Self-Harm & Suicide IT S OKAY TO TALK ABOUT IT. 1
Self- Care for Today Our topic is sensitive and at times may feel uncomfortable. Please take care of yourself and feel free to step out of the room, take a break, grab a drink, etc. as needed to care for your needs. 2
Outline of Presentation Introduction Definition of Self-harm Links between Self-harm & Suicide Incidence, Prevalence- Adolescents/Adults Self-Harm Behaviours Reasons for Self-Harm, Myths about Self-Harm. Assessment of Self-harm Risk Warning signs Observation, what to look for Communication, questions to ask Intervention & Harm Reduction Self-Management Tools/Promoting Resilience Harm Reduction Approach Video- Hurting to Heal (Lora s Story) Q&A Take Home Messages Resources 3
Definitions of Self-Harm & Self Injury Self harm: is a continuum of damaging behaviours that include socially acceptable behaviours with; nail biting at one end and self damage at the other, e.g. abusing alcohol/drugs, eating disorders, risk-taking, Self- Injury: is deliberate self-inflicted harm resulting in tissue damage without the conscious intent of suicide, but as a way of managing emotions (positive and negative) that seem too painful for words to express. Behaviors include (but are not limited to): Cutting, scratching Burning Interfering with the healing of wounds Hitting or biting oneself Head banging Hair pulling 4
Self-Harm Behaviours. 5
Self-harm & Suicide Not about wanting to die Self-harm and suicide lie on a continuum Socially acceptable self-harm self-harm Suicide 6
Links Between Self Harm & Suicide. Those who self-harm want to live but they feel the only way to remain in control, sane, intact, etc, is to self-harm. This does not mean that suicidal ideation does not exist, but shouldn t be assumed just because of the self-harm behavior. 7
Self-Injury What and Why? Causing deliberate Harm to oneself Not a suicide attempt A maladaptive coping mechanism Temporary Relief- Underlying Cause not addressed. 8
Negative emotions Cycle of Self Harm Tension Self harm act Positive effects ( endorphins and tension released) Negative effects 9
Incidence and Prevalence Varying statistics The highest rates of self-harm behaviour in Europe are found in the UK (Bowen & John, 2001; Lowestein, 2009) 4% in the general population = numbers of males and females (though more females present for treatment) Typical onset: puberty though can be seen in young children(7yrs) and adults (17+) Often lasts 5-10 years Can lasts day weeks months years without treatment. Self-harm is cyclical in nature (used for periods of time). 10
Who Self-harms? Anyone at any age can self-harm, behaviour is not limited by gender, race, education, age, socioeconomics, sexual orientation or religion. People who are at greatest risk include: Demographic Youth Female sex Sexual minorities Social and Family Environment Adverse childhood environment and experiences Interpersonal difficulties in adolescence Adverse life events Social Isolation Psychological Factors/Situational factors Mental health disorder (Depression, bipolar disorder) Impulsivity, poor problem-solving Vulnerable groups at risk include: young people, LGBT community; youth sub-cultures who self-harm, children and young people who have experienced domestic violence/physical, emotional or sexual childhood abuse. 11
Myths and Stereotypes Self harm is manipulative? It is a form of revenge? It s attention seeking? It s a cultish teenage behaviour? It s a failed suicide attempt and the person should be placed on suicide watch/in hospital? Evidence of a borderline personality disorder/other mental health illness. Self-decoration is self-injury Evidence of physically or sexually abuse Self-injuring adolescents have borderline personality disorder 12
Warning signs Spending more time in the bathroom Unexplained cuts or bruises Wearing long sleeves or trousers-especially if this is a change from normal behaviour Razor blades, scissors, knives etc have disappeared Unexplained smell of dettol, tcp etc Plasters disappearing Art and writing displaying themes of pain, sadness, physical harm Changes in social interactions or interests Low mood-seems depressed/anxious/rage/fear 13
Assessing the Risk Show willingness to talk about self-harm, wounds and first aid. Denote some awareness about the reasons behind selfharm. Be non-judgemental Validate the service users experiences, emotions and feelings. Go at their pace. Explain confidentiality procedures including who you will discuss confidential material and where. Explain in which circumstances you may have to break confidentiality and what would happen. Work on assessing the risk around self-harm and/or suicide with the service user. Make sure that crisis plans are up to date. 14
Responding effectively to people who self-harm Be honest about the feelings and issues self harm raises for you and make sure you have good support to be able to off load the issues Show concern for injuries Balance confidence and curiosity. Let the young person teach you about their experience. Be open and make time to listen Empower person to make own decisions Be calm and patient Do not worry about saying the wrong thing-just letting them know that you are there for them to talk to is enough. Copyright Carol-Ann (c) Chapman-Gibb Mind s Well 2015 2016 15
SELF- HARM: Interventions/Harm Reduction. Safe self-harm Risk assessment Wound care Implements, safe self-harm Emotional resilience What is the person trying to manage Working on overwhelming emotions and how to express them in a safe way Working with the urge Distraction techniques 16
SELF-MANAGEMENT TOOLS Diaries, journals, dream boards. Exercise and healthy eating Emotional release Learning new coping skills, engage in arts or creative outcomes. Reducing impulsivity. Self-education Personal growth and goal setting Person centered planning tools PATH (Planning Alternative Tomorrows with Hope) Circles of support 17
Alternatives to Self Harm Self harm websites usually have lots of ideas about alternatives to self harm. These include: Clenching ice cubes ( make them with fake blood) Draw red lines on your skin Elastic bands on wrist Harmless pain eating a chilli IMPORTANT TO RECOGNISE THAT PERSON MAY REQUIRE DIFFERENT COPING STRATEGIES IN PLACE FOR DIFFERENT TIMES OF THE DAY/NIGHT. 18
Areas to pay special attention Responding to emotional states Recognise and name feelings Interpersonal effectiveness and relationships Developing problem solving skills 19
Safe plan Safe plans will include: Telephone numbers of people the person can talk to. Examples of times when they felt similar and they did not self-harm What strategies worked for them and why? Safe places in the house Self-nurturing activities such as having a bath. 20
What you always wanted to Know about Self-Harm Lora s Story Hurting to Heal 21
Questions & Answers. Always ask about NSSI Therapeutic Refer out Teach coping Watch for infection Be aware of your own bias! 22
Take home message Many similar risk factors for self-harm and suicide BUT - Risk factors are not causes, someone can have all the risk factors and still not do the behaviour Self Harm is not the Problem, but the solution. IT IS A COPING MECHANISM. The function of self-harm is not one-dimensional and can serve many functions for someone. Understanding the individual and their unique experience is most important. Please provide me with your email address if you would like a copy of the PowerPoint for this presentation.
Resources Provided by HelpGuide.org General information about cutting and self-injury (http://www.selfinjury.org/docs/factsht.html) (http://harm.me.uk/) About Self-Harm: Why You Self-Harm and How to Seek Help Get the facts about cutting and self-injury. Learn what purpose it serves and how you can overcome it. (Mind) The Truth About Self-Harm (PDF) In-depth guide for young people and their friends and families. Includes tips for talking about it and strategies for stopping self-harm. (Mental Health Foundation) Cutting Article written for teens explains what cutting is, why people do it, how it starts, and where to go for help. (TeensHealth, Nemours Foundation) Self-Harm Introduction to self-harm, including what makes people do it, danger signs, treatment, and things you can do to help yourself. (Royal College of Psychiatrists) Self-Harm and Trauma: Research Findings Learn about the relationship between self-harm and childhood trauma and abuse. (U.S. Department of Veterans Affairs) 24
References. Whitlock J. (2010). What is self-injury. Cornell Research Program on Self-Injurious Behaviours in Adolescents and Young adults. Towards a Mentally Flourishing Scotland, 2009-11, Scottish Government Publication. National Institute for Clinical Excellence (NICE), Guidelines for Self-Harm (2004). www.nice.org.uk https://www.ncbi.nlm.nih.gov/pubmed/1462 6459 25