Supporting pupils who self-harm

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Many people find it difficult to understand why their pupils self-harm and this can make it hard to know how best to help them. Dr. Pooky Knightsmith outlines nine pieces of advice to help school staff support pupils.

Summary

  • School staff can have a key role in supporting pupils who self-harm.
  • Don’t let the presence of physical injuries stop you supporting a child emotionally.
  • Create an environment where the pupil can talk openly and honestly.

The issue of self-harm has grown in prominence over recent years and can be very difficult for schools to address. Theresa May’s mental health prevention plan includes support for those with responsibility for mental health in schools with a focus on self-harm. The plan also states that, from 2020, parents will get access to targeted advice on how to deal with it if they recognise the signs in their child.

For many people, self-harm is a way of coping with difficult thoughts, feelings or experiences.  Self-harm can affect people of any age, ethnicity and gender.  It is most common amongst teenage girls but they aren’t the only people affected and this assumption can sometimes lead us to miss the warning signs in other pupils.

The following points aim to give insight into how to support pupils who self-harm.

1 Have clear procedures in place

Uncertainty about what to say and do when staff suspect a pupil is self-harming can prevent them from taking appropriate action.  Avoid this by having clear procedures in place and named members of staff to whom concerns can be referred.  It’s important too that pupils know what action will be taken if they disclose self-harm or that of a friend to a member of staff.  This doesn’t need to be complicated, but it does need to be clearly communicated.

2 Many pupils will not require specialist input

Sometimes self-harm is linked to an additional need such as autism, depression or an experience of trauma and may require specialist input. However, many pupils who self-harm will be able to make good progress with a little support and input from a member of school staff. 

Staff often worry that they don’t have the expertise needed to help, but input from someone who knows the pupil well and with whom they have an established relationship with is often incredibly powerful.

“ Look beyond the injuries and see the child ”

3 Don’t dismiss minor injuries

A common misconception is that the bigger the injury, the bigger the underlying issue. This is not always the case and we should aim to enable pupils to feel heard and supported, regardless of the severity of their injuries. 

4 Look beyond the injuries

Many people who are excellent listeners and who have a great track record of supporting pupils can struggle to put this into practice when supporting a pupil who is self-harming. This may be because they feel out of their depth or distressed by the injuries or behaviour. 

The best advice I can give here is to look beyond the injuries and see the child.  Consider what you would say and do if you could not see the physical injuries but could tell the child was hurting. Don’t let injuries stop you doing what you do well.

5 Be unafraid to talk directly to a child about their injuries and build bridges

Being unafraid to talk directly about self-harm and to check that injuries are not infected and are healing well can help to build the relationship between child and adult.  Many people can be squeamish or skirt about the subject but it can be beneficial to treat injuries matter-of-factly.  The best advice here is to treat self-harm injuries as you would any other injury – this will often mean referring them on to your first aider or school nurse. 

6  First aid first

Pupils who regularly self-harm should also be taught how to care for their injuries and how to recognise signs of infection or shock.  Many people worry that this will condone or encourage self-harm but, in fact, this is about safeguarding a child’s well-being whilst we work towards a healthier way of coping.  Again, a school nurse or first aider is a great person to involve here.

7 Be inquisitive

Understanding what need self-harm is meeting is the first step to supporting a pupil to change this behaviour.   The best way to begin to understand this and to help a pupil to better understand themselves is to ask ‘Why?’ 

Creating an environment where a pupil can talk openly and honestly about their experience of self-harm and why they keep returning to it is an important starting point when looking for alternatives. If, for example, a pupil says that hurting themselves makes them feel calmer when they are overwhelmed by anger or anxiety, you then know to explore other methods for calming with them. 

It is hard to know how to help when we don’t understand the problem, so be prepared to be inquisitive and to explore non-judgementally and without assumptions. There are lots of ideas for alternatives to self-harm that you could explore with your pupil in the toolkit Handout – Healthy coping strategies and alternatives to self-harm.

“ Be prepared to be inquisitive and to explore non-judgementally and without assumptions”

8 Reduce risk by writing a safety plan

Writing a safety plan is a recognised method of reducing the risk of self-harm or suicide.  The act of writing the plan is helpful in its own right as it can help the pupil recognise sources of support and ways to stay safe.  The plan can also be helpful in moments of crisis when it is very hard to make good decisions; it’s somewhat easier to try to follow a pre-agreed plan. 

Safety plans are primarily used with people at risk of suicide but are also helpful for pupils who self-harm with no suicidal intent (see the Form – Pupil safety plan for an example safety plan or visit www.stayingsafe.net to create an online safety plan).

9 Signpost anonymous sources of support

It is important to clearly signpost where and how pupils can access support if they are worried about themselves or a friend.  Ideally, we’d like pupils to talk to a trusted adult at school or home. Sometimes, however, pupils will not yet feel ready to take this step but may feel more able to open up anonymously.  For this reason, it’s important to highlight anonymous sources of support, such as Childline or the Samaritans.

Further information

PM launches new mission to put prevention at the top of the mental health agenda: https://bit.ly/2KsLcd9

Toolkit

Use the following items in the Toolkit to help you put the ideas in this article into practice:

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About Author

Dr. Pooky Knightsmith

Dr. Pooky Knightsmith has a PhD in child mental health from the Institute of Psychiatry. She is the author of five books and is the current Chair of the Children and Young People’s Mental Health Coalition. You can email Pooky on pooky@inourhands.com and her Twitter handle is @PookyH. Her YouTube channel is www.youtube. com/pookyh where she uploads new videos twice a week.

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