Introduction

 This chapter is based on the Fostering Network Fact Sheet on self-harm by teenagers in foster care. One of the most difficult situations foster carers face is when confronted with a young person who deliberately harms her/himself. Whether it is a one off or a regular occurrence, it causes a gamut of strong feelings from intense anger through to fear, anxiety and sadness. As fostering is about caring and making life better for those in foster care, acts of self-harm can lead the carer to feel a strong sense of failure and helplessness.

There are no simple answers but this chapter provides some facts about self-harm and suicide, reasons why young people harm themselves, helpful responses and information on where to go for more detailed advice.

What is self-harm?

 Many people harm themselves, for example by smoking, drinking, reckless driving or not taking good care of themselves. Self-harm is a deliberate act which inflicts pain or injury to one’s own body. It is a way of coping and getting through a bad patch, or dealing with what is perceived to be, or is, a major life crisis. However, it is helpful to put such deliberate acts in the wider context of potentially harmful, although considerably more minor, acts everyone participates in to some extent.

How do young people harm themselves?

 In many ways, including:

• cutting or scratching (arms, legs etc)
• banging or bruising
• hair-pulling
• scrubbing with abrasives, such as bleach
• swallowing harmful substances.
• starving, anorexia, and bulimia

How often does it happen?

 As self-harm is often a secretive act it is not possible to know how often it occurs. It can happen once or many times, as a daily response or periodically when a problem arises.

It is important to remember that:

• most people who hurt themselves do so quite superficially and carefully, it is only a minority who so severely and need outside medical treatment for their injuries
• most people do stop self-harming, when they are ready.

What is the difference between self-harm and attempted suicide?

It is not easy to draw a distinction between attempted suicide and self-harm. However, self-harm is not the same as an attempted or actual suicide although it is easy to think one would or could lead to the other. Both reflect deep distress but the young person who self-harms is not wanting to kill themselves but to deaden the painful feelings they are experiencing. It is an attempt to cope with these painful feelings, yet stay alive.

Some key messages

Self-harm

Self-harm behaviour is not usually lethal and so, except in very unusual circumstances, is unlikely to lead to death. However, it is important not to make simple generalisations such as ‘it is just attention seeking behaviour’; there are many reasons why a young person may harm themselves.

Attempted suicide

Young women are 4 more times likely to attempt suicide as young men but young men are more likely to commit suicide.

1 in 100 young women aged 16 to 19 attempt suicide each year.

Overdosing is the main source of attempted suicide (75%), other forms include hanging, and jumping from buildings.

Those who attempt suicide fall into two groups:

• those with clear suicidal intentions
• those in distress who are making a serious cry for help.

Completed suicides

Young men outnumber young women by 3 to 1.

During the past 10 years the suicide rate for young men has increased by approximately 70 % but has remained static for young women. Reasons for this include:

• increased male unemployment/poorer long term job prospects
• increased availability of drugs and alcohol
• poorer communication skills amongst men.

Why might a young person self-harm?

A young person may self-harm for many reasons. S/he may see it as a way of coping and, for a time, feeling better by:

• releasing tension and feelings that have got bottled up inside and hurt so much as to become unbearable (these feelings may stem from current difficulties in life, such as stress of exams, a break up with a girl/boy friend, racial harassment or confusion about sexual identity, or may be a response to past painful experiences such as physical or sexual abuse)
• making oneself unattractive in their body so keeping others at bay
• gaining some control which is particularly so for young people who have been abused and were powerless
• punishing themselves so atoning for feelings of being bad or guilty
• seeking help by demonstrating their distress
• comforting themselves – not just the release of tension but also having something ‘special’ one can do for oneself which may also gain attention and care from others.

Cycle of self-harm

The following diagram outlines the process which young people who self-harm may go through and experience:

How can you help a young person who is self-harming or attempts suicide?

The following will help you to be prepared to help:

• gather information about self-harm, Health, and Children and Families guidance and support available including specialist services
• training and supervision will help to prepare and support you to recognise possible signs, adopt helpful responses, recognise and handle your own potentially strong feelings and those of your family as well as handle issues of confidentiality and recording.

Helping the young person

 General help may include the following:

• information on past history of self-harm and/or significant events that might cause distress to the young person
• reduce their feelings of powerlessness by consulting and acting on the young person’s views
• do not let their behaviour or the way you deal with it make you lose sight of the young person themselves. Remember all the skills and experience you already have acquired in fostering teenagers – use them by:
  • giving praise
  • valuing them
  • looking after them in all ways
  • providing opportunities to talk
  • showing in your daily life that there are other ways of coping with the stresses and problems of life
  • talking with them, not at them
  • actively listening.
• reduce the need to self-harm and the harm itself by offering other options,
• recognise it may take considerable time and support. For example:
  • encourage and create opportunities to talk, doing so at their pace and
  • in their time and place
  • think and encourage other ways of communicating and expressing
  • feelings, through writing or provide a punchbag or a cushion
  • think about who else they may feel comfortable talking to
  • be sympathetic and understanding to the feelings of shame, guilt and
  • confusion caused to the young person by their problems and self-
  • harming behaviour
  • provide practical care and comfort – a favourite meal, a pet or a bath
  • provide basic assistance, such as a first aid box and simple instructions to the young person. Help them to help themselves; it isn’t necessarily helpful to step in and do it for them.

Specific help following an episode of self-harm or attempted suicide

This could include:

• in the immediate crisis there are several things to deal with – getting help, dealing with the emergency services, supporting the young person through the medical examination and treatment at hospital
• subsequently you or the young person may feel you just want to get home but before doing so a better move may be for the young person to have a thorough psychological assessment by a trained mental health professional with expert advice to you because you probably are feeling confused and shocked and need to a chance to talk about your own feelings
• you will be better placed to help everyone to recognise and deal with any anger that is around
• you may be fearful of another attempt at self-harm so an assessment will provide some guidance for yourself and your family as well as showing the young person the problem is being taken seriously – research shows that those who try again feel they were not given sufficient attention.

Afterwards

It is not always easy to live with the aftermath of a serious incident of self-harm or attempted suicide as it creates additional problems; family life will not be the same again. However, by using your skills and being patient, it is possible to help the young person to:

• have a sense of being taken seriously
• feel supported so as to feel that things will be right again, by getting a sense of perspective and a future
• feel loved and attached to people who would be hurt by their behaviour.

Be aware of your own limitations. You will also need support and guidance from social workers, your own family and friends and sometimes specialist professional input, for example your GP, counsellor, psychiatrist or specialist agency.

It is also important to know what not to do.

Here are a few tips:

• don’t think you can stop the young person if they don’t want to (time and patience may well be needed)
• don’t feel responsible
• don’t try to make the young person feel guilty
• don’t tell other people the self-harm without the young person’s consent (or at least an explanation of why you have to do so).

Conclusions

We hope that in learning more and sharing with others you will be able to more confidently care for any young person who self-harms.

Remember: with help and support things can, and usually do, get better and young people find other ways of sorting out their problems and dealing with their feelings.

Further information and resources

The Health of the Nation: mental illness – Can children & young people have mental health problems?
Department of Health 1994
This free booklet tells young people and their families about mental illness – what it is , some of its causes and symptoms and treatments available. Designed to reassure teenagers and their families about what are ‘normal’ worries.
Available from Health Literature Line: tel 0800 555 777

Understanding Self-Harm; How to Help Someone Who is Suicidal
Mind Publications Department, Granta House, 15/16 Broadway, Stratford, London E15 4BQ

Attacks on the Self: adolescent behavioural disturbances and their treatment
Derek Miller Basic Books 1986

Women Who Hurt Themselves
Derek Miller Basic Books 1994

What’s the Harm? A book for young people who self-harm;
Working with Self Injury: a practical guide
available from The Basement Project, 82 Colston Street, Bristol BS1 5BB tel 0117 922 5801