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Helping teens who self harm

“If you’re hurting so badly in your head, to harm yourself on your skin stops the feelings in your head.”

“The more upset I would get about my dad not being around or stuff at school, the more I would do it and pretty soon I was doing it almost every day.”

These are some of the reasons young people have given for why they deliberately hurt themselves.

Self-harm can include cutting or burning skin, overdosing, hitting or bruising parts of their body, hanging or suffocation.

When a parent discovers their child is self-harming, it can be devastating, and it’s a phenomenon that experts say is increasing among young people.

It can start in the pre-adolescent and adolescent years and, in some cases, persist into adulthood.

“It’s hard enough when your child hurts themselves accidentally when they are younger, let alone finding out down the track that they are actually trying to do that to themselves — it’s just so hard to comprehend,” says social worker Vikki Ryall, executive director of clinical practice at Headspace.

“There is good information to say the numbers of people who are self-harming have gone up.

“It’s not that everyone is doing it but if someone is self-harming, the parents should take them to see someone because it is a significant issue.”

Parents can initially engage with their GP, who may then refer the young person on to mental health services.

Ms Ryall also points out there is plenty of helpful information for parents online, for example, through Headspace, ReachOut.com and Beyondblue.

“It’s OK to have a conversation about suicide and risk with a young person, even though it can feel like a very scary thing to do,” she adds.

“There is good information that asking someone about suicide won’t plant the idea in their head but I do recognise that for parents, it’s an incredibly difficult conversation to have, so we try to encourage parents to say, ‘I am concerned, I love you, this is what I am worried about’.

“Just be really transparent and honest about what your concerns are, so, if it is a cut on the arm or a burn, ‘I am worried you don’t want to live anymore. What can we do to help?’.”

While there are no exact numbers for this behaviour, which is often kept hidden from adults, research shows at least 10 per cent of adolescents report having self-harmed.

And, it suggests three main factors make a person vulnerable to it.

First are individual such as low self-esteem, anxiety, depression, eating disorders or bullying.

Second is family including abuse, neglect, poor parental relationships, unreasonable expectations and excessive punishments and restrictions.

Third are social factors such as friends who self-harm, media and internet influences, availability of methods of self-harm, difficulties in peer relationships and peer rejection.

Anecdotally, there are also concerns the internet is spreading acts of self-harm around, prompting people to try it who might not normally or causing distress among young people who viewed it.

“You also hear about peer groupings where lots of them are hurting themselves,” adds Ms Ryall. “The research isn’t necessarily clear about contagion effect though.”

More often, self-harm is hidden from everyone, sometimes under long sleeves and trousers or through avoiding certain activities such as swimming.

A parent may not hear it is happening directly from their child, but from a teacher, sports coach or a friend instead.

Dr Ashleigh Lin, head of youth mental health at Telethon Kids Institute, says it can be difficult for parents to cope without the right support.

“When a parent encounters something like this, it’s usually the first time they’ve come across anything like it so knowing what to do and where to go can be really difficult,” she says.

“I think (an attempt by the young person to take their own life) is their first worry but often the behaviour is a way of releasing stuff that is going on for them.”

The research is clear now that self-harm is often used as a way of managing difficult emotions.

Put simply, it doesn’t mean a young person is attempting suicide. A consequence of self-harm can be accidental death though.

Experts also say some people who self-harm may also be suicidal. “Seeing your child cutting themselves and harming themselves can just be really distressing,” says Dr Lin, adding sometimes parents may need to manage their child’s injuries, such as applying pressure to bleeding cuts or cleaning the wound or managing burns.

“Parents can have a very strong feeling of helplessness because of just not knowing how to help their child in the best possible way when they can see they are in so much pain,” she adds. “The other thing is the mental health system is not always that easy to navigate, so trying to know where to take your child and how to get help can be quite complex.

She says if parents are concerned about a wound being too deep to manage or any other type of serious injury, they should seek urgent medical help.

Her research team at the Institute is working through a self-harm booklet with carers to determine if it is useful in helping them cope better.

“It’s important people understand that youth have special needs compared to children and compared to adults and Headspace is very youth friendly and also easy to access and meant to be a no-wrong-doors service for young people aged 12-25,” Dr Lin says.

Ms Ryall says young people who self-harm often stop once they are treated and given other techniques to manage their emotions.

How to support your child

Have a conversation, but don’t bring up self-harm straight away.

You could organise this around another activity, like a walk or drive.

Ask if anything is worrying them and how they are feeling.

Let them know you are not judging them or putting them down, and that you love them and that will not change.

Show that you are prepared to listen to your child.

If your child does not want to talk, see if they will write you a note, email or text message about how they feel.

Ask if they would rather speak to someone else (a GP, counsellor or helpline).

If your child is able to be open about their self-harm, try to help them work out feelings and situations that may trigger it.

Try to think together of ways to handle strong feelings that don’t involve self-harm.

Help them think through their problems and see possible solutions.

Encourage them to think about the long view and how things may change in the future.

Reasons for self-harm

  • to manage extreme emotional upset.
  • to reduce tension.
  • to provide a feeling of physical pain to distract from emotional pain.
  • to express emotions such as hurt, anger or frustration.
  • a form of escape.
  • an effort to regain control over feelings or problems.
  • to attempt to punish themselves or others.
  • to elicit care from others.
  • to identify with peer group.
  • self-harm can also be a suicide attempt.

Source: Coping with self-harm: a guide for parents and carers.

Developed by researchers at the University of Oxford.

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