Transcript What is Mental Health?

Introduction to self-harm
A risk and resilience model
Charlotte Levene
Mental health: A definition
‘the strength and capacity
of our minds to grow
and develop, to be able
to overcome difficulties
and challenges and to
make the most of our
abilities and
opportunities’
Aims for the
session...
• Understand why some young people might self
harm
• Explore risk factors
• Explore helpful responses
• Consider what young people have told us
• Develop strategies to build resilience in young
people
Child Mental Health
• A capacity to enter into, and sustain, mutually
satisfying and sustaining personal relationships
• Continuing progression of psychological
development
• An ability to play and to learn so that attainments
are appropriate for age and intellectual level
• A developing moral sense of right and wrong
• A degree of psychological distress and
maladaptive behaviour within normal limits for the
child’s age and context
Problems & Disorders
Mental health problem
A disturbance of function in one area of;
relationships, mood, behaviour or development,
of sufficient severity to require professional
intervention.
Mental disorder
A severe problem (commonly persistent) or the
co-occurrence of a number of problems, usually
in the presence of several risk factors
A bio-psycho-social model
NATURE
(what we are born with)
EVENTS
(what happens to us)
NURTURE
(what we grow up
with)
Defining Self harm
• When some people feel sad, desperate, angry
or confused, they can hurt themselves. This is
called ‘self-harm’.
• People can do this in a number of ways and for
different reasons.
• People who harm themselves on more than one
occasion may do so for a different reason each
time. They may also harm themselves and not
tell anyone about it
NICE Guidance on Self Harm (2004)
Truth hurts
Young people who self-harm
do so because they have no
other way of coping with
problems and emotional
distress in their lives…. It
provides only temporary
relief and does not deal with
the underlying issues.’
Truth Hurts, Mental Health Foundation (2006)
http://www.mentalhealth.org.uk/publications/truth-hurts-report1/
Methods of self harm
Excessive
risk taking
Cutting
Restrictive
eating
Methods
Ingesting
Banging
Breaking
bones
Scalding
burning
Hair
pulling
YoungMinds & Cello Research
research
• 3 in 4 young people don’t know where to turn to talk
about self-harm…most seek information online
• A third of parents would not seek professional help if
their child was self-harming
• Almost half GPs feel that they don’t understand
young people who self-harm and their motivations
• 2 in 3 teachers don’t know what to say to young
people who self-harm
Talking self harm YoungMinds/Cello (2012)
http://www.cellogroup.com/pdfs/talking_self_harm.pdf
How common is it?
Approximately 2
children in every
classroom will
have self-harmed
How common is it?
• Between 1 in 12 and 1 in 15 young people self-harm
(truth hurts 2008)
• 7% of young people aged 15-16 in England selfharm (Hawton, et al., 2002)
• 37,000 young people presented to hospital in
2010/11 and many report previous episodes when
they did not go to hospital (hospitals admissions
statistics 2010)
• Inpatient admissions of young people under 25 for
self harm have increased by 68% in the last 10
years (hospitals admissions statistics 2010)
Increased Vulnerability
• 318 out of 1000 young people in young offenders institutions report that
they have self-harmed (ONS 2010)
• 18% of children aged 11-16, with a hyperkinetic disorder (similar to
severe ADHD) reported that they have self-harmed. This compares to
7% without this disorder. (ONS 2004)
• 25% of parents, who had a child with an autistic spectrum disorder,
reported that their child had self-harmed. (ONS 2004)
• Looked After Children and care leavers are between 4 and 5 times more
likely to self harm in adulthood than those not Looked After (Annual
Report of the Chief Medical Officer 2012)
Self Harm Myths
• What do you think are the main myths that
surround self-harming behaviour in young
people?
Self harm myths
Attention seeking
Just about
cutting
Its because of
the internet
Myths
associated with
self harm
Is a suicide
attempt
Fashionabledidn't happen
in my day
Associated
with specific
sub cultures
(Emo, goth)
Copying others
Consider what the effect of this stigma is
What is the effect of
this stigma?
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Increase feelings of shame and guilt
Encourage likelihood of hiding self-harm
Reduce willingness for open discussion/disclosure
Increase judgement
Add to risk
Reduce likelihood of adults identifying young people
Increase angry responses
Increase in panicked responses
Increase in “not taking it seriously” responses
Inaccurate and inappropriate referrals
Why do some people self-harm?
What young people
have told us…
“The thoughts are in
my head every day, I
can’t take it. Cutting
myself is the only way I
can deal with him
being around
Cutting takes my mind
off things, when I’m
unhappy about myself,
the way I am.”
“I don’t really like school and
nick off as much as I can. There’s
always arguments at home so I go out
and hang around with a group of lads
and lasses. We all drink a bit;
sometimes I cut my arm with a bit of
broken glass. It feels good, but
then I regret it the next day
when I see the scar.”
Release of unbearable pressure
“Cutting for me releases all the built up anger and
frustration and pain I feel inside. There are many
things that happen to me in my life which cause
the pain I feel and how I release it. Mostly the
feelings of isolation like being outcast pretty much
from relationships altogether. I don’t feel like I am a
very stable person and I hate myself a lot of the
time. I think body image also has a lot to do with
my cutting. School is stressful, home life I can’t
handle sometimes.”
Jolt back to reality (when
disassociating)
“Sometimes when I felt numb and empty, scratching myself
helped me to feel emotions again. Brought me back to life
in a way”
Young person
To physically feel
something
“Why do kids hurt themselves? Because they can’t feel
anything else. Why can’t they feel anything else? Because
a previous pain has scarred them, just like scar tissue that
you might have now, it doesn’t tan in the sun because it’s
dead! If you hurt inside for whatever reason, your inside will
die. And then you don’t feel anything. But your brain still
works you are still physically alive and the only way to bring
those feelings back is to physically feel something”
Escape from the unbearable emotional
present
For some young people, there are times
when the present is just too painful.
Something may trigger a past memory or a
current situation may be too difficult to bear.
Self-harm is a way that the young person
can escape from the unbearable emotional
present.
It’s a deflection of emotional to physical
pain
“My emotions can vary rapidly and be
very intense. If in an emotionally
charged situation, I will either during or
shortly after harm myself. I’m not good
at dealing with emotions or
communicating mine to others.”
Self-punishment
Some people carry feelings of self-hatred or
self-blame. When such feelings are very
powerful, people may use self-harm to
punish themselves. This may help reduce
their guilt.
(HandsonScotland)
“I would just like to mention the adrenalin rush that one
experiences with the pain. When I feel numb and like I
don’t really exist, I cause myself harm and it brings this
rush that brings you back to earth”
Physical release and feeling of calm and well
being
• Self-harm can bring its own physical release. Neurochemicals, such
as serotonin, are released when the body is injured in any way and
these may bring about feelings of calm and well-being. They
produce insensitivity to pain which help the individual survive when
faced with danger.
• Some people say that self-harm gives them this feeling of calm
•
It is likely that the body grows to expect a higher level of these
chemicals.
...and some people won’t be able to tell you
why they self-harm.... they might not know
or they may not be able to express it in
words
Self harm and suicide
“Pain works. Pain heals. If I had never cut myself, I probably
wouldn’t still be around today. My parents didn’t help me,
religion didn’t help me, school didn’t help me but self-harm
did. And I’m doing pretty well for myself these days. Don’t
get me wrong, not in a heartbeat do I think that self-harm is
a good or positive thing, or anything besides a heartbreaking desperate act that saddens me every time I hear
about it. But there is a reason why people do it.”
What are risk factors?
Conditions, events or circumstances that are
known to be associated with emotional or
behavioural disorders and may increase the
likelihood of such difficulties
Risk is cumulative
Risk is not causal but can predispose children
to mental health problems
Individual Factors
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Being Bullied
Not getting on with parents
Stress about school
Divorce
Bereavement
Unwanted pregnancy
low mood/anxiety
difficulty communicating
poor problem solving skills
Impulsivity
Experience of abuse
• Difficulties associated with
sexuality
• Problems to do with race,
culture and religion
• Low self esteem
• Feeling rejected
• an existing psychological or
developmental difficulty
• Hopelessness
• drug or alcohol abuse
Family Factors
• unreasonable
expectations
• Religious, ethnicity,
cultural identity
dilemmas or conflict
• young carers’ role
within the family
• domestic violence
• neglect or abuse
(physical, sexual or
emotional)
• poor parental
relationships and
arguments
• depression, deliberate
self harm or suicide in
the family
Social Factors
• difficulty in making
relationships/
loneliness
• persistent bullying or
peer rejection
• Racism
• homophobic attitudes
or bullying of children
who think they may be
gay, lesbian or
bisexual
• easy availability of
drugs, medication or
other methods of self
harm
What can you do to
help?
Listen non
judgementally
Explain what is
going to happen
next
Acknowledge
emotional
distress
Encourage
young person to
identify their
own support
network and
encourage them
to access other
support
Recognise your
limitations and
refer to
appropriate
service for
clinical
assessment
Show care and
respect
Control
contagion- talk
to any others
involved
Ensure that you
have time and
space to reflectlook after
yourself too
Assessing Risk
• Ask the young person to explain in their
own words, why they have self-harmed
• Remember- people self-harm for different
reasons at different times.
Don’t….
React with
horror or
discomfort
Ask
abrupt or
rapid
questions
Threaten
or get
angry
Engage in
power
struggles;
demanding
‘just stop’
Accuse
them of
attention
seeking
Get
frustrated
Ignore
other
warning
signs
Promise
to keep
things
secret
Resilient Children
“can resist adversity,
cope with uncertainty
and recover more
successfully from
traumatic events or
episodes”
Newman, T (2002)
Resilience
•Normal development under difficult circumstances.
Relative good result despite experiences with situations
that have been shown to carry substantial risk for the
development of psychopathology (Rutter)
•The human capacity to face, overcome and ultimately
be strengthened and even transformed by life’s
adversities and challenges .. a complex relationship of
psychological inner strengths and environmental social
supports (Masten)
Sarah’s film...
Harm minimisation
Taking control
of their lives
(helping to
reduce risk
taking
behaviours)
Developing
more healthy
ways of
coping
Increasing
their self
esteem
Increasing
their
assertiveness
in a positive
way
Developing a self harm policy
What do you think an effective policy would
look like?
1. Who would it target?
2. What would it need to contain?
3. How will you know that its having an effect?
4. Which local services need to be involved
in?
So what have we
learned..?
• Defined self harm and explored methods
• Recognised that the myths and stigma surrounding self-harm lead to
numerous adverse affects for those young people who do self-harm
• Recognised that there are many different reasons why a young
person may self harm and they may be different on different
occasions
• Most young people are secretive about self-harm
• Those who disclose must be listened to, cared for, taken seriously
and be assessed by professionals
• There are many ways you can help a young person reduce risk and
build resilience
YoungMinds
 Parents Helpline: 0808 802 5544
 Tel: 020 7089 5050
 Website:
http://www.youngminds.org.uk
 Training & Development:
[email protected]