Beauty for Ashes Born Identity? Supporting young people who s elf-harm 7 February & 21 February 2009

1. Beauty for Ashes Born Identity?Supporting young people who self-harm7 February & 21 February 2009 Audrey Johnson Fiona Callaghan Paula Rice Educational Psychologist Educational Psychologist Youth Worker

2. What are your hopes for the seminar?

3. What is self-harm?

4. What is self-harm? Self-harm happens when someone hurts or harms themselves. They may: • Cut themselves • Take too many tablets • Burn their body • Throw their body against something hard • Punch themselves • Stick things in their body • Swallow inappropriate objects • Break bones • Run into traffic

5. Who self-harms? • Anyone... • About 1 in 10 young people will self-harm at some point, but it can occur at any age. • It is more common in women than men • Higher rates of self-harm among gay and bisexual people • People who self-harm are more likely to have experienced physical, emotional or sexual abuse during childhood

6. Why do people self-harm?- what are the causes? • Feeling bad about yourself • Physical or sexual abuse • Feeling depressed • Relationship problems with partners, friends and family • Bullying • Confusion regarding sexuality • School issues

7. Why do people self-harm?- what purpose does is serve? • Gets the pain out • Distraction from emotions • Communication • Provides comfort • Self-punishment • Gain control

8. How common is self-harm? • National survey indicated that about 6% of people have self-harmed • In a school survey 13% of young people aged 15 and 16 reported having self-harmed • Overall women are more likely to self-harm • Adolescents and young adults most likely to self-harm

9. How common is self-harm?- What does this mean? • In your average youth group... 1 • In your average school class... 2 • In this room...

10. The consequences of self-harm • Self-harm is about trying to stay alive • Rate of suicide increases between 50 and 100 times • 25% of all people who die by suicide would have attended hospital for a self-harm incident • 1 in 6 people who attend A&E following self- harm will self-harm in the following year

11. Is self-harming behaviour attention seeking? • Can be hard to understand and sometimes seen as manipulative • Feelings of helplessness when faced with self-harm • A method of communication • The size of the wound isn’t a measure of the conflict inside

12. How do you feel about self-harm?

13. Case studies • How would you approach this case? • What is your personal reaction? • What is your immediate response? • Do you involve anyone else? • What would your long term response be?

14. Case study 1 Abigail, 12 is an infrequent member of your YF. One evening, in conversation with you, she admits to self-harm. As the night unfolds you find out this involves cutting herself on the arms and thighs with broken glass. She also reports starving herself, experimenting with drugs and engaging in sex to feel bad about herself. She makes reference to past sexual abuse, then asks you not to tell anyone about the cuts she has.

15. Case study 2 Beth, 17 is one of your enthusiastic regulars. She is bright, bubbly, outgoing, and a high achiever at school and the arts. She is hoping to go to university next year. Clearing up the café one night you notice some scratches healing on her arm and enquire. She breaks down sobbing, telling you she cuts herself in order to cope with her parents who want her to do well at school.

16. Supporting someone who self-harms- immediate support • Listen to the young person • Do not panic or judge • Assess whether medical attention is required • Do not assume that people who self-harm are looking to commit suicide • Ensure the young person has telephone numbers of friends or help lines

17. Supporting someone who self-harms- long term support • Read up on the subject – be prepared • Look after yourself • Have realistic expectations – do not expect a quick fix • Be available to listen • Empower the young person to make choices • Promote positive self esteem • Reduce stress • Harm reduction – stay safe, within limits

18. Supporting someone who self-harms- practical strategies • Gather information about the behaviour – keep a diary • Be creative – use cushions, draw with red pen • Take up sport/exercise • Distraction Box • Elastic bands or ice

19. Remember you are not a therapist or doctor- you can support and point in the right direction, there are people who can help • GP, Psychologists, • Childline 0800 1111 / www.childline.org.uk • Samaritans 08457 90 90 90 / jo@samaritans.org • NHS Direct 0845 4647/ NHS 24 08454 242424 • www.breathingspacescotland.co.uk / 0800 83 85 87

20. What does the Bible say? • Jesus had compassion upon those he met [Mark 5 account of Legion] • Don’t misquote the OT at your youth [Levi 19:28] • The greatest commandment is to LOVE one another [ matt 22:39] • Develop Y/P identity in Christ as loved, and lovely.

21. Guidelines for your youth group • Who do you involve? At church? Parents? • At what point does it become a child protection issue? • When do you do first aid (do you?) and when do you take young person to A and E? • Do you have numbers of relevant local agencies?

22. References • www.mind.org.uk • Understanding resolution of deliberate self-harm: qualitative study of patients’ experiences (2005). Sinclair, J. & Green, J. BMJ, 330, p. 1112-1115. • Suicide and deliberate self-harm in young people (2005). Hawton, K. & James, A., BMJ, 330, p.891-894 • NICE Clinical Guidance 16. Self-harm – The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care (2004) National Institute of Clinical Excellence: London • The Scarred Soul: Understanding and Ending Self-inflicted Violence by Tracy Alderman: New Harbinger Publications

23. Other additional reading you may find useful: • Their own young hand, Hawton and Rodham, 2006, Jessica Kingsley Publishers, London • Deliberate self-harm in adolescence, Fox and Hawton, 2004, Jessica Kingsley Publishers, London • Young people and mental health, Edited by Aggleton, Hurry and Warwick, 2000, Wiley, West Sussex • self-harm, Fiona Gardener, 2001, Brunner-Routledge, East Sussex • Bodily Harm, Conterio and Lader, 1998, Hyperion, USA • Cutting, Levenkron, 1998, Norton, USA

24. Any questions?