Clinical update

Young people and self-harm Essential facts

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Self-harm refers to a wide range of behaviours where people injure or damage their body intentionally. It ranges from cutting, burning or pinching to abusing drugs and alcohol or having an eating disorder. According to the Royal College of Psychiatrists, the incidence of self-harm in the UK has continued to rise over the past two decades and is said to be among the highest in Europe for young people.

Advice for young people www.selfharm.co.uk www.thesite.org/ mental-health/self-harm

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YoungMinds www.youngminds.org.uk

What’s new? Figures collated by the Health and Social Care Information Centre show that the number of children being admitted to hospitals in England for self-harming is at a five-year high. Admissions of girls aged ten to 14 rose by almost 93 per cent, from 3,090 in 2009/10 to 5,953 in 2013/14. There was an increase of 45 per cent for boys, from 454 to 659. The website selfharm.co.uk says that the figures for boys in particular could be the tip of the iceberg.

Signs and symptoms Signs include unexplained cuts, bruises or cigarette burns, usually on wrists, arms, thighs and chest; keeping fully covered at all times, even when it is hot; becoming withdrawn; bald patches from pulling out hair; unusual eating habits; and low self-esteem.

Causes and risk factors Triggers are individual and may come from an emotion that is difficult to manage, such as anger, distress, fear, worry, depression or low self-esteem. Some people self-harm because their friends do or because they see it as a sign of commitment to a gang. It can also be a form of self-punishment or a symptom of an

Expert comment Mervyn Townley is nurse consultant in child and adolescent mental health services at Aneurin Bevan University Health Board in Newport

underlying mental health issue. According to the website selfharm.co.uk, it is thought that around 13 per cent of those aged 11 to 16 will self-harm at some point. Research suggests that children exposed to the self-harm of others, such as siblings or friends, may be more likely to begin harming themselves.

Treatment Young people who have harmed themselves need an approach that encompasses biological, psychological and social factors. The risk of further harm needs to be assessed and a person-centred management plan provided. Addressing current problems is a major principle in all care and treatment.

How you can help your patient Self-harm can be difficult to talk about because of stigma, with young people often feeling embarrassed or ashamed and worried that they will be judged. Disclosures of self-harm should be handled sensitively. Prevention is also important – self-harm can be reduced through psychological wellbeing programmes in schools.

‘The majority of young people who self-harm are not at a heightened risk of killing themselves. Everyone who works with young people should be able to assess the risks. Instead, we see people panicking and referring them to specialist services. ‘People are frightened to ask the obvious question when they see a

Childline tinyurl.com/la2dn7q Mind tinyurl.com/p4njd4u NSPCC tinyurl.com/nd65qef Advice for care professionals Royal College of Psychiatrists www.rcpsych.ac.uk/files/ pdfversion/cr158.pdf NICE guidelines www.nice.org. uk/guidance/CG16 Nursing standard article Self-injury and harm minimisation on acute wards (2012) tinyurl.com/NS-self-injury

patient with cuts on their arm. There is a fear that by asking “did you intend to kill yourself?” you will plant the seed in someone’s head – but there is no evidence to support that this happens. ‘More often than not the young person will say that they do it when they need to relieve an emotion. To help them, more training is vital.’

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