Self-harm

What is self-harm? 

Self-harm is when an individual intentionally damages or injures their body. It is often a way of dealing with very difficult feelings, painful memories, or overwhelming situations and experiences. 

Self-harm may include overdose (self-poisoning), hitting, cutting, burning, pulling hair, picking skin and head banging. Self-harm behaviour is usually aimed at coping with life rather than ending it, however it is important to recognise there is an increased risk of suicide if someone already self-harms. 

NHS and Mind provide further information about what self-harm is. 

Why is it important for schools and settings to be aware of self-harm? 

Self-harm is not uncommon, a recent survey showed about 22% of young people aged 15 said they had self-harmed. Self-harm can impact people of any age but evidence suggests the average age of onset around 12-13 years of age, and peak prevalence during mid-adolescence when children and young people are attending secondary school. 

It's crucial for schools to be aware of self-harm among children and young people for several reasons: 

1. Invisibility of Self-Harm: Self-harm often goes unnoticed in educational settings. By being aware, schools can prioritise this issue within the curriculum and provide necessary support. 
2. Support and Intervention: Schools can play a significant role in prevention and intervention. They can help children and young people to cope with emotional distress in healthier ways, promoting their well-being and academic success. 
3. Understanding and Eliminating Stigma: Understanding self-harm can help eliminate stigma and discrimination. It can also foster an understanding of why it happens, how it happens, and ensure that children and young people get the help and support appropriate to their needs. 

4. Reduce impact of risk factors: 

• Anxiety and stress: Schools need to be aware that anxiety and stress e.g. associated with exams may escalate self-harm. By being aware, they can implement strategies to manage academic stress among children and young people. 

• Bullying: Bullying can contribute to self-harm. Schools need to be proactive in addressing bullying to prevent such outcomes. 

5. Strategies to respond: By being aware and prepared, schools can respond more effectively when instances of self-harm are disclosed. 

In summary, schools and settings play a pivotal role in identifying, preventing, and addressing self-harm. By fostering a supportive and understanding environment, they can make a significant difference in the lives of children and young people who may be struggling with these issues.  

What signs should schools and settings look out for? 

It can be common for young people to hide their self-harm, but there are a number of signs to look out for. These include unexplained cuts, burns or bruises, keeping themselves covered and avoiding swimming or changing clothes around others.  

Behavioural or emotional signs of self-harm include becoming withdrawn or isolated, low mood, lack of interest, sudden changes in behaviour such as becoming irritable, angry or aggressive, excessive self-blame for problems and expressing feelings of failure, uselessness or hopelessness. 

It's important to note that these signs are not definitive proof of self-harm as they could be related to other issues as well. If a staff member suspects a child or young person is self-harming, it's crucial to approach the situation with care, seek advice from mental health professionals where necessary, and follow safeguarding policies. 

Charlie Waller provides further information about reasons for self-harm and risk factors.  

What does the law say? 

Schools have a responsibility to safeguard and promote the welfare of their children and young people, and this includes addressing issues related to self-harm. Here are some key pieces of legislation and guidance that schools need to follow: 

1. Keeping children safe in education (KCSIE) statutory guidance outlines the statutory duty for all schools to promote the welfare of their children and young people. This includes:  

• preventing impairment of children's health or development  
• taking action to help all children have the best outcomes  

2. Working Together to Safeguard Children  
3. Health Education Curriculum: Since September 2020, health education has been a statutory part of the RSHE curriculum in primary and secondary schools in England. The Government has published statutory guidance on RSHE, including recognising and discussing mental health concerns. 
4. Schools have statutory responsibilities in relation to social, emotional and mental health needs as outlined in the special educational needs and disabilities (SEND) code of practice.   

What support is available? 

National 

National Institute for Health and Care Excellence (NICE) Guidance: NICE guidance provides comprehensive guidelines on the assessment, management, and prevention of self-harm. This guideline applies to all sectors that work with people who have self-harmed, including educational settings. It covers various aspects such as information and support, consent and confidentiality, involving family members and carers, risk assessment tools, and more.  

No Harm Done: This guide includes information on the warning signs of self-harm, starting conversations with children and young people about self-harm, and ways of addressing self-harm as part of a whole-school or college approach. 

Anna Freud: Anna Freud provide a range of guidance including understanding self-harm in primary aged children, recognising and dealing with self-harm, self-harm guidance for further education colleges and guidance on how to support staff who may be at risk of self-harm themselves. 

TALK Centre: The Talk Centre have upcoming training focused on 'Working with young people who self-harm and/or feel suicidal'. 

Pooky Knightsmith: Pooky Knightsmith, a specialist in child and adolescent mental health, provides practical and accessible guidance to schools about self-harm through webinars and whole school guidance. 

The Charlie Waller Trust: The Charlie Waller Trust have developed a guide for school staff on young people who self-harm. 

Norfolk 

Mental health support for 0-25 year olds across Norfolk & Waveney will be processed by Just One Number. The team will review all the information outlined in the request and support children and young people and their families in accessing a range of options to improve their mental health and wellbeing, including:  

• Self-care resources  
• Advice and guidance  
• Access to mental health or emotional wellbeing support services.  

When appropriate, the team will pass any information you share to an organisation that will best support the child or young person. Sometimes, further intervention will not be needed, but the JON team will contact you to let you know this and offer some advice and guidance to support.  

Staff wellbeing 

Supporting children and young people who are in emotional distress or who are self-harming can be physically and mentally draining for staff; this needs to be recognised and appropriate support put in place, both in terms of training and supportive listening.  

• You can access wellbeing support from a team of specialists as well as 24/7 phone support and self-help workbooks through Norfolk Support Line. 
• Norfolk Wellbeing Service offer a range of wellbeing support offered to adults in Norfolk and Suffolk. This includes self-referral, self-help, social support. workshops, wellbeing podcasts and blogs. 
• Qwell offer free, safe, and anonymous mental wellbeing support for adults. This includes professional support, community support and professional development tools. 

Key contacts  

To contact Just One Number, follow the links on this page Norfolk & Waveney Access to Mental Health Advice & Support (justonenorfolk.nhs.uk).