Self-harm is not just attention-seeking: it’s time to talk openly about the issue

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attention-seeking, Bullying, causes, emotional distress, emotional pain, emotions, isolation, obsessions, pain, physical pain, professional help, relief, secret, self-harm, stress, teenagers, young people

Self-harm is not just attention-seeking: it’s time to talk openly about the issue

Three years ago, with her parents and sisters out for dinner, then-13-year-old Lucy found herself alone in her family’s Lincolnshire home. Dressed in her pink Tinker Bell pyjamas, she began to make herself a cup of tea. Then she spotted an object on the kitchen counter that immediately diverted her attention. “Shall I do it?” Lucy asked herself. “Will it stop the pain?”

For Lucy, now 17, that evening marked the start of a two-and-a-half year struggle with self-harm. Two weeks before, she had been brutally attacked and raped (which she now describes as “the incident”). At the time, anxious they wouldn’t believe her, Lucy never fully revealed to anyone what had happened. In her mind, she tried to repress the rape. She began shutting herself in her bedroom. She told her parents she was feeling unwell. Physical pain, she decided, was the only way to purge her pent-up emotional pain.

“When you keep all your problems in, it feels like you’re screaming inside,” Lucy says. “But when you cut or burn yourself, the pain is more physical. You feel like you’re releasing that scream. After a few months, self-harming became part of my daily routine.”

Eventually, both at school or at home, Lucy was self-harming four times a day. She wore black jeans, black tops and even black gloves to conceal her scars. “I pushed everyone everyone away” Lucy says. “I stopped caring about school. My grades suffered. Self-harm became a real obsession. It took over my life.”

Today, having made a huge effort to stop, Lucy has not self-harmed for more than six months. But self-harm is still on the rise among the UK’s young population. Data published last year by a collaborate study from England Health Behaviour in School Aged Children (HBSC) revealed that up to one in five 15-year-olds across the country self-harm. During the past decade, according to the same study, there has been a three-fold increase in the total number of UK teenagers self-harming.

What drives young people to self-harm? Therapist Jenna Mutlick, who has a personal experience of it, says it is usually some form of “self-punishment”. People believe they have done something wrong – even when they haven’t – and then feel they deserve the pain. “I know a few people who self-harm because they are bullied and eventually come to believe that they then deserve to be bullied,” she says. “When you self-harm, it is so hard to escape from the [mental] space that you are in.”

“It’s a very heterogeneous group of people who self-harm, and there are a variety of reasons why people might start,” says Professor Glyn Lewis, head of psychiatry at University College London. “Clearly, there are people who self-harm because they want to take their own lives, but there are also people who want to self-harm because they are in difficult situations or want to relieve stress.

“As a long-term strategy, of course, self-harm is not very effective,” he adds, “but people do report that they get some form of relief from upsetting thoughts or emotions. Some forms of self-harm are obviously very dangerous, but there’s a continuum. Some people may only scratch themselves very superficially, for example, which won’t do any long-lasting damage.”

The causes of self-harm are likely to be complex, even if the person harming does not see the issues in that way. Kieran, from Glasgow, began self-harming after five years of “constant” physical and verbal bullying at school. His parents split up when he was seven, though he says it was the bullying – which still torments him today – that incited his self-harming. “The bullying made me feel really unbalanced,” says Kieran, now 23. “I started to self-harm when I was aged 11, and it kind of just snowballed from there. I stopped eating. I isolated myself from a lot of my friends and family. I kept it a secret for almost a decade.”

Like Lucy, Kieran says that self-harming became a secret obsession. The bullying made him feel “physically and mentally numb”. Self-harm, by contrast, made Kieran feel more alive, and he would regularly self-harm in his bedroom at night. “It brought me out of my slumber,” he says. “It made me feel normal, and I became addicted to doing it for that reason.” He says that the self-harm was like an “adrenaline shot” that brings everything back into focus.”

Kieran admits that he still has a “daily battle” with self-harm. He is significantly better than he was a few years ago, though, when he would harm himself up to 400 times in one evening. “It’s a high level of emotional distress that causes people to resort to self-harming,” he says. “People sometimes feel like they can’t cope with their emotion. It’s how they cope with life’s daily stresses.”

Chris Leaman, from the UK mental health charity YoungMinds, says it is still very much a taboo subject in British society. “Every year, we work with Childline, YouthNet and selfharmUK to try and combat these sort of stigmas for Self-Harm Awareness Day,” he says. “There is a definite problem around young men not feeling like they can talk about their issues, which can make self-harm quite a common issue among them.”

“Some people do talk about self-harm quite openly, but that’s relatively unusual,” says Professor Glyn Lewis. “A lot of people conceal self-harming behaviour from their friends and family. There are not necessarily signs to look out for; it’s more a case of often asking people how they are feeling, and keeping communication open with them. As a rule, families and friends concerned about someone self-harming always should talk to the person themselves and encourage them to seek professional help.”

Statistically, teenage girls are still more than twice as likely to self-harm than young males, and this has helped create another gender-based stigma: that self-harming girls are simply seeking attention. Fiona Brooks, professor of adolescent and child health at the University of Hertfordshire, who led the investigations for last year’s HBSC report, identifies this as a prevalent problem. “Nowadays, young people are in a much more uncertain world than before,” she says. “Instead of self-harming just being dismissed as attention seeking, it’s something that needs to be taken seriously. Equally, if young girls are self-harming for attention, that’s a different matter that needs to be taken just as seriously.”

Lucy thinks back on that evening she started self-harming, and wishes that she could tell herself to stop – and talk to someone. Talking, like with most former self-harmers, has been a significant part of Lucy’s recovery, but she also credits her own determination as a decisive factor. “If you don’t want to stop, you won’t,” she says. “In the end, a lot of it comes down to how you see yourself. I used to feel people were always judging me, but now I feel I don’t care what they think. Why should I let them control my happiness?”

Self-harm sites and cyberbullying: the threat to children from web’s dark side

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Bullying, Depression, mental health issues, self-harm, social networks, suicide, teenagers, young people

Self-harm sites and cyberbullying: the threat to children from web’s dark side

“Some of the images do scare me, especially if it’s my friends. Once my friend cut lines down the side of his face as a ‘Chelsea Smile’, he put it online and it was the worst thing I had ever seen. He’s my friend, I don’t want to see him that upset. He got so much hate for it and ended up going into hibernation, nobody heard from him for over a week and we honestly thought he had killed himself.”

Frankie* is 15 and lives in the Midlands. For the past year or so she has updated her Tumblr blog most days. On other social networks she uses her real name, but on Tumblr – a blogging platform – she shares her darkest thoughts about depression, anxiety and self-harm anonymously. “The other day I put up a self-harm picture,” she says. “I was alone and in a dark place. […] Of course, nobody would help, but posting it boosted my confidence a little; finding it buried in amongst all the other self-harm posts reminded me I’m not alone.”

Fears about self-harm sites have been growing since the suicides of two teenagers who, it emerged, were obsessed with self-harm and depression blogs, with mental health campaigners and experts warning that the UK’s teens are at risk of becoming a lost generation if parents and adults cannot reach out to them across the digital divide.

Tallulah Wilson, a 15-year-old who killed herself in 2012, was caught up in a “toxic digital world”, according to her mother, while the parents of Sasha Steadman, a 16-year-old who died from a suspected drug overdose in January after looking at self-harm sites, said her “impressionable mind” had been filled “with their damning gospel of darkness”.

For the uninitiated, self-harm blogs present a surreal world of fantasy and pain. Countless sites dedicated to self-harm and depression are filled with images of bleeding wounds juxtaposed with pixelated gifs, flickering eerily with snippets of Hollywood angst. Helen, who is now 18, visited them regularly, before stopping to help herself move on from self-harming. “You have people asking you how to cut yourself deep enough because their therapist said it wasn’t bad enough,” she says. “I have had people tell me to kill myself. I think the most traumatic is when you find someone’s suicide note online and there is no way to actually get in contact with the person.”

Isolated and lonely, she used the blogs because they gave her a sense of belonging. “You want to find people who are similar to you. That is what humans do,” she says. “It starts off as trying to help, but then it becomes competitive and dangerous. You get sucked into this world of who can cut the deepest/be the skinniest and avoid notice by the outside world. You end up spending hours a day searching these sites for reassurance, but it just makes it harder.”

Keeping children safe online is the “child protection challenge of this generation”, according to Peter Wanless, head of the NSPCC. ChildLine, part of the organisation, registered an 87% rise in calls about cyberbullying last year, a 41% increase in calls about self-harm, and a 33% increase in calls about suicide, with the biggest increase among 12- to 15-year-olds.

While the internet provides unprecedented opportunities for young people to communicate and learn, it can be a dangerous place for vulnerable teenagers, says Sue Minto, the head of ChildLine. “Children are communicating in a way we have never seen before – all the time and instantly,” she says. “Personally, I think this kind of relentless exposure is the biggest challenge we have ever faced.”

Minto notes that while peer pressure and bullying have been around for a long time, the ability to be contacted at all times is new. The cloak of anonymity can lead children to make comments they would shy away from in “real” life, she says. “The pressure on children is immense and very worrying – there is no break for these young people, it is quite relentless. Children who are being bullied tell us there is no point in turning off their phone, because the messages will just be there waiting for them.”

A recent survey carried out by youth charities ChildLine, Selfharm.co.uk,YouthNet and YoungMinds revealed that 61% of the 4,000 young people who responded said they self harmed because they felt alone, while 25% cited bullying. Almost 40% said they had never spoken to anyone in the “real world” about it.

Rachel Welch, director of Selfharm.co.uk, which supports young people affected by self-harm, says there is a huge gap between what adults see of the online world and their children’s experience. “So many young people are drifting into a world where they are completely disconnected,” she says.

But how dangerous are self-harm sites? Do they simply show teenage angst and creative expression, or highlight a worrying deterioration of teenage mental health?

Mary Hassell, the coroner presiding over the inquest of Tallulah Wilson, was concerned enough to write to Jeremy Hunt, the health secretary, to warn him of a risk of future deaths without a greater understanding of children’s online worlds. Although Tallulah was treated by healthcare professionals, they didn’t have “a good enough understanding of the evolving way that the internet is used by young people, most particularly in terms of the online life that is quite separate from the rest of life”, she wrote.

A study into possible links between suicide and the internet has just been commissioned by the Department of Health and will report in two and a half years: a department spokeswoman said children’s mental health was a priority for the government and pointed to the introduction of “family-friendly filters” and internet safety into the national curriculum.

But for Sarah Brennan, chief executive of the youth mental health charity Young Minds, the real issue is ignorance of the scale of the problem, or even denial that the problem exists. The current NHS commissioning of youth mental health services is based on data collected in 2004 – the year Facebook launched.

“It is shocking that the government is allowing NHS commissioners to plan services based on out of date and inaccurate data,” Brennan says, adding that a Young Minds freedom of information request recently revealed that 34 out of 51 local authorities in England have reduced the budget for their children and adolescent mental health services since 2010, while a Community Care/BBC investigation this week showed that a growing number of seriously ill children are being admitted to adult psychiatric wards or sent hundreds of miles from home for hospital care.

“We are sitting on a ticking time bomb here,” says Brennan. “At the same time that we are seeing an increase in need, youth mental health services are being cut. There is an explosion of bullying online and young people struggling to cope with mental health issues, anxiety, eating disorders. If we don’t do something about it we could have a lost generation.”

What can be done? Since Tallulah Wilson’s suicide, Tumblr has introduced a warning that pops up when users search for terms related to self-harm, directing them towards sites offering support and calling on users to report blogs with “inappropriate content” so they can be taken down. A Tumblr spokeswoman said the site was “deeply committed to protecting our users’ freedom of expression”, but that it draws lines “around a few categories of content we consider damaging to our community, including blogs that encourage self-harm”.

And while there have been calls to shut down certain sites, such as Ask.fm – which allows users to ask anonymous questions and has been linked to teen suicides – teenagers and professionals spoken to by the Guardian agreed that simply banning sites or “dangerous” search terms was futile. Regulation can also backfire – recent efforts to impose opt-out “objectionable content filters”, backed by the prime minister, have resulted in sites such as ChildLine and Refuge also being blocked.

“We cannot put our head in the sand, simply blame these sites or hope to regulate our way out of this,” says Minto. “We are playing catch-up, but we need to take responsibility. You wouldn’t let your child cross the road without talking to them about road safety and the same goes for the risks of the internet – if we don’t tackle this it’s like opening the door and letting them walk through this cyberworld completely unequipped.”

Welch at Selfharm.co.uk agrees: “Calling for any type of ban is just missing the point. What we have to do is make sure our young people are emotionally resilient, emotionally aware and they know where to go to get help if they need it.”

Others say that while parts of the internet can be dangerous for vulnerable children, it can also provide the means to keep others safe and let them talk about their problems. As many young people contact ChildLine online as call its helpline. Online friends can be a force for good.

Samantha, a 17-year-old who started self-harming when she was 14, says her Tumblr site helped her recover from depression. “I felt like I belonged somewhere, they understood me in a way I felt I had never been understood before,” she says. At one point, she was off school with depression and spent all day online, answering 10-15 messages from other troubled teenagers every day. Now she “has a life” again and is online less frequently. “I’ve been told that I’ve saved lives and it made me feel good about myself that I was helping other people,” she says. “It’s really odd – but it works for me.”

Frankie, who is still working towards recovery, has mixed emotions. While she recognises that some blogs might encourage self-harmers, or make them feel worse, she still believes they can help. “I think for [people] like myself it can be reassuring just to know there are others out there that do it too [but] what scares me is thinking how many there are, how they are all posting it online, are they all cries for help? If that many people are crying for help then something needs to be done, and fast.”

*Names of young people have been changed. If you face any of the issues in this piece, you can call ChildLine on 0800 1111

Social workers need training to help them better understand self-harm

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autism, awareness, education, family, online support, physical health, self-harm, social workers, support, training, understanding, young people

Social workers need training to help them better understand self-harm

It is estimated that one in 12 young people have self-harmed at some point in their lives, according to charity YouthNet. The charity says 3,000 people aged 16 to 25 visit its digital support service TheSite.org every month after looking up self-harm on a search engine. Yet, despite these statistics, self-harm awareness training for social workers is not always as comprehensive as it could be.

Nushra Mansuri, professional officer (England), at the British Association of Social Workers (BASW), says while some social workers – such as those working in mental health – may be sensitive to the issue of self-harm, there needs to be more awareness of the problem within the profession and that self-harm training is patchy.

“Whatever client group you work with, it will be a feature – it [self-harm training] should be integral because you are working with people whose lives are in crisis – there is a high correlation between the people you work with and people with a propensity to hurt themselves,” she says.

“Social workers need a greater awareness of the issue and need to understand why people self-harm. I wouldn’t lump everyone together, but it can be the impact of trauma, it can be a cry for help, it gives someone, who may have had control taken away from them, a sense of control.”

What mistakes could a social worker who lacks awareness of the issue of self-harm make? “An untrained person may have a tendency to look at the superficial and not go beyond that,” Mansuri says. “A social worker may be out of their comfort zone and not be able to deal with it – dealing with someone’s raw pain is really hard.”

Mansuri adds that social work “doesn’t have all the answers” when it comes to self-harm and that more education is required. “There is an underestimation of the importance of looking at self-harm,” she says.

Jennifer McLeod, managing director of self-harm training provider Step Up! International, says in some regions self-harm training for social workers is inadequate.

“Social workers ought to be trained in spotting the signs; if they aren’t spotted, it could be fatal,” she says. “It’s about listening to what’s not being said, looking for physical signs and emotions – they [people who self harm] are generally hiding something.”

McLeod adds that well-trained social workers will broach the topic with the young people and their families. “There might be denial from parents and social workers will have to find ways of eliciting information from young people.”

McLeod says delegates at Step Up! International training courses are often in a state of panic about the issue as they are uncertain about how to deal with the problem or even broach the subject.

“Some professionals don’t feel confident about bringing up the issue directly, they daren’t ask about it as they think it might make it worse”, she says.

McLeod suspects self-harm is on the increase – and is being talked about more – because of the current economic climate.

“In addition to the emotional and biological changes [young people experience], there is the recession, labour market issues, parents being made redundant – parents may not be managing and may be economically struggling,” she says.

Caroline Hattersley, head of information, advice and advocacy at theNational Autistic Society (NAS), says people with autism face a “raft of challenges” that might make self-harm more likely.

“Autism does bring specific difficulties – we’d like to see more training on understanding autism and its relation to self harm,” she says. “The key is understanding the individual and understanding the underlying causes.” Lacking this understanding could lead to a social worker misinterpreting why someone is self-harming, Hattersley adds.

“The individual might not have done it before, they may be hitting their head because they may have communication difficulties and they’re trying to communicate a physical problem – you might miss an ear infection,” she says.

Hattersley acknowledges that it can be difficult for professionals to admit they are struggling with the issue of self-harm. NAS has set up Network Autism, a forum where professionals can read research, and discuss with each other, the issue of self-harm and how it relates to people with autism.

YouthNet’s chief executive Emma Thomas says all practitioners working with people who self-harm would benefit from a better understanding of the problem. She adds: “If social workers are more aware of services like TheSite.org, many more young people can be directed to safe, anonymous online support to complement the vital offline support they need.”

We Need to Break the Taboo Surrounding Self Harm and Start Talking About It

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Children, GPs, hospitalisation, parents, self-harm, support, teachers, young people

We Need to Break the Taboo Surrounding Self Harm and Start Talking About It

One in 12 children and young people deliberately self-harm with around 40,000 cases needing hospitalisation each year because their injuries are so severe. Those statistics alone suggest that we must do more to help children and young people who are turning to self-harm and our new research shows how imperative this task is.

Research by YoungMinds and the Cello group launched today shows:
• Three out of four young people simply do not know where to turn to talk about self-harm
• A third of parents would not seek professional help if their child was self-harming
• Almost half GPs feel that they don’t understand young people who self-harm and their motivations
• Two in three teachers don’t know what to say to young people who self-harm

The research findings are worrying. Among young people, parents, teachers and GPs self-harm is considered more concerning and more serious than many high-profile youth issues such as youth gangs, drugs, binge-drinking or eating disorders. Young people themselves also rank self harm as a very high area of concern.

Myths, misconceptions and lack of understanding characterize self-harm, our research shows it can be viewed as too serious with links to suicide or too trivial to prompt action by being seen as attention seeking. With this polarisation of views it makes it really difficult for people to seek or provide support.

As a society we feel ill equipped to talk to young people about self-harm and at the same time young people are saying they don’t know where to turn. If as our research shows, parents, teachers and GPs don’t feel equipped and confident then is it any wonder that young people are stuck not knowing where to go?

Only one in 10 young people are comfortable seeking advice from teachers, parents and GPs. Over half would go online to get support about self-harm despite only one in five trusting online sources. Thousands of young people are getting emotional support from online communities rather than going to their parents, teachers or GPs. Everyone concerned about the emotional wellbeing of young people needs to acknowledge and accept this and look at why young people are supporting each other online.

We shouldn’t blame people for not being confident or equipped our research shows a real desire for people to be able to talk to young people about self harm. The majority of people believe that they need to be able to offer support to young people who self-harm; however, nobody feels empowered to act.

Thousands of young people are suffering in silence every day. Our research demonstrates that we need to break the conspiracy of silence around self-harm so young people feel more able to seek support and parents, teachers and GP’s feel equipped to provide it. We also need to find ways to breach the gap online that exists between adults who want to help but don’t know how to enter the online space and young people who find peer support there but may also come across the more negative and dark side of online communication.

The YoungMinds Parents’ Helpline offers free confidential online and telephone support, including information and advice, to any adult worried about the emotional problems, behaviour or mental health of a child or young person up to the age of 25.

Call us free on 0808 802 5544  Monday to Friday 9.30am-4pm or email parents@youngminds.org.uk

Nice’s New Guidelines on Self-Harm Management

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self-harm

http://www.nice.org.uk/nicemedia/live/13619/57179/57179.pdf

Self-harm figures soar in a generation under pressure

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Bullying, Children, mental health issues, Self-esteem, self-harm, Teens, Therapy, Young adults

http://www.independent.co.uk/life-style/health-and-families/health-news/selfharm-figures-soar-in-a-generation-under-pressure-6272072.html

More than 1,800 children aged under 10 have been hospitalised for self-harming in the past decade, sparking fears of a generation unable to cope with the pressures of childhood.

Last year alone almost 150 boys and girls aged 10 or under were admitted to hospital for intentional self-harm, including more than 80 pre-school children.

In a sign of a worsening problem, the number of girls and women aged under 25 admitted in the past 10 years has soared by 44 per cent to more than 26,270 in 2010-11. Among boys and men of the same age, the figure has leapt by a third to 11,656. The figures are for hospitals in England.

The Department of Health (DoH) admits that “only a fraction” of cases of self-harm are seen in hospitals, so the true scale of the crisis will be much larger.

“These shocking statistics should act as a wake-up call to everyone who cares about the welfare of young people,” said Lucia Russell, the director of campaigns, policy and participation at YoungMinds, a charity which is working with the Government to redesign mental-health services for children. “Self-harm is often dismissed as merely attention-seeking behaviour, but it’s a sign that young people are feeling terrible internal pain and are not coping.”

According to officials, an episode of self-harm is often triggered by an argument or another upset, but can also be linked to bullying, low self-esteem, and worries about sexual orientation. The Government has promised £32m to improve access to psychological therapies for children and young people over the next four years.

Paul Burstow, a Liberal Democrat health minister, told The Independent on Sunday that, for too long, mental illness among children was overlooked by the NHS. “It has really suffered from being the poor cousin of mental health, which was itself the Cinderella service. It was not a priority for the NHS.

“For half of all mental health problems in this country the symptoms first show during adolescence. Let’s look at the early signs and support families with proper therapies. It is about moving to intervene early.”

More than one in 10 children aged 15 to 16 report having self-harmed in their lifetime. However, the DoH insists it is “rare for very young children” to self harm. A million children will have a diagnosable mental-health disorder. Childhood mental illness costs up to £59,000 per child every year.

The rise in hospital admissions has been steepest among women aged 17 to 25, rising by 50 per cent between 2001 and 2011.

Separate figures released last week show 40,000 under-25s were rushed to A&E in 2009-10 after self-harming, up from 36,000 in 2007-08.

Earlier this year, the Government launched a new strategy, No Health Without Mental Health, to tackle the problem. Officials are working with young people, parents and YoungMinds to redesign specialist services for children, focussing initially on cognitive behavioural therapy and parenting therapy.

Ministers hope to reduce by as much as 40 per cent the number of people in adulthood who have mental health problems. The economic and social costs of mental health in the UK are almost £100bn.

Last month a study by the charity Mind warned that a combination of rising demand and spending cuts was threatening the viability of mental health services.