TERMS USED TO DESCRIBE SELF-HARM
You may hear a wide variety of terms used to refer to self-harm including:
•self-harm
•deliberate self-harm
•intentional self-harm
•parasuicide
•attempted suicide
•non-fatal suicidal behaviour
•self-inflicted violence.
Increasingly we tend not to use terms like ‘deliberate’ or ‘intentional’ as these terms are felt to place a negative value judgement on the individual concerned and also infer intent and control where this is not always the case.
Self-harm is sometimes considered to include three subtypes:
•self-poisoning
•self-injury
•self-mutilation.
Severity of behaviours
It is common for people to believe that the severity of a student’s self-harming or eating-disordered behaviour is a direct reflection of the severity of the underlying psychological difficulties they are trying to cope with. Whilst this is sometimes the case, it is not always so and it is inappropriate for us to dismiss less serious cases out of hand. In some instances, students will even lie about carrying out self-harming or eating-disordered behaviours, pretending that they are self-harming and perhaps even sharing images sourced online of others’ self-harm and passing it off as their own. This should not be dismissed as ‘attention-seeking’ – this student is seeking your attention in an unusual way, but they are clearly indicating that they are in need of support. Students whose invented or lower-level issues are not offered the appropriate support often go on to carry out more extreme behaviours in order both to cope with their underlying issues and/or to help them to access the support they are in need of.
Self-harm and suicide
Self-harm and suicide are often considered under the same umbrella. In fact, the National Collaborating Centre for Mental Health guidelines1 use the definition ‘Self-poisoning or self-injury, irrespective of the apparent purpose of the act’ to describe self-harm – which means that someone would be considered to be self-harming even when their intention was to take their own life.
In this book, I approach self-harm separately to acts with suicidal intent because my work with students leads me to understand that these are two very different types of behaviour. In fact many students express the belief that self-harm is the one thing that helps them to cope with day-to-day life enough not to contemplate suicide.
‘I would get overwhelmed and feel like I didn’t want to be alive any more, but cutting would help me to calm down. It stopped me doing something even more stupid.’
It can, however, sometimes be hard to differentiate between self-harm and suicide attempts. For example, imagine two students who arrive at a hospital: 15-year-old Jenna has taken 20 painkillers whilst 17-year-old Ranj has life-threatening cuts to his arms. Are these examples of self-harm or are they suicide attempts? The only way we can gain any real insight is to ask the student about their intention at the time when the behaviour was taking place. However, they may not be able to remember, may feel ambivalent or may find it difficult to articulate their reasons.
Many people self-harm for months or even years without ever feeling suicidal. Self-harm is a separate behaviour from suicide and the intent is to cope with feelings rather than to end life. However, if people who self-harm don’t receive the support and help they need to overcome their underlying difficulties, they may go on to contemplate suicide later on.
If you are at all concerned that a student is feeling suicidal you should seek help immediately. When people suffer with suicidal feelings they can often feel very alone and they are very, very vulnerable. You should also seek immediate help for students with severe physical injuries, whether or not you believe they intended to take their own life.
LEARNING TO TAKE AWAY FROM THIS CHAPTER
•Whilst different eating disorders may have a markedly different impact on the sufferer’s appearance, the underlying thoughts, feelings and psychological distress are often very similar.
•There are three major eating disorders: anorexia nervosa, bulimia nervosa and binge eating disorder. Many young people with food and weight concerns will not fit within the criteria for these disorders, but it is still important that we offer our full support.
•Children under 11 often use food to express concerns/feelings they do not have the language to articulate.
•With common childhood issues such as ‘faddiness’, if the child is growing normally, is not hungry and is happy then there is often no need for concern.
•Self-harm is an unhealthy coping mechanism students may use to manage difficult feelings or emotions and can be carried out in a variety of ways.
•Most people who self-harm have no suicidal intent. Many people who self-harm express the belief that self-harming protects them from taking more serious measures.
1National Collaborating Centre for Mental Health (2004) Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. NICE Clinical Guideline 9. London: The British Psychological Society and Gaskell.
CHAPTER 2
Overcoming Stigma and Exploring Common Misconceptions
This chapter will enable you to:
•increase staff confidence in talking about self-harm and eating disorders
•correct common misconceptions about self-harm and eating disorders
•run parent workshops and information sessions.
Many school staff that I’ve worked with have told me that in their school topics like eating disorders or self-harm were taboo, either because the school was uncomfortable admitting there was a problem or because there was concern that talking about eating disorders or self-harm would lead to a rise in cases. Other staff simply feel understandably uncomfortable or out of their depth when talking about mental health and emotional wellbeing issues so they end up avoiding the topic.
In order to effectively support students with self-harming or eating-disordered behaviours at your school or college, it’s important that the taboo is tackled. It’s important that we get more comfortable discussing these topics; not doing so can cost lives:
‘Everything came to a head one day when she collapsed at school. She was rushed to hospital but there was nothing they could do. She died of a heart attack. It turned out that several members of staff, myself included, had been worried about her, but we all assumed that someone else was taking care of it – it wasn’t exactly the kind of thing we discussed in the staffroom.’
Increasing staff confidence in talking about sensitive issues
Staff feeling comfortable talking about eating disorders and self-harm can prevent students falling through the gaps and ensure that cases are picked up. A series of ideas that your school or college could consider implementing to tackle stigma and get people talking about self-harm and eating disorders are explored below.
Offer all staff relevant training
Some members of staff are likely to need more extensive training than others due to differing roles but, as a minimum, all members of staff should have a basic understanding