in seeking professional help; e.g., GP, counsellor but avoid taking control many young people who self-harm struggle with control issues Help them to think about their self-harm not as a shameful secret, but as a problem to be sorted out

15 Assure them that it s okay to talk about their need to self-harm, and reassure them that they have your support even if you don t understand why they are doing it or what they are going through Any indication of a negative emotion or being judgemental is likely to aggravate the situation

16 Emotional Awareness and Resilience Learning to cope better with the emotions associated with self-harm can help reduce/stop it Talk about the emotional states that can lead to selfharm and increase coping and resilience Resilience is the happy knack of being able to bungee jump through the pitfalls of life

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18 Try to be their therapist therapy is complicated and you have enough to deal with as their parent, relative or carer Expect them to stop overnight it's difficult and takes time and effort React strongly, with anger, hurt, or upset - this is likely to make them feel worse. Talk honestly about the effect it has on you, but do this calmly and in a way that shows how much you care for them

19 Try not to take it as a personal affront if the young person says they cannot talk to you about it Avoid giving ultimatums; e.g., stop or else... as they rarely work, and may escalate the situation It is important that the decision to stop comes from the person themselves

20 Struggle with them when they are about to selfharm it's better to walk away and to suggest they come and talk about it rather than do it Make them promise not to do it again Say that you won't talk to them unless they stop selfharming

21 Summary: There is no right or wrong way to respond.and this is what makes it hard for us!!!! DON T: Ignore it, get angry, stop talking to them or demand that they stop DO: ask them how they re feeling, let them know you ll be there for them, talk when they are ready to talk, help them get professional help

22 Need to develop preventative strategies Healthy lifestyle Relaxation Assertiveness Effective thinking Time management Enhancing study skills

23 Effective Thinking Challenging negative beliefs: When I make a mistake it is terrible, catastrophic, disastrous If someone gets upset when I say something to them, then it is all my fault If someone turns down my request, they are rejecting me It is vital that everyone approves of me and what I do all the time (even if I am totally irritating and unreasonable)

24 Irrational Belief Effective Thinking I need to be a high-achiever or I am not worthwhile My past is the cause of my present problems Rational Equivalent Although I m proud of my achievements, I need to accept that I m not perfect and no-one else is either Just because past events have strongly influenced me, I do not have to be attached to them for ever, I can learn from them

25 Constructive Self Talk Calming Self-Talk Tell yourself to stay calm relax, calm down, take a deep breath, count to 10, breath slowly Tell yourself you can cope I can handle this situation. I ve got the skills to cope with this. I can solve this problem if I relax and think about it Coaching Self-Talk This might involve using a problem solving framework Right! First define an objective now think of possible solutions now choose one to implement Or reminding yourself to use new skills in tricky situations Right! She s getting angry. I must listen to what she is saying and acknowledge her feelings

26 It s all about control...??? People who believe they can exercise control do not engage in apprehensive thinking, they are not bothered by threat or challenge (Frydenberg, 1997)

27 Planning ahead helps to achieve a sense of control Imagine situation in detail 2. Prepare - seek support 3. Be aware of all possibilities and tell MIND to stay calm in each one 4. Make contingency plans e.g. make notes for your presentation! 5. Relax genuine relaxation before the event 6. Unwind reward yourself 7. Think about something positive before bed!

28 How you can help them cope with stress and anxiety..

29 Diet Relaxation Meditation Time management Physical exercise Counselling Reframing Improving social support networks Peer support groups Improved resource allocation Self-analysis

30 The power of the internet

31 Online impact One in five school children with a history of self harm questioned by researchers at Oxford and Stirling Universities said they first learnt about it after seeing or reading something online, second only to hearing about it from friends The Royal College of Psychiatrists says it is now "seriously concerned" about the growing number of websites which glamorise the problem or show gory images of cuts and scars

32 Graphic images "The kinds of things we are worried about are the graphic videos of self harm [injuries] that are posted to sites like YouTube," said Dr Margaret Murphy, chair of the College s child and adolescent section "Young people tell us that images can trigger memories and that makes them much more likely to self harm"

33 Source of image: Tumblr

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37 The impact recognised In 2010, the International Society for the Study of Selfinjury (ISSS) recognized the emergence of NSSI activity on the Internet and the importance of research in this area. Online communication about the impact of NSSI e-material has also received media attention In 2011 alone, there were over 400 news stories published globally, most of which focused on the impact this e-material may have on those who access it

38 However... The data from the Journal of the American Academy of Peadiatrics found more than 5,000 YouTube videos on self-injury, including live enactments and graphic images of cutting arms and legs with razors complete with haunting music, attracting millions of hits from viewers "Our policies try to strike the right balance between enabling people to talk honestly about the issues they have faced, but prohibiting videos that actively encourage dangerous acts. When people see content they think is inappropriate they can flag it and our staff then review it. If the content breaks our terms then we remove it and if a user repeatedly breaks the rules we disable their account"

39 What the research tells us... A mixed message The internet is anonymous which may hold particular appeal for those who experience psychological distress and other emotional difficulties many of the factors associated with NSSI risk. Many young people who self-injure go online to share their NSSI experiences and connect with others who self-injure; this can be very appealing to individuals who may not feel comfortable discussing their NSSI experiences offline. BUT some people report that they self-harm less after joining these sites

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41 Impedes help-seeking.. Many self-harm experiences disclosed online contain detailed descriptions of NSSI that emphasize emotional pain and suffering without offering any support for recovery In some cases, self-harm is discussed as not always painful and/or as an unstoppable addiction. In other cases, it may be justified or even glamorised Messages indicating that self-harm is not always painful and that little can be done to end self-harm may reinforce the behaviour

42 Reinforces and normalises.. If viewed repeatedly, self-harm videos may reinforce the notion that self-harm is a viable response to distress and one that is difficult to overcome Self-harm sites share tips and methods so that young people who self-injure may therefore be exposed to learning new ways to self-injure, how to prepare for and carry out self-harm, and how to hide this from others (e.g., friends, family)

43 What can we do? This issue will not go away and will go underground if such sites are made illegal We need to understand how this all works and the effects on young people Encourage alternative OFFLINE activities Offer helpful self-harm websites to support young people We need to let them know HOW MUCH we know and dispel the mystery...let s TALK

44 What do WE do? Contact parents/trusted adult Counsellor CAMHS Strategies Safety contract Safe place Medical room TLC