Feeling sad, mental illness, and self-harm are still taboo topics in society, despite feeling sad being part of the normal range of human experience and emotions, and the increasing incidence, research into, and understanding of mental illness.
It can be very difficult for anyone to comprehend why someone would consciously and deliberately hurt themselves. Self-harm can be observed as cuts from razors commonly on wrists or upper thighs, scratching and picking at skin until it bleeds, as well as hitting heads on walls or punching them with fists. It is essential to know that for those that engage in self-harming behaviours, there is an expectation that injury will lead only to minor or moderate physical harm – that is, they are not self-harming with the intention to cause death. However, the risk of accidental death is very real, and it is not uncommon to experience thoughts of suicide in addition to self-harm.
Many young people have described self-harm as something they become dependent on, like an addiction, and engage in it repeatedly. Some have been doing it for years, regularly or sporadically. For others as they get older, it appears that the incidence of self-harm decreases; however this may be because it is commonly replaced by alcohol or drug consumption to self-medicate. In situations where the self-harming is chronic, young people have been living with the self-harm for so long that they have lost sense of their identity and don’t know who they are without it. Self-harming behaviours are often seen as ‘attention seeking’ and have very negative connotations associated with it. When adults hold this view, they tend to ignore and minimize the behaviour. What if these young people are seeking our attention, in the sense that they require and are worthy of our care, compassion and support? Self-harm is their coping skill and the only way they know how to communicate the intense emotional distress they are experiencing. Young people have stated various other reasons for self-harm including: A sense of relief and to avoid unpleasant thoughts and emotions such as depression, anxiety, anger, and worthlessness; to gain a sense of control as they feel they have none; to punish themselves; to feel ‘real’ as otherwise they feel ‘numb’ and detached from life.
Despite the perception that self-harm is ‘attention-seeking,’ it is actually predominantly a ‘secret’ behaviour and at times, people engaging in self-harming behaviours may be those we least expect. Young people will say they do not want to ‘burden’ others with their difficulties and will self-harm in the privacy of their own room or bathroom. They cover up their injuries with long sleeves or pants, even when the weather is hot. Although the self-harm provides them with an immediate sense of relief, strong feelings of guilt and shame come soon after and this can perpetuate their desire to self-harm further.
In supporting young people (or undoubtedly any individuals) who self-harm, there is always the short term and practical strategies of providing first aid (and call emergency 000 if found at risk of serious injury) in addition to teaching them the importance of, and how to apply basic first aid; ensuring that an environment is ‘safe’ (limiting access to sharp objects, medication etc.); and helping them find temporary distractions. Additionally, Youth Mental Health First Aid suggests advice for approaching a young person who is engaging in self-harming behaviours:
- Find a private and safe space to communicate your concerns
- Adopt a calm, supportive and non judgmental manner, even if naturally we may feel shock, upset or anger. For example, I once had a parent who reacted with ‘Oh, not again’ which made the young person feel worse.
- Actively listen empathize – do not give unhelpful advice or statements such as “You’ll get over it” or “but you’ve got a great life”
- Be comfortable sitting in silence
- Don’t try and force them to stop or promise to stop self-harming
- Ask if they are feeling suicidal
- Reassure them that there is support available and encourage accessing this support
Supporting those who frequently self-harm can be a long and ongoing process towards recovery. At Youth Off The Streets, many of our practices are based on the model of the ‘Circle of Courage.’ This concept identifies four areas of need for children and young people to develop emotional wellbeing: Belonging, Independence, Generosity, and Mastery. In assisting young people to identify their interests, values, and beliefs, they will discover their own identity and subsequently find a sense of belonging within themselves and with others. Adults can help young people build independence by providing them with the opportunity and autonomy to make and be responsible for their own choices, in addition to modelling problem solving skills. In doing so, they develop a sense of mastery and competence. We focus on a young person’s strengths and abilities in what they can do, rather than what they cannot. Lastly, creating an environment and teaching young people the virtue of generosity and selflessness can provide those that self-harm with a purpose and value for living.
In supporting those engaging in self-harming behaviours, it is imperative to remember that we must also take care of ourselves. Be mindful of your own overall wellbeing, know and do what activities and interests invigorate you, and identify who your own support people are.
Undoubtedly, the conversation around self-harm is not an easy one to have and there is often difficulty in knowing how to respond. Some people are scared or worried that talking about self-harm with young people will put the idea in their head, when in reality it is an issue that they are already aware of. It is vital to be open to having these conversations and being comfortable to learn more. This way, we slowly break down the stigma associated with self-harm and subsequently allow those that engage in these behaviours to find the support they need so that they can continue to live.