How to spot the signs of self harm in a young person and handle the situation
Nursing students at the University of Leeds looked into the issue of self-harm as part their studies on the mental health of children and young people
Nursing students at the University of Leeds looked into the issue of self-harm as part of their studies on the mental health of children and young people
Self-harm and the issue of young people's mental health was the focus of a workshop involving children's nursing students and mental health nursing students at the University of Leeds. During the study day the students designed a poster looking at what signs to look out for, how to interact with young people experiencing self-harm and what not to do. This poster, titled Help Break the Cycle, won a competition which was judged by a young adult with experience of mental healthcare services and a retired mental health nurse.
The remit of the poster was to raise awareness of young people’s mental health issues among nurses and other healthcare professionals, who might consult with young people, but may not have the related experience or training to assess and initiate early intervention. This is is relevant to many healthcare professionals, including primary care and children’s nurses, who are not trained specifically in assessing and managing mental health disorders.
The poster that was produced by the authors features the case of 16 year old Ben, which is not his real name. He is doing his GCSEs and is worried about the upcoming exams. Ben thinks his parents are getting divorced. He has no brothers or sisters and often feels alone, although he has many friends. Ben has been self-harming to cope with his stress.
The information on the poster includes the following:
What is self-harm?
- Self-harm is the ‘intentional self-poisoning or injury, irrespective of the apparent purpose of the act’ (National Institute for Health and Care Excellence 2013).
- It can be planned, but is often impulsive.
- It is often not about ending life but expression of emotion and a way of coping with emotion and distress.
What to look for?
- Unexplained bruises, cuts, burns, scars, hair loss.
- Signs of depression for example, low mood, low self-esteem.
- Social and emotional withdrawal.
- Young people who are experiencing:
- Trauma or traumatic event for example, relationships, abuse, loss.
- Change in behaviour for example, misbehaving, irritability, aggressiveness, increase in risk-taking.
How to interact with young people experiencing self-harm
- Gain consent.
- Be empathetic.
- Be approachable.
- Be available.
- Actively listen.
- Provide person-centred care.
- Maintain a safe environment.
- Liaise appropriately.
- Use positive verbal and non-verbal body language.
Adolescence is a turbulent period of life where many biological, psychological and social changes take place and self-harm is often an expression of complex internal emotions that are easier for the young person to manage than emotions (Burton et al 2014). Interventions that can break this stigma are important due to increased risk of suicide in adolescents (National Institute for Health and Care Excellence 2011).
All healthcare professionals, including primary care and children’s nurses, who do not receive comprehensive education in adolescent mental health, should feel able to respond to any intuitive feelings that may arise when caring for a young person (Burton 2014). For this group of healthcare professionals, education on appropriate skills should be provided to increase their confidence in talking to and supporting young people who struggle with self-harming. These skills include, listening, being non-judgemental, maintaining confidentiality and providing the opportunity to talk outside of the family, friend or educational setting (McAndrew and Warne 2014).
To access the poster, contact University of Leeds’s associate professor Dr Linda Miles here
- Burton M (2014) Self-harm: working with vulnerable adolescents. Practice Nursing. 25, 5, 245-251.
- Burton M, Pavord E, Williams B (2014) An Introduction to Child and Adolescent Mental Health. SAGE, London
- McAndrew S, Warne T (2014) Hearing the voices of young people who self-harm: Implications for service providers. International Journal of Mental Health Nursing. 23, 6, 570-579.
- National Institute for Health and Care Excellence (NICE) (2011) Self-Harm in Over 8s: Long-Term Management. NICE, London.
- National Institute for Health and Care Excellence (2013) Self-Harm. NICE, London.
About the authors
Grace Daniels and Madeline Devine are mental health nursing students at the University of Leeds.
Amy Smith, Jessica Seaton and Hannah Vangundy are children’s nursing student at the University of Leeds.
Written on behalf of the RCN’s Research in Child Health community.