Self-harm

Self-harm is on the rise and is now a more common coping mechanism than alcohol and drugs. It’s saddening, complex and often difficult for us to understand. So, what is it?

Self-harm is a broad term that covers a whole range of behaviours. Some methods of harm produce signs such as scars and bruises, while others are more hidden. Self-harm is a behaviour that causes harm or injury, and is performed with that purpose in mind.

Emotions are very powerful things. They are the brain’s way of grabbing our attention and signalling that important things are going on. In times of stress and change, they can feel overwhelming and children and young people might not know good ways of coping or dealing with them. When this happens, they may try to supress or ignore these emotions, but they will gradually build up and can engulf them. When children and young people feel like there is pressure building inside them, self-harm can feel like the only thing that is able to release that pressure and prevent it from getting any worse.

Here are some of the reasons young people may begin to self-harm (this is a starting point, not an exhaustive list).

Control

Young people will often begin to use self-harm to gain some sense of control. This may be due to exam pres­sure, poor social relationships that lead to bullying and feelings of isolation, or a situation where there is family breakdown. Young people who experience parental divorce and other family issues can feel completely out of control, and this may lead to them developing harming behaviours. For some it becomes the only thing they feel able to control.

They decide how often, how deep and where on the body to cut. There is a similar thought pattern with control when it comes to eating disorders. Young people can feel so out of control that they begin to limit their eating so that they are able to control something in their lives.

If you are concerned about a child or young person self-harming, perhaps start by talking about whether they feel in control of their lives. Help them try to find places in their lives where they do have control, and encourage them to continue talking to you or someone else they trust.

How to help

It can be helpful to ask young people to write down (or document in some other way if they struggle with writing) the things they want to be in control of, but feel they can’t be. There is something about allowing the young people we work with to communicate with us without having to find words or use eye contact. Journaling can be a helpful resource for a whole host of things.

If you are working with younger children, make two jars. One labelled “Things I can control” and the other “Things I can’t”. Help them to place ideas in each jar. These can be written out by you or them.

Control is a difficult one to help young people overcome, and none of us like feeling out of control. I think the best way we can help is to ensure that children and young people have the tools they need to articulate their thoughts when they are feeling out of control.

Anxiety

There is ongoing research into the links between anxiety and self-harm. In this instance, we’re not talking about the low-to-medium level anxiety we can all feel from time to time, but the ongoing fight-or-flight feelings so many young people feel, which are debilitating and difficult to manage. Many young people who post on the SelfharmUK forum talk about uncontrollable anxious feelings that stop them from engaging in everyday activities and often push them to harm.

Anxiety is a normal response to some situations, but in others it can become excessive, making a child dread every­day life. Anxiety and depression are caused by the same chemical imbalance in the brain, and are simply different outworkings of it. Anxiety may be a cause for self-harm, but it’s also worth noting that your child might be struggling with other emotional difficulties. Just try to remember that continuing communication is hugely important with any diagnosis.

How to help

If you have young people who are struggling with anxiety, Youthscape’s new #Whatif? resource may help. It contains four games to help teenagers identify and cope with anxious thoughts and feelings.

Panic attacks

Many people feel totally out of control during panic attacks. They are draining and all-encompassing. These are very emotive words, but that is how overwhelming they can feel. A panic attack is real for your child or young person. It is a crushing experience, and it will take time to overcome. Self-harm may appear to be the only thing that can calm them down and allow the space they need to think and breathe; to feel able to move past the all-encompassing turmoil they are feeling, and trying to process and express.

How to help

The most important thing to remember when someone is having a panic attack is that they will feel unable to talk or explain what is happening during the attack. Panic attacks make people feel like they are going to die. Their heart will beat faster, their palms will be sweating and the last thing they will feel able to do is calm down.

As a parent, carer, youth or children’s worker, the most important thing in this moment is to flood their brain with oxygen and slow their breathing. One of the best techniques is 7:11 breathing. Encourage the panicking child to breathe in for seven seconds, hold for seven seconds and, if they are able, to breathe out for eleven seconds. This will allow the brain to flood with oxygen and give the child or young person time to properly calm down. Once this has happened you can begin to ask if they know why they became so anxious and what invoked the attack.

Depression

Depression is difficult to live with. It is very painful. As with anxiety, we all have times where we feel sad, and this may last a couple of days or a week, but depression is charac­terised by those feelings lasting for a longer period and can mean that sufferers lose all enjoyment from the things they once found exciting or fulfilling. The diagnosis of depres­sion and / or anxiety will come alongside the feelings being persistent and continuous.

Depression is hard, and people will often speak of a ‘black cloud’ that wipes out any sense of hope they once felt. Depression takes time and often medication to overcome. Remember that, if a child or young person is prescribed medication and they are self-harming, it is vitally impor­tant you keep this medicine out of their reach. They will be feeling frightened and overwhelmed, so keep conversations calm and empathetic.

How to help

Depression can be a long-term condition that means life may feel overwhelming and difficult to live with. It is important that depression is not confused with sadness. These are two very different things. We will all have times of sadness in our lives. That does not mean that we are depressed. The language we use is vitally important when we are tackling the subject of mental health. Many young people talk about being depressed when they are not. This is not appropriate and should be challenged.

The online video at youthandchildrens.work/links explains depression and some of the ways in which you can help.

Sexuality and gender dysphoria

The statistics relating to young people exploring their sexu­ality and gender who also self-harm are very concerning. Not all young people who self-harm are confused about their gender identity, but this is one reason why some young people do it. The shame some young people feel due to misunderstandings from peers or lack of knowledge in society may mean they begin to manage that pain through self-harm. It’s important to begin to try to understand these feelings so you can support them.

This is likely to be a confusing time and may result in young people feeling powerless and out of control. These feelings may also lead to times of self-loathing because of societal norms. Imagine feeling every day that you are living in the wrong body. This is an incredibly difficult process to manage, and can cause young people to turn to self-harm.

How to help

Giving children and young people space to talk through their feelings is vitally important if they are questioning or struggling with their sexuality and gender identity. A safe place without judgement is often needed for these young people. If you feel unable to provide that, it is crucial you pass this on to someone who can.

Stonewall (stonewall.org.uk) is a great charity for young people struggling with their sexuality. Mermaids (mermaid­suk.org.uk) is great for children and young people struggling with gender identity. Mermaids also has dedicated sections for parents and professionals.

Self-harm is not a mental health problem. It can be an indicator of a mental health problem, but as a standalone concern it is not. Self-harm is a coping mechanism for an unmet emotional trauma or need. Young people may exper­ience low mental health, wavering resilience and emotional difficulties for a whole number of reasons. What is import­ant is that we respond to them well and ensure they feel listened to and supported. We must be ready to think about our responses as youth and children’s workers, parents and friends. The response must be one of love and acceptance, no matter how hard that may be.

Youthscape understands the importance of equipping and resourcing those who work with and parent young people, especially around mental health. We are hosting Tenacious Parents, a training day for parents, on 17th March in Luton. There will be workshops, time to meet other parents and one-to-one consultations with the team at SelfharmUK. For more information visit youthandchil­drens.work/links. Spaces are limited, so please book soon to avoid disappointment.

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