I feel like I m invisible Children talking to ChildLine about self-harm Submission to the National Inquiry into Self-harm among Young People Camelot Foundation/Mental Health Foundation Pamela Dow June 2004 1
Children talking to ChildLine about self-harm I cut myself when I m angry, it hurts but it helps my anger. The thoughts are in my head every day, I can t take it. Cutting myself is the only way I can deal with him being around. Cutting takes my mind off things, when I m unhappy about myself, the way I am. 1. Introduction 1.1 This paper forms ChildLine s response to Young People and Self-Harm, an 18 month inquiry being conducted by the Mental Health Foundation and the Camelot Foundation 1. The Inquiry aims to research all aspects of self-harming, to connect research and practice, educate and raise awareness, and make policy recommendations. ChildLine s findings are based on an analysis of children calling the helpline between April 2002 and March 2003, who disclosed self-harm to their counsellor. 2. About ChildLine 2.1 ChildLine provides a free, confidential, 24-hour telephone helpline for any child or young person with any problem. Children in distress may speak to a counsellor once, a few, or many times, to receive both immediate support and advice, or more substantive counselling over a period of months or even years. 2.2 ChildLine talks with children and young people about the concerns in their lives, some of which may provoke them to consider drastic actions such as suicide or running away. ChildLine assists children in escaping from immediate danger and facilitates them in looking to longer-term solutions to their problems. ChildLine links callers to other agencies, including social services and mental health services, and will work alongside other professionals in continuing to support a caller through often difficult processes of investigations, treatment or court hearings. 2.3 A schools programme, ChildLine in Partnership with Schools, CHIPS, was launched in 1998 to enable young people to play a bigger part in ChildLine s work and for them to establish their own projects within their schools to help each other for example anti-bullying and peer support schemes. CHIPS complements the helpline by offering direct work in schools on the issues that young people ring about. It provides a range of 1 Self Harm Inquiry, Camelot Foundation, 11-13 Lower Grosvenor Place, London, SW1W 0EX www.selfharmuk.org. Inquiry Chair, Catherine McLoughlin CBE, Inquiry Project Manager, Dr Marcia Brophy 2
services from workshops, conferences, and seminars to training in the skills and knowledge young people need to keep themselves safe and tackle problems. 2.4 One of the explicit aims of ChildLine is to make sure that the issues children bring to our attention reach the adults who can make a difference in their lives, including parents and carers, professionals and government. Campaigning and research is also vital, based on the assumption that changes in public awareness and attitudes change parental behaviour, social policy provision, and reduce the culture of silence that keeps child victims quiet. 3. Definitions and data 3.1 The content of ChildLine counselling conversations is captured through written records. Every time a trained counsellor speaks to a child, they note the main problem, any other concerns raised, any details of family and living circumstances revealed by the child, and a narrative of the discussion. Conversations are child-led, and not conducted for the purpose of collecting research information; nevertheless they reveal information that formal research might not uncover. 3.2 ChildLine counsellors use the following definition to identify self-harm: Self-harm is cutting, overdosing, or intention to injure without obvious intention to commit suicide. This is compatible with the Inquiry, which has restricted its remit to study self-harm as a range of things that people do to themselves in a deliberate and usually hidden way, which are damaging, excluding other forms of self abuse. Other definitions of selfharm are wider, to include risk behaviour such as substance misuse and eating disorders. It is interesting to note that many of the same themes that emerge in calls where self-harm is disclosed are also present where an eating disorder is the young person s concern, or another form of self abuse. However, for the purposes of this paper we have restricted ourselves to the narrower definition. 4. Main helpline figures 4.1 ChildLine counselled around 120,000 children and young people during 2002/03. For 1,122 (1%), concern about deliberate self-harming was the main reason for making the call. A further 2% (2,223: 1998 girls, 225 boys) disclosed self-harm to the counsellor, though this was not the reason why they had called ChildLine. In total therefore, 3,345 (3,032 girls, 313 boys) children and young people talked to ChildLine last year about selfharming. 4.2 Eighty per cent of these children talked about other problems in their lives. Forty per cent talked about tensions within their family for example separation or divorce, or maltreatment - and14% said they were experiencing symptoms of depression or had other mental health 3
problems. Twelve per cent of the children who called were being bullied at school. 4.3 ChildLine also receives calls from children and adults who are concerned about a young person they know. In 2002/03 nearly 800 people (children and adults) contacted ChildLine because they were worried about a child they suspected or knew to be self-harming. The majority (737, 93%) were calling out of concern for a girl only 52 (7%) were concerned about a boy. Of these callers, 637 of were children calling about their friends, 597 girls and 40 boys. 4.4 The number of children disclosing self-harm to ChildLine s counsellors has increased steadily over the last ten years, dramatically increasing by around 65% in the last two years. It is important to remember that this figure does not necessarily equate to a rise in incidences of self-harm. There are many other possible contributing factors, such as increased recognition of the problem and self-diagnosis by young people, or better identification by ChildLine counsellors. Preliminary figures for this year (2003/04) show a less significant increase that is in line with the increase in children counselled across all problem types. 4.5 The total number of children counselled has increased by an average 5% per year, over a ten-year period. Where self-harm is the main concern the average increase per year is 23%. Gender 4.6 Across all problems, ChildLine normally hears from four times as many girls as boys this ratio is relatively unchanged throughout ChildLine s existence. However, the gender ratio shifts considerably when self-harm is disclosed: 12 times as many girls than boys are counselled about selfharm. 4.7 Furthermore, fifteen times as many girls than boys call out of concern for someone else and 20 times as many girls will have spoken with a friend about their self-harm prior to calling ChildLine. Boys appear either not to self-harm as prevalently as girls, or be more reluctant to seek help, or a combination of the two. It should also be clear to those providing face-toface services, and to those working with boys and young men, that those boys who do self-harm are harder to reach. Age 4.8 Across all problem types the age breakdown approximates a normal distribution curve: while around 30% of children did not disclose their age to their counsellor, of those that give an age nearly a quarter were 5-11 years old, just over 60% were 12-15 years old, and the remaining 17% were 16-18 years old. 4
4.9 Around a quarter of children who talked about self-harming did not give their age, but children who self-harm (where it is a main concern) are typically older. Only 2% of children who gave their age were between 5-11 years old, whereas those aged 16-18 years were more likely to disclose self-harm (16%). Sixty-two per cent were aged 12-15 years old in line with the national figure for all problem types. 4.10 Nearly 50% of girls were aged 14 or 15; nearly 50% of boys were aged 15 or 16. Age breakdown of children counselled about self-harm (where age given) Age Girls %* Boys %* All %* (Across all problems) 5 11 years 28 4 1 1 29 3 25% 12-15 years old 564 71 38 56 602 70 60% 16-18 years old 198 25 29 43 227 26 17% Total who gave their age 790 68 627 71% * Percentage of the total number of children who gave their age 5. How children and young people self harm 5.1 Cutting is the most common form of self-harm disclosed by young people calling ChildLine. Sixty-two per cent of children counselled about self-harm told counsellors that they had cut themselves. They also talk about harming their bodies in other ways that include deliberate bruising, banging their heads against a wall, pulling out their hair, burning, falling over, and in at least one instance purposefully breaking a limb. 5.2 Twenty per cent of the children and young people counselled said they had been self-harming for up to one year, for 14% it was an ongoing problem, and 12% said they had been self-harming for between one and five years. 5.3 Nearly half of the callers (44%) disclosed that they had spoken with someone prior to contacting ChildLine. Sixteen per cent (176: 168 girls, 8 boys) said they had turned to a friend for support and comfort, but they also found comfort talking to their mums, a teacher, or a counsellor or doctor. Compared to ChildLine s national figures (inclusive of all problem types) children calling about self-harm are more likely to have spoken with someone prior to contacting ChildLine, and they are more likely to speak to their friends than anyone else. This has implications for targeting services aimed at helping those who self-harm, particularly the importance of training for young people, and peer support programmes. 5
6. What children and young people tell ChildLine A female caller told her counsellor that her parents had gone through a messy divorce that resulted in her dad walking out of her life. She hadn t got on with her mother since, and they were constantly fighting. She starting cutting her wrists a few months before and each time the cuts were deeper. She didn t want to create any more arguments because she felt there was enough of that in her family. 6.1 The feelings expressed by the young people calling ChildLine about selfharm obviously differ according to the individual circumstances of the caller, but two main themes emerge. Callers often disclose anger and frustration at their situation, with self-harm providing their only outlet for this emotion. As with other mental health problems (eating disorders, depression, and suicidal thoughts e.g.) children who self-harm also talk about a loss of control over their lives, and by inflicting injury and pain on their bodies they gain a sense of control and personal ownership. 6.2 One female caller had been staying at an adolescent unit. After leaving the unit she took 42 paracetamol tablets and was admitted to hospital. She told her counsellor that she regularly self-harms by cutting herself. She talked about feeling like a fool: I can't take responsibility for myself. She felt she was in control when she cut herself. 6.3 Another girl had been hurting her wrists since May. She cut herself about once a week, when she was upset about things, arguments with friends or parents. She called ChildLine because she wanted to stop but feels in control when she cuts her wrists. 6.4 Linked to the release of repressed emotions and anger, and to the need to exert control, are feelings of exhilaration at inflicting injury upon themselves. One girl, who told her counsellor she had a good relationship with her parents but didn t want to speak to them about cutting herself, said that she did it if she had a bad day at school it feels good. Another girl who had been cutting herself for five months said it felt good while she was doing it but then it hurt. 6.5 Callers often disclose a trigger or circumstance that led them to begin self-harming. In some cases this is prompted by bullying, or other incidences connected to education or schooling, such as being kicked off the YT class, for example. Many triggers are connected to another important factor in a young person s life family relationships. One boy called because his parents were putting so much pressure on him to do 6
well. The first time he cut himself was after a row: they made me feel little, useless and depressed. A female caller said that her parents constant arguing was making her so anxious she kept cutting her arms and legs. 6.6 Some experiences demonstrate that more research need to be done into whether self-harm should automatically be equated with suicidal feelings. A number of callers disclosed that they began self-harming after a crisis in their lives. One young person s father had died the year before and since his death she had experienced panic attacks that resulted in her cutting her arms. The girl told her counsellor that her mum knew, and was worried that she would try to take her own life, but she insisted that the cutting was a way of coping with her grief. 6.7 One caller had been sexually abused by her older brother when she was younger. The abuse stopped when her brother moved out, but he had recently divorced and moved back home. Her brother threatened her to keep quiet, but the thoughts are in my head every day, I can t take it. Cutting myself is the only way to forget. Self-harm in this context can be compared to other risk behaviour that begins when a young person is sexually abused, such as alcohol or drug misuse, or offending. One caller told his counsellor that the cutting relieved much of his doubt, anger and frustration, but that he did feel guilty about harming himself. 7. How does ChildLine help? 7.1 Though our recording and identification systems are clear in distinguishing between calls from children who are suicidal or have attempted suicide and those who self-harm, every call in which a child discloses self-harm is treated as a child protection issue. This means that the counsellor indicates the issue to a supervisor, who supports them through the call and counselling process. The team makes a risk assessment of the individual situation the child describes, and decides whether or not confidentiality needs to be broken and emergency agencies contacted. 7.2 The confidential nature of ChildLine's service is key. If the young person does not feel 'safe' then they will not disclose their actions or feelings. That the counsellor is accepting and not judgmental, and that there will be no immediate repercussions, are all also fundamental to the disclosure process. As is the case in all calls to the helpline, the young person is in control of the service they receive. 7.3 The counsellor will explore how and when the caller self-harms, to try to identify how they feel before, during and after. In this way the reasons why the young person might be self-harming are often exposed. Alternatives to self-harm are also explored, though the caller has to accept the alternative, if not suggest it themselves. If not, whatever action is suggested will not represent an alternative for them. 7
7.4 Finally, the counsellor will suggest that the next time the young person feels like self-harming they should ring ChildLine. The benefits of a 24- hour, direct access, service are evident. As indicated before, many young people who ring ChildLine are in touch with another helping agency but the limited access and provision of services are not fulfilling their needs. 8. What can we do? 8.1 The children and young people who contact ChildLine often talk about finding it difficult to stop, and wanting to understand more about why they do this to themselves. In some cases the caller clearly needed targeted face-to-face mental health services. Many young people who call have already accessed helping agencies or services of some sort, but these were not working. For example, a female caller asked ChildLine what she should do to stop herself cutting her arms. She used to bang her knees with heavy books when she was little but since last year she had been cutting herself. She d also been taking Prozac but felt it was not working. 8.2 Another lesson for practitioners is that self-harm can be triggered be external circumstances, and therefore that some young people are more at risk than others are. A female caller said that cutting herself was the only way she could release her unhappiness when being bullied. She had tried telling her teachers but the bullying continued. 8.3 The importance of training for adults, particularly professionals, can also be demonstrated by our data: nearly half of callers had told someone else before ringing ChildLine, including teachers, counsellors and doctors. Parents should also be able to access training and advice, to make them more aware of the reasons why their child might self-harm. One aim of the Inquiry should be to try and break down the stigma attached to young people who might self-harm. As the statistics show, many callers had told their mum before, but others spoke of not wanting to worry their parents by disclosing the activity. 8.4 As ever, the experiences of the young people calling about self-harm emphasise the need for better-resourced services. One caller had told the school nurse, who referred her to a counsellor whom she saw once. She was having trouble setting up another appointment. With this problem in particular, direct access to local child and adolescent mental health services for children and young people is paramount. Young people are always reluctant to access help if it requires referral through another agency, or awareness of a parent or carer, and those who self-harm are particularly anxious not to be labelled. 8.5 Finally, that children calling about self-harm are more likely to speak to their friends than anyone else suggests a role for peer support programmes in schools. Even if young people cannot themselves provide support for their friends who self-harm, if trained to recognise signs and approach the issue in the right way, they represent an important way for targeted services to reach out to and access those who need them most. 8
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