Understanding what to do if students self-harm

Issue: Volume 97, Number 18

Reference #: 1H9mTT

Self-harm is the direct, deliberate act of hurting or injuring your body, without necessarily wanting to die. Teachers and school staff can support students who are self-harming by understanding and learning about possible steps to prevent or reduce its occurrence.

Self-harm (also referred to as non-suicidal self-injury, or NSSI) amongst students is not uncommon. While some young people may only self-harm once, others repeat the behaviour to cope with intense, difficult or overwhelming emotions, situations and life events.

So what exactly is self-harm? Common ways of self-harming include:

  • cutting skin on wrists, arms or legs
  • biting and scratching at skin
  • head banging and punching self
  • burning of skin
  • hair or eyelash pulling
  • taking overdoses of drugs or medication
  • taking poisonous substances
  • inhalation of harmful substances.

How common is self-harming behaviour amongst young people?

Victoria University of Wellington research shows that 20–25 per cent of young people between the ages of 12–15 engage in self-harm.

Victoria University Professor of Psychology Marc Wilson says this figure increases for older students, with their research suggesting almost half of young people aged 16–18 had hurt themselves at least once.

“That’s a higher prevalence than you find in most parts of the world. International reviews suggest that between 15 and 18 per cent of young people say they’ve hurt themselves at least once, so there’s reason to think that this is a fairly common part of the lives of our young people.”

What leads a young person to self-harm?

Self-harm is not necessarily an indication of mental illness, Marc says, but is usually used as a way to manage negative emotions.

“We typically think of self-harm as serving a function; it’s something that people do as a symptom of something else,“ he says.

“For example, if you get bullied you might feel sad, ashamed and angry. If you don’t have a good set of emotional tools to deal with that, then one of the ways you might seek to avoid those emotions is to hurt yourself.

“We’re really well designed to avoid pain so we pay attention to it. What happens is if you’re feeling sad or angry and you hurt yourself, you’re no longer worried about feeling sad or angry because you’re dealing with the [physical] pain.”

How do you know if someone is self-harming?

Most self-harm is private. Others become aware of self-harming behaviour either when it is discovered (for example, seeing cuts on a person’s body) or when the young person confides in someone.

“There is also a grey area in between, where people don’t necessarily have the words to go to someone and say, ‘Look, I need help, I’m hurting myself’ so instead they may not cover their scars, for example, and wait for people to say, ‘Hey, what’s going on?’” says Marc.

International experts on self-harm encourage teachers, pastoral care workers and parents to look out for the indications of self-harm, which are similar to those of depression and anxiety.

“Has a young person’s behaviour changed recently? Are they more withdrawn than they may have been previously? Are they spending more time on their own? From a parental point of view, are they shutting themselves away in their rooms more? Are they wearing clothes that obscure parts of their body that may be seasonally inappropriate, like long sleeves in summer? Are they showing a preoccupation with media or stories or fiction that may have a theme around self-harm?” says Marc.

“That’s not to assume that that is always going to be an indication that they’re hurting themselves. It could be an indication of something else and it could be an indication of something completely innocuous, but we would advocate that it’s always better to ask the question.”

How can we support young people who self-harm?

 Discuss a self-harm protocol

“Schools may not have protocol and therefore deal with it on an ad hoc basis, so they may not have a systematic approach to it,” says Marc.

“Or, they bring it under their suicide protocol – I think there are lots of good things about that because I think it’s really important that you should take self-harm seriously. But the problem with treating it like a suicide attempt is you might be over dramatising or ‘freaking out’ from the point of view of the young person.”

Marc’s team has worked with international researchers to better understand what these self-harm protocol discussions might look like.

“Even if a school ultimately decides that they don’t want to have a protocol, it’s a really useful discussion to have.

“Schools should identify the roles and responsibilities of different staff because you don’t necessarily want to have everybody as a first responder, but you do want to make sure you have some people who are the right people, who have the right knowledge and skill.”

Conduct a risk assessment

Following an incident of self-harm, schools should conduct a risk assessment to determine why the young person is self-injuring, whether they have suicidal intent, and what response is needed.

“On the one hand we know that suicidal and non-suicidal behaviours are different, but we also know that they are importantly related. So you can’t assume that just because someone’s cut their arm that it was a suicide attempt, but you also shouldn’t assume that it doesn’t mean that person is not very distressed,” says Marc.

“A risk assessment needs to be done by a mental health professional or someone in the school environment who has the skills and training to work with youth who self-injure, both upon initial discovery of self-harm and on an ongoing basis.” 

Manage your reaction

Whether a young person intends to suicide or not, self-harming expresses strong emotional distress and the need for support. Ask them if they would like to talk about what is going on for them, and be patient if they do not want to open up straight away.

“We know that first response is really important. The way that someone responds to a disclosure of self-injury is really key to whether or not people ever go back to ask for help.”

It is important not to overreact as this can make a person feel ashamed or frightened that there may be something wrong with them. Being overly concerned can also provide positive reinforcement for the self-injuring behaviour.

“Sometimes people can hurt themselves because they don’t feel like they’ve got anyone in their lives, so if someone responds by being excessively compassionate that can be really reinforcing and actually they might hurt themselves in order to get that reaction again,” says Marc.

“[Self-harm expert] Barent Walsh says the way to respond is a kind of dispassionate, engaged, curiosity – so basically you find a nice middle ground,” he says.

“You want to show empathy and one of the sorts of ways to do this is for people to say, ‘It seems to me that you must be in a fairly unhappy place’ and that validates people’s experiences without saying they should carry on doing this. The curiosity element is, ‘I’d like to understand what’s going on for you, tell me about it?’.

“Ask the young person what typically happens before and after they hurt themselves, if they care for their wounds, and if so, how? Questions such as these can help keep the focus on the functional aspect of self-harm and understanding the root causes, rather than focusing on the fact of the injury itself.”

Request skilled help if needed

Research shows that people who feel they do not know enough about self-injury tend to be much more negative towards people who do self-harm.

“We would always advocate that people should not overstep the boundaries of their competence,” says Marc.

“By that I mean schools typically have people who are really well positioned to help a young person once there’s been a disclosure, but not everybody is in that position. It’s important to try and make sure that young person then gets the help of someone who does have those skills.”

Another important consideration for schools is whether or not they notify parents immediately when a young person has hurt themselves.

“With people under 16, parents are the people who are the guardians of those young people. Schools and guidance counsellors might feel a responsibility to inform them, but at the same time, that might compromise the rapport or the trust between the student and the teacher or guidance worker.

“Sometimes the sources of the negative emotions that young people are seeking to avoid through self-injury originate from the home … so it’s important sometimes the school ascertains what the role of the home environment potentially is in this.”

What is the impact of self-harm on other students?

The impact of self-injury on other students in the school should also be considered. It is important to support the friends and peers of students who self-harm.

Whilst there is a reasonable concern about contagion amongst peers, there is little evidence to suggest that talking about self-harm makes people hurt themselves when they otherwise would not have, says Marc.

School communications about self-harm should be handled with care and focus on the larger context of coping behaviours. Peer communication around self-harm should be guided but not banned, he says.

“We know that often adults avoid exactly the same sorts of things, but they do it differently from  young people. Focus on positive coping behaviours,  as well as unhealthy coping behaviours, as a broad family.”

Positive coping behaviours include talking to friends, taking a shower or a bath, listening to music, going for a walk, doing something creative, playing with a pet, or dropping a deck of cards and picking them up in order. Alternative activities such as these can all help to “surf the urge”.

“And just as the best practice guidelines around reporting suicide say, we would generally avoid discussion of how someone has self-harmed, for a bunch of reasons, one of which is that they can be triggering for people with a history of self-harm.” 

Resources available

The Mental Health Foundation(external link) has information for those self-harming and for people supporting someone who is self-harming. 

The Ministry’s Pastoral Care Guidelines – Te Pakiaka Tangata Strengthening Student Wellbeing for Success – help secondary schools and wharekura discuss the roles, expectations and legal requirements of families/whānau teachers, deans, guidance counsellors, school trustees and principals, in the provision of pastoral care.

For further information and resources about self-harm(external link).

BY Education Gazette editors
Education Gazette | Tukutuku Kōrero, reporter@edgazette.govt.nz

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