Self Harm

1. Self Harm Key understandings Jon Dauphinee Sarah McMullin Natasha Brewer

2. What is self harm? • The act of deliberately causing harm to oneself either by causing a physical injury, by putting oneself in dangerous situations and/or self neglect. • Cutting, burning, biting • Substance abuse • Head banging and hitting • Taking personal risks • Picking and scratching • Neglecting oneself • Pulling out hair • Eating disorders • Over dosing and self-poisoning

4. Proposed Criteria DSM V 1. The individual has, on 5 or more days, engaged in intentional self-inflicted damage to the surface of his or her body of a sort likely to induce bleeding, bruising, or pain (e.g., cutting, burning, stabbing, hitting, excessive rubbing), with the expectation that the injury will lead to only minor or moderate physical harm (i.e., there is no suicidal intent). • Note: The absence of suicidal intent has either been stated by the individual or can be inferred by the individual’s repeated engagement in a behavior that the individual knows, or has learned, is not likely to result in death.

5. 2. The individual engages in the self-injurious behavior with one or more of the following expectations: • To obtain relief from a negative feeling or cognitive state. • To resolve an interpersonal difficulty. • To induce a positive feeling state. • 3. The intentional self-injury is associated with at least one of the following: • A: Interpersonal difficulties or negative feelings or thoughts, such as depression, anxiety, tension, anger, generalized distress, or self-criticism, occurring in the period immediately prior to the self-injurious act. • B: Prior to engaging in the act, a period of preoccupation with the intended behavior that is difficult to control. • C: Thinking about self-injury that occurs frequently, even when it is not acted upon.

6. The behavior or its consequences cause clinically significant distress or interference in interpersonal, academic, or other important areas of functioning. • 5. The behavior does not occur exclusively during psychotic episodes, delirium, substance intoxication, or substance withdrawal. In individuals with a neurodevelopmental disorder, the behavior is not part of a pattern of repetitive stereotypies. The behavior is not better explained by another mental disorder or medical condition (e.g., psychotic disorder) • 6. The behavior is not socially sanctioned (piercing)

7. Why Youth Might Self Harm? • Self harm is primarily a coping strategy • Regulation of affect, such as to reduce tension or relieve dysphoric or unpleasant feelings. (depression or anxiety) • Self punishment (self-hatred, self anger) • Interpersonal reasons (A means of gaining an identity with peers) • Sensation seeking (to feel physical pain vs emotional pain or feel alive inside) • To gain control over their body

8. Quiz Facts: • Most often the youth will go to great lengths to hide their cuts, bruises, and scars. • Vicious cycle (endorphins) • Self-harm is not associated to suicide • Severity of self-harm is not an indication of the level of emotional stress • Individuals often learn of the behavior on the recommendation or observation of another.

9. Some #’s • A study in the UK found that in 15-16 year olds, approximately 6.9% of young people (3.2% males and 11.2% females) had self harmed in the last year • "We're seeing twice as many kids as we were 10 years ago," said Dr. Hazen Gandy, division chief of community-based psychiatry at the Children's Hospital of Eastern Ontario in Ottawa • The province's largest health authority, Eastern Health, started tracking mental health statistics in 2012. Those results so far suggest the number of youth who arrived at the Janeway emergency department for depression, suicidal thoughts or self-harm jumped to 418 last year from 280 in 2012 • Ratio of female to male 3:1 or 4:1 (DSM V)

10. Warning Signs • Noticeable scars, wounds, or bruises • Change in social behavior • Changes in activity and mood • Wearing long sleeves, pants • Wearing multiple bracelets • Marker slashes • Talk of self-harming or suicide

11. School Interventions • Recommended Teacher Reponses • What do we do • Recommended School Responses • What do we do as a school community

12. Teachers • Teachers are not medical professionals. • Ensure that there is a positive safe environment for the student • Watch for student connectedness in the larger school community.

13. Missing Manual for teachers

14. Teacher “do’s” and “don’ts” “Do’s” • Act on your suspicions • Extend and attitude of calm and understanding/reduce stressors • If open wounds are present refer to school nurse “Don’ts” • Think it is not my problem • Freak out or give ultimatums or get angry • Accuse of attention seeking • Give attention to the wound in publicly

15. Teachers “do’s” and “don’ts” Do’s • Inform of limitations of confidentiality • Be the link for the on site and off site mental health staff • Ensure a connectedness to the school Don’ts • Promise to keep it a secret • Take a completely hands off approach • Contact the home yourself

16. Please do not get frustrated or discouraged if this behaviour continues. It takes time to learn new coping strategies.

17. Teacher- Guidance • Advise of the limitations of confidentiality • Suicide Assessment to rule out suicide attempt • Refer youth to appropriate services • Develop a communication plan with the youth to advise the parents • Advise the parents • Follow-up with the family up 7 to 10 days • Create/ refer to support groups

18. Support Groups • Trained leaders • Closed Groups to promote trust • No discussions of wounds or scars- focus on the underlying issues • Very structured session based on new skills and behaviours (emotional regulation, mindfulness, self-soothing, exercise) • http://www.teensfindinghope.org/worksheets.html

19. School • Need to educate all adults within the building about Self-Harm • Create an awareness within the general community-be aware of contagion • Develop a clear plan or policy • Ensure a positive, safe environment • Engage with students as much as possible

21. What Can Families and Friends Do? Gain knowledge about self-harm Show concern for their well-being Contact and encourage discussion counselors Support new behaviors Avoid guilt, shame, judgment Discuss stressors, coping strategies, negative and positive thoughts and strategies to get support

22. Interventions in the Community • Screening Procedures • Counseling • Family level • Individual Level • Two Types of Therapy • Self help strategies • Group Level • Proven effectiveness • Potential problems

23. Interventions in the Community • Online Support Groups • Facts are that adolescents are online more and are seeking answers for their problems there • Anonymity factor may encourage more disclosure • Adolescents report positive experiences • Potential problems

24. Interventions in the Community • Residential Facilities • Appropriate for structured, intensive treatment • Staff supervision • Risks

25. Resources • http://www.ascd.org/publications/educational_leadership/dec09/vol67/num04/Helping_Self-Harming_Students.aspx • http://educatorsandselfinjury.com/educator-response/ • http://www.selfinjury.com/schools/ • http://www.insync-group.ca/ • www.selfinjurysupport.org.uk • http://journals.psychiatryonline.org/data/Journals/AJP/3323/867.pdf • www.heretohelp.bc.ca • www,nshn.co.uk/whatis.html • DSM V , psychiatryonline.org • www.lifesigns.org.uk • www.samaritans.org.uk • Journal of Youth and Adolescence, Vol.34, No.5, October 2005, Nonsuicidal Self-Harm Among Community Adolescents: Understaning the “Whats” and “Whats” of Self-Harm.