Self harm in Surrey’s children and young people
Written by Dr Andrew Hill-Smith, Consultant Child Psychiatrist, Surrey and Borders Partnership Foundation NHS Trust
Dr Andrew Hill-Smith discusses why self harm happens and what can be done to help sufferers.
Surveys have indicated that around 25% of young people self-harm at one time in their lives with 10% self harming on more than three occasions. Self harm is about three times more common in females than males.
Some authors refer to self-harm as including a broad range of behaviours like drinking too much or over-exercising but in Surrey CAMHS we follow the NICE guidance definition which is self-injury or self-poisoning. Self cutting is the most common of the self harming behaviours.
Self harming happens for a range of reasons, most commonly a means of managing high levels of distress or difficult feelings, but it can also be a means of coping, or communicating this distress to others.
For a young person’s parents it is distressing to find out that their son or daughter is self-harming, so young people often hide what they are doing, causing feelings of discomfort and shame to build up.
Many young people find their own solutions to cope with the distress of self-harm. They may seek the help of peers or professionals in schools and elsewhere. It is really important to be compassionate and non-judgemental when hearing about self-harm since this is critical in finding solutions.
Surrey CAMHS may be asked to get involved if a young person is thought to be at high risk or if they are self harming and simultaneously suffering from significant mental health problems such as depression or an anxiety disorder.
There are no right or wrong ways to help with self-harm. There are a few things you can do which seem to be important for everyone. These include:
- forming a positive, helpful relationship with the young person
- acting with compassion and minimal alarm
- collaboratively find a positive solution to the problems that fuel the distress
- help them to communicate about their problem and monitor progress.
The Royal College of Psychiatrists has recently updated its guidance (mainly written for professionals) called “Managing self-harm in young people”, which includes a number of helpful sources of information.
North Bristol NHS Trust has written a helpful guide for school staff that contains instructions and suggestions on how to approach self harm in schools.
MindEd offers 20-30 minute online learning sessions, including several about self harm, which help adults identify mental health problems in children and young people
Self-harm consists of behaviours that range from occasional self-scratching, to stabbing, hanging, jumping, taking an overdose with intent to die, to suicide.
Self-harm is common. A 'Deliberate self harm by adolescents survey' (Hawton 2004) of young people aged 15 to 16 found that more than 10% of girls and more than 3% of boys had self harmed in the previous year.
The Royal College of Psychiatrist’s report, produced by our own Dr Andrew Hill-Smith in partnership with fellow psychiatrists and with contributions from Surrey CAMHS CYA team, “Managing self-harm in young people” shows that there is a gap in professional knowledge and understanding of how to support young people who self harm.
Teachers, counsellors, GP’s, nurses and CAMHS professionals who engage with children and young people who self-harm often do not know what to say to them and what approach to take.
Page ten of the report provides guidance on the roles of each professional in managing cases of self harm and tips on how to relate to the child or young person. There is also a section of useful resources at the end.
Why I self harm
A member of CYA talks candidly about self-harm and respecting yourself
I started self harming when I was ten years old. For a long time hurting myself was my only coping mechanism. It was familiar, and it was my escape from reality and the pounding voices in my head. It numbed the pain in my head for a while.
I self-harmed most when I had been drinking as I forgot how sharp the knives really were.
Those scars are red and raised and I swear I can physically feel them burning when people “subtly” glance at them. I can’t take the questions, the looks, the whispering. At the time I didn’t care about having them but now I am stuck with them for the rest of my life.
Teenagers have enough to be insecure about - how utterly stupid of me to give myself something so abnormal and blatant to worry about too.
Self harm has been romanticised and signifies fragility and beauty on some social media sites rather than real life pain and suffering.
Self harm is unacceptable and not something that should be praised. People who hurt themselves need support and protection from professionals.
I decided to find positive coping mechanisms rather than self-harming if I felt angry or alone. To make things much clearer, I stopped drinking and talked about my problems or made a note of them.
The most important lesson I've learnt is that you are your own best friend, so respect yourself the way you would respect anyone else you care about.
Look after yourself, love yourself, and be kind to yourself. You don't deserve to feel the pain that you feel, so don't take it out on yourself; work to find other means of coping to improve your life.
Written by a member of the CAMHS Youth Advisors team (CYA)
Self harm is also known as ‘self mutilation’ or ‘self destruction’. It is a way that some people ‘deal’ with their emotions.
They may be feeling numb, and want to know if they still can feel some sort of pain. They may feel overwhelmed and are seeking a way to deal with this feeling. Often the person will not know why they self harm but use it as a sort of coping mechanism.
The most common type of self harm is cutting, along with burning, swallowing foreign objects, taking an overdose of tablets, hitting your head or any body part against something in order to bruise yourself, or sticking things into your body.
Here are some ways to deal with the urge to self harm:
- Squeezing a stress ball to relieve anger and keep your hands distracted
- Punching something soft such as a pillow
- Snapping an elastic band against your wrist, this causes pain but without the scars or bleeding
- Drawing on yourself with a red marker instead of cutting
- Distract yourself by doing something that you enjoy
- Take a walk or exercise, this releases endorphins which will put you in a better mood
There is also another way which is called the ‘butterfly project’. You draw a butterfly on your arm or hand with a marker of a sharpie.
You then name the butterfly that you drew after a loved one. You must let the butterfly fade naturally, so you cannot wash it off deliberately.
If you cut or self harm in any way, the butterfly dedicated to your loved one dies. This is a creative and helpful way to make you think of who you’re affecting when you hurt yourself.
Written by a member of the CAMHS Youth Advisors’ team
A new app has been launched that aims to give discreet help and advice to children and young people who self-harm.
The ‘Recovery from Self-Harm’ app was developed by charity Broadway Lodge after it was noted that children and teenagers are reluctant to pick up leaflets or actively seek help or advice from doctors and charities for fear of embarrassment or being overlooked as attention seeking.
Children and young people can access websites, online support groups and find contacts and videos of professionals giving advice. There is also a quiz about the misconceptions and facts of self-harm.
The app is available for free from the App store and can be found by searching for “Recovery from self-harm”.
Anger can be perfectly normal and healthy for children and young people if it is expressed appropriately.
Children and young people can show their anger by shouting, refusing to do what they are told, saying horrible things and trying to upset others.
They can break or smash things, and hit or hurt their parents and other family and friends and disrupt lessons at school.
Children and young people can feel angry for many reasons, including the following:
- Struggling to cope with hormonal changes during puberty
- Friendship problems
- Being bullied or hurt
- Struggling with reading, writing or schoolwork
- Exam stress or academic pressure
TES has a collection of resources to help teachers and mental health professionals share anger management strategies with children and young people. The anger management programme includes PowerPoint presentations, activity booklets and worksheets that can be used with groups or individuals.
Anger management strategies for students and teens can also be found on Pinterest and parents and carers can find out how to cope with anger in children and young people on the Young Minds website.
Read the booklet 'How to deal with anger' produced by the mental health charity “MIND”.
Find out about Surrey libraries' selection of self-help books
Surrey County Council libraries is part of the national ‘Reading Well’ scheme and offer a selection of self-help books for children and young people with mild to moderate mental health problems such as anxiety and depression.
Themes such as anger management and stress are among the titles that have been recommended by GPs and other health professionals.
All titles encourage self awareness and understanding of health issues and help children and young people to develop strategies for coping that will aid improvement to their health and wellbeing.
Take a look at the libraries’ web pages to see a list of the libraries involved in the scheme and how to get copies of the books both hard copy and online.
A report released this month by Health Watch Surrey, the local consumer champion for health and social care services, has found that emotional wellbeing is the top health priority for young people.
In a survey of 220 young people in Surrey carried out by Surrey Youth Focus, more than 70% were concerned about potential health issues.
The four most reported concerns all related to emotional wellbeing: depression, self-image, self harming and exam pressures. Bullying was seen as a common origin of these problems.
To read the full report including young people’s views on CAMHS visit the Health Watch Surrey website.
CAMHS Youth Advisors (CYA) is made up of a group of young people who have their own personal experience of accessing CAMHS. We have a say in what goes on in CAMHS and take part in a variety of projects.
CYA works to ensure that children and young people who use CAMHS have a voice, through being involved in recruitment, staff training, service development and lots more.
Our main aim is to get more users involved with the decisions within the service, because a service aimed at young people should be developed by them too.
Over the last couple of months we:
- Presented at the Quality Network for Community CAMHS (QNCC) Conference on young people’s involvement in the recruitment of staff in CYPS in Surrey.
- Gave CYA in Schools talks, raising awareness and reducing the stigma around mental health.
- Ran Upload training for No Labels workers for one day and also for YSS professionals.
- Ran stalls in Surrey libraries promoting mental health awareness and CYA to children and young people during the October half term.
- Presented at the SABP membership Event at G live, sharing personal experience of accessing mental health services and the important of getting help.
- Presented at the National CAMHS Conference in November. We shared what the group gets up to and the different projects it has which give young people a voice and focusing specifically on Recruit Crew and involving young people in the recruitment on staff in CYPS in Surrey.
Upload training dates
Upload is mandatory service user perspective training facilitated by young people at CYA. It gives professionals an insight into what it‘s like to be a young person accessing mental health services in Surrey.
Training will be on 8 January at Quadrant Court, Woking. Booking for all CYPS workers is via ESR.
CYP Now Awards
The 'Children and Young People Now awards' is a nationally recognised annual award that has become the gold standard for everyone working with children and young people in the public, private and voluntary sector.
Surrey's own CAMHS Rights and Participation Team were short-listed for this award, within the Health and Wellbeing category and were invited to attend the Award Ceremony in London on the 20 November.
The evening was full of entertainment and celebrated the achievement of services working to support children and young people in different ways around the country.
Although we didn’t win the category we had a great evening!
CYA West is a fortnightly meeting group held at the Bisley youth Centre from 5.30-7.30pm which is supported by Chris, a youth worker from the centre.
The group has been working on CYA in Schools projects and posters to raise awareness about mental health as well as taking part in team building exercises.
CYA Woking now meets most Thursdays at Quadrant Court in Woking from 5.30pm - 7.30pm. The group has taken part in different consultation work and has already started to look at the CYA Awards 2015 project.
The group also enjoyed bowling after the meeting at the end of November. All new members are welcome! Please contact us below for more information.
Redhill drop-in usually runs on the fourth Wednesday of every month at the Redhill CAMHS Clinic from 5.30pm - 7.30pm.
We have been working on articles for our magazine, Our Voice, have also done a clinic make-over and are currently working on some ideas for an art project for the CYA Awards in 2015.
Dementia Friendly Surrey
Every other Saturday CYA members go to a care home in Woking to spend some free time with the residents there. We read through magazines or talk about weekend television – the residents particularly enjoy Strictly Come Dancing!
Other residents like talking about their past or simply playing cards. CYA members enjoy taking part in this intergenerational project.
CYA in School
CYA has presented at a few Surrey schools and colleges in the past months and has presentations also booked for the New Year.
Parent involvement group
During the group’s first meeting, parents and carers discussed their plans for 2015. If you are a parent or carer with a child who accesses services in Surrey and would like to get involved please email us on: email@example.com.
Come and join us
We are always looking for young people to join CYA. If you’re interested email us directly or give us a call.
Professionals should always get the young person’s permission before passing their details on to us. We will contact the young person as soon as we can.
Email us on: firstname.lastname@example.org or call 01483 519 571.
Young people are calling for widespread change to make sure authorities respect their rights and protect them from harm. Most young people find life hard to understand at the best of times but if they are suffering from a mental illness life is even more difficult for them to manage.
Hundreds of young people participated in working groups, focus groups, a national survey and a youth editorial board, to produce the Young People's Make Our Rights Reality manifesto , which covers:
- access to health services
- education rights
- employment rights
The manifesto was produced in association with , a coalition of charities campaigning for fair access for children and young people to advice, advocacy and legal representation.
Some of the changes to the way being called for include improving access to young person-friendly advice services and lawyers, ensuring young people are taught about their rights as part of the National Curriculum.
To get support for their campaign, young people have calling on the Government to carry out an urgent review of young people’s access to information, advice and legal support.
For more information and to support the campaign take a look at the documents below:
The Deputy Prime Minister, Nick Clegg, has said he will establish and chair a new Mental Health Taskforce, which will urgently examine how mental health services for young people can be improved.
It will focus on bringing treatment for mental health problems in line with physical health, and end years of discrimination.
Read the full story here.
The government has announced it will work with the PSHE Association to help schools improve how they teach pupils about mental health and banish the stigma which can leave young people with mental health problems feeling isolated.
It will also set out a blueprint for schools to use when delivering their counselling services, to make sure the advice given meet the needs of the people it is intended to support.
The government issued advice earlier this year on how to identify and support pupils whose behaviour suggests they may have underlying mental health problems so that fewer pupils will be wrongly labelled trouble makers.
Open to all CAMHS professionals including child and adolescent consultant psychiatrists and clinical psychologists, therapists, nurses, service managers and commissioners this national event offers an opportunity to share ideas, find out about the latest innovations and developments in CAMHS from around the country and gain new knowledge and skills.
Key themes for the day include suggestions for improving service quality in CAMHS with limited resources, streamlining the CAMHS acute care pathway, achieving integrated health and care pathways, and improving the transition from childrens mental health servies to adult services.
For details of the agenda and to book a place see the Young Minds website.
East Surrey Hospital - 12 January
Ashford & St Peter’s Hospital - date TBC
Epsom Hospital - 2 February
Frimley Park Hospital - date TBC
- What is Psychosis?
- Eating Disorder Awareness
- Self Harm Awareness
To register your attendance please email: email@example.com
For more information see the course flier.
SEND conference 2015
Friday 6 February, 9am to 4.00pm, Epsom Race Course
This annual event for SENCOs working in all phases of education provides an invaluable opportunity to update knowledge and improve practice in schools to enhance educational outcomes for children with special educational needs and disabilities.
See the Babcock 4S website for more information and to book.
8th Annual New Savoy Conference
“Psychological Therapies in the NHS”
11 – 12 February 2015, London
Simon Stevens, Chief Executive of NHS England will give a keynote speech on the 5-Year Forward View and Talking Therapies. Find out what the additional £120 million allocated for mental health services through to 2015/2016 has been earmarked for.
Download the conference programme and book your place.
Read “A systemic family therapy service within a social-care setting”, written by Stefania Whitten Rialti and Chris Vincent, Highly Specialist Family and Systemic Psychotherapists in the CAMHS Children in Care Service.
This article was recently published in “Context” the family therapy magazine and describes the development of the Family Therapy Service.
In the latest edition of SEND Bytes from the Special Educational Needs and Disabilities team meet Mindful Health Service Worker, Sharon Snape and find out about the CAMHS Eating Disorders team.
Children’s Services CSF e-newsletter
Find out about the new domestic abuse campaign, NHS 111, randomised coffee trials and more in this month’s Children, Schools and Families e-newsletter.
Parents' Pages 5 to 19 e-newslette
Our December issue includes an update on how Early Help works, how food banks work, information about a new course for parents of 14-19 year olds, and where you can get the best advice about benefits careers and more.
In the latest edition of Way Ahead, the Surrey Early Years and Childcare e-bulletin, find out more about free early education for two year olds and take part in a children’s wellbeing questionnaire.
Find out what happened at the Early Intervention in Psychosis, East Surrey Recovery Workshop that was held on 7 October 2014 at the Bickfield Centre in Epsom.
Early Intervention in Psychosis, East Surrey Recovery Workshop