Discussion Q&A

Question:
What would you advise the math teacher to do exactly when told by a student’s friends that a student is harming herself?

Answer:
Good question, okay so let’s play with that example a little more. The first challenge is to thank the kids. If you already have a designated person in the school who can be a significant contact for the student who has cut herself, I would connect them right away. You’ll want to see if there is a physical first aid challenge that needs to be addressed. It is very common, for example, that the cut might be quite shallow and still draw blood. If it is quite a gash, there is a challenge there. If the child looks like she is in reasonably good shape to take part in the class, I would tell her, “I will talk to you afterwards but we have a class to right now. If you would like to go and talk to someone you can do that but I would like you to take part in the class”. So do not alter your schedule.

Question:
I would like to go back to your comment about completing a suicide intervention, if a young person is engaging in self harm behaviour. In previous training, I was told that we needed to determine the young person’s intent. If the intent is not to die or the intent is low, then we would not proceed with suicide intervention. Can you clarify?

Answer:
There are several important pieces of information. One is asking directly, are you trying to kill yourself? If the answer is no and you believe that answer is true, does it make sense to go through all of the other elements of a suicide intervention? I would keep that as a possibility, but I would also be wondering about what kind of behaviours they are using to harm themselves. Cutting is by far the most common self-harm behaviour, but not that many people die by cutting. It is a relatively small amount. If it is determined for certain there is no intent to die, then an intervention should not be needed.

Question:
Are there school protocols that can be accessed as a template to develop with local school board?

Answer:
You can see where this is a fuzzy kind of behaviour because an educator should manage these kinds of behaviours but doesn’t want to take on the role of treating them. I think I saw a question go by asking what kinds of treatments are available. Some treatments would first of all address the self harm behaviours. They wouldn’t treat the self harm as the problem, they would treat it as a symptom of other difficulties. Some of the kinds of treatments that are most commonly used would be cognitive behavioral therapy (CBT) and dialectical behavioural therapy(DBT).You can google those and look them up if you aren’t familiar with them. There is a pretty good marriage between understanding self harm behaviour and how addictions function. There is a sense that this is a compulsive kind of behaviour. They look back and feel like they failed but they almost can’t stop themselves from doing it. In terms of school policies, you have come from to this webinar from a lot of different places, so I don’t know what your polices are like, but I know in Calgary in the Public and Catholic school system that there has to be one person on staff trained in suicide intervention training.

Barton-Beck, A. & Heyman, B. (2012). Accentuate the positive, eliminate the negative? The variable value dynamics of non-suicidal self-hurting. Health, Risk & Safety. 14 (5): 445-464.
Some respondents describe using self-hurting for a range of intrapersonal and interpersonal reasons such as making suffering bearable; establishing a private sense of autonomy; combating disassociation, and creating opportunities for self-nurturance. Others normalized it as equivalent to acupuncture, an aspirin or a stiff drink.

Bjarehed, J., Wangby-Lundh, M. & Lundh, L. (2012). Nonsuicidal self-injury in a community sample of adolescents: Subgroups, stability, and associations with psychological difficulties. Journal of Research on Adolescence 22 (4): 678-693.
Young adolescents who engage in self-injury are a heterogeneous group and most seem to self-injure only occasionally. Those adolescents with more severe NSSI incombination with risk for psychopathology show primarily internalizing problems (mainly girls), and those who show a combination of internalizing and externalizing problems (both boys and girls).

De Kloet, L., Starling, J., Hainsworth, C., Berntsen, E., Chapman, L. & Hancock, K. (2011). Risk factors for self-harm in children and adolescents admitted to a mental health inpatient unit. Australian and New Zealand Journal of Psychiatry 45: 749-755.
Child and adolescent services should be aware of the increased risk of self-harm in young people with mental health problems who live in blended families.

Hawton, K., Bergen, H., Kapur, N., Cooper, J., Steeg, S., Ness, J. & Waters, K. (2012). Repetition of self-harm and suicide following self-harm in children and adolescents: Findings from the Multicentre Study of Self-harm in England. The Journal of child Psychology and Psychiatry. 53 (12): 1212-1219.
Suicide was the cause of approximately half of all deaths following non-fatal self-harm. Self-harm by cutting was particularly associated with risk of suicide.

Hawton, K.,Saunders, K.E.A. & O’Connor, R.C. (2012). Self-harm and suicide in adolescents. The Lancet 379: 2373-82.
Important contributors to self-harm and suicide include genetic vulnerability and psychiatric, psychological, familial, social, and cultural factors.

Herpertz-Dahlmann, B, Buhren, K. & Remschmidt, H. (2013). Growing up is hard: Mental disorders in adolescence. Deutsches Arzteblatt International 119 (25): 432-440.
“Puberty brings on many biological, mental, and social changes. In this phase of life, the prevalence of serious mental disorders is about 10%.”

Moran, P., Coffey, C., Romaniuk, H., Olsson, C., Borschmann, R., Carlin, J.B. & Patton, G.C. (2012). The natural history of self-harm from adolescence to young adulthood: A population-based cohort study. The Lancet 379 (9812): 236-243.
“…most adolescent self-harming behaviour resolves spontaneously. However, young people who self-harm often have mental health problems that might not resolve without treatment, as evident in the strong relation detected between adolescent anxiety and depression and an increased risk of self-harm in young adulthood.”

Richardson, B.G., Surmitis, K.A. & Hyldahl, R.S. (2012). Minimizing social contagion in adolescents who self-injure: Considerations for group work, residential treatment, and the internet. Journal of Mental Health Counseling 34 (2): 121-132.
Social contagion among adolescents is a growing concern as the numbers of youth who self-injure increases. Social contagion is one factor motivating self-harm in group settings, residential facilities, and audiences for social and electronic media.

Sternudd, H.T. (2012). Photographs of self-injury: Production and reception in a group of self-injurers. Journal of Youth Studies 15 (4): 421-436.
Being exposed to or producing self-injury photos cannot easily be understood as something negative for young people that self-injure.

Tatnell, R., Kelada, L., Hasking, P. & Martin, G. (2014). Longitudinal analysis of adolescent NSSI: The role of intrapersonal and interpersonal factors. Journal of Abnormal Child Psychology 42 (6):885-896.
A combination of interpersonal and intrapersonal variables contributes to the onset, maintenance and cessation of NSSI in adolescence. Perceived family support appears to be an important safeguard against NSSI.

Tuisku, V., Pelkonen, M., Kiviruusu, O., Karlsson, L. & Marttunen, M. (2012). Alcohol use and psychiatric comorbid disorders predict deliberate self-harm behaviour and other suicidality among depressed adolescent outpatients in 1-year-follow-up. Nordic Journal of Psychiatry 66 (4): 268-275.
Deliberate self-harm was common in depressed adolescents and they shared the same risk factors with depressed adolescents with other types of suicidal behaviour.

Table of Contents

Self-harm and suicide

Centre for Suicide Prevention

Discussion Q&A

Further Reading