Introduction

Self-harming behaviour is a very common problem particularly among children and young people.

Self-harm is increasingly recognised as an issue schools, colleges and other youth settings have to deal with. Working with children and young people who self-harm can evoke a wide range of emotions; anger, frustration and sadness which often reflect the emotions of the child or young person who is self-harming. Therefore it is important that anyone working in these settings has a general understanding of self-harm, signs to look out for and what to do if they become aware that a child or young person is self-harming, including knowing how to offer initial, brief support and when to share that knowledge.

All those working with children and young people need to:

• Better understand self-harm and the underlying reasons for it
• Understand what to do if a child or young person self-harms
• Help children and young people to be emotionally resilient, act sensitively and appropriately

Research from the Truth Hurts inquiry (2006) showed that the first response children and young people received when they first disclose their self-harm behaviour is key in them deciding whether to access further support or not.

It can sometimes seem difficult to talk to children and young people about sensitive topics. However if we show that we are able to do this confidently and calmly, it can open up a safe space for the person where they may have previously felt that it was taboo, shameful, or means that they have a mental health disorder. Sometimes the focus is on the self-harm rather than the causes and that have led to this expression of distress; some of the resources here can be used to explore these underlying issues.

These guidelines aim to share good practice and empower schools and other settings to help children and young people who self-harm and explain the roles of other teams who can provide specialised support.

In their setting, staff and colleagues will know who to inform, which agency should be contacted and what steps need to be initiated if deliberate self-harm is witnessed or suspected.

Likewise, parents and carers need to understand about self-harm and support their child, and young people need to know how and where they can get information, help and support from for themselves or their friends. The appendices in the information section can be shared to inform and support this process.

It aims to:

• Increase understanding and awareness of self-harm
• Alert staff to warning signs and risk factors
• Equip all front line staff to feel confident, informed and able to support children and young people most at risk
• Provide more advanced resources and guidance for staff regularly supporting students who self-harm
• Help senior leaders consider how to support staff that deal with self-harm, and the feelings this evokes.
• Signpost to mental well-being and self-harm support, resources, information and training suitable for educational and youth settings, children and young people and their parents and carers.

This approach will ensure a consistent, caring and appropriate response, provision of adequate support for the pupil, other pupils who have witnessed or know about the self-harm, and members of staff who may be experiencing significant shock or distress following a pupil’s disclosure or the discovery of self-harm.

Every school should have a ‘healthy school’ approach including strategies for mental health promotion and providing extra care for students and teachers at risk of mental health problems. Such an approach contributes to the prevention of self-harm as it is aimed at improving factors such as resilience, coping skills, social inclusion, and a safe school environment, which function as protective factors for self-harming behaviour.

This toolkit was developed by a multi-agency group in response to a request for guidance on self-harm for schools and other settings from the Milton Keynes Safeguarding Children Board. It should be applied in conjunction with the Milton Keynes Safeguarding Guidance.

It is not within the scope of this document to go into detail about specific difficulties that may be associated with self-harm, or its links with emotional or mental health concerns such as drug taking or drinking alcohol in excess which require specific interventions.

Acknowledgements

This resource pack has been produced by the Self-Harm Task and Finish Group chaired by Milton Keynes CCG and coordinated by Public Health at Milton Keynes Council and MK Together in consultation with a range of partners. It includes original resources available on the internet such as the University of Oxford Self-Harm Guidelines for schools staff and for parents (https://www.cwmt.org.uk/resources/) and the National Self-Harm Network (http://www.nshn.co.uk/).

In developing this Toolkit we drew on a number of similar toolkits developed in other areas including those for Northamptonshire and Nottinghamshire, but primarily would like to thank the authors of:

Buckinghamshire Guidelines and resources for schools to help support children and young people who self-harm. Aylesbury Vale Clinical Commissioning Group and Chiltern Clinical Commissioning Group with Buckinghamshire Safeguarding Children’s Board and Buckinghamshire County Council (2015)

Self-harm: Guidelines for Staff within School and Residential Settings in Oxfordshire. Oxford Health NHS Foundation Trust (2016)

As Chair of the Task and Finish Group I would personally like to thank all members for the sharing of their experience, skills and time dedicated to the production of this piece of work. Special thanks go to Dr Marianne Vinson, Public Health Principal at Milton Keynes Council for taking a lead role in developing this valuable toolkit.

The toolkit provides the framework to develop processes and support for children and young people in your setting:

• Devise a self-harm policy, including a clear confidentiality policy
• Raise awareness of self-harm with school staff
• Train specific staff to deliver the support to students using the toolkit
• Educate students to be ‘good friends’ by reporting concerns
• Address emotional well-being, promoting coping strategies and self-harm (secondary schools) as part of the PHSE curriculum
• Have leaflets and sources of information available for young people and parents or carers
• Control contagion (when self-harm becomes a common occurrence amongst a group of children or young people)
• Develop a ‘Names to Know’ list of students with wellbeing concerns
• Develop and nurture relationships and communication routes with the health professionals providing care for students who self-harm

Using the toolkit

The toolkit is largely made up of three parts:

Part 1: Dealing with Self-harm incidents: Guidance and resources for professionals

Part 2: Information and resources for Parents, Carers, Children and Young People

Part 3: Forms: Copies of embedded forms (Part 1) that can be downloaded and revised

References

We recommend you use the following information sources as the foundation for your awareness raising, information for staff and parents, and self-harm policy. They are all reproduced in this toolkit:

• “Information about Self-harm.” Children and Adolescent Mental Health Service (CAMHS) Milton Keynes, Central and North West London NHS Foundation Trust (CNWL) 2014 – updated 2019 for this toolkit and reproduced in the following pages.
• “Young People who Self-harm. A Guide for School Staff” produced by The University of Oxford in Association with the National Institute for Health Research (NIHR) and Oxford Health NHS Foundation Trust.
• “Coping with Self-harm. A Guide for Parents and Carers” produced by The University of Oxford in Association with YoungMinds and the respective Royal Colleges of Nursing, of Psychiatry and of General Practitioners.

Free copies and downloads of these last two guides are available from The Charlie Waller Memorial Trust https://www.cwmt.org.uk/schools-families-resources, email web@cwmt.org or call 01635 869754

MK CAMHS Information about Self-Harm Leaflet

Please refer to the Self-harm NICE Guidance: assessment, management and preventing recurrence for advice on what is required and good practice. Assessment in schools and education settings can be found in sections 1.8.3 – 1.8.7.

Flow diagram for dealing with self-harm/suicidal thoughts with a child or young person

2a. For adults in any setting: Responding to a self-harm disclosure

According to Mental Health First Aid England, when helping someone who is self-harming, your goal should never be simply to stop the self-harming behaviour. This is because often self-harm is a coping mechanism and to take that away without addressing the underlying causes can increase the person’s risk. Essentially, that individual is still full of uncomfortable and painful feelings but has no means of expressing them.

It is not easy to tell if someone is self-harming and children and young people find it difficult to approach people for support. This is partly because they might feel ashamed and guilty about their behaviour. The stigma associated with self-harm can prevent children and young people getting the support and information they need to establish better ways of coping.

There are a number of misconceptions about self-harm. It is often seen by others as a cry for help, a ploy to gain attention or as manipulation. However more often than not self-harm is a very private and hidden behaviour that does not involve anyone else. Some people will take great care in hiding their injuries and scars through shame, embarrassment or fear. They may conceal injuries under clothing, jewellery or make up excuses and explanations. A large number of people who self-harm treat their wounds themselves at home rather than seeking medical help. Other individuals who do let people know about their self-harm may do this as they have no other way to communicate how they are feeling. Self-harm for these individuals may be a cry for help. If someone goes to these extremes it is clear that they are in distress.

Don't panic! The worst thing you can do is to do nothing and ignore the self-harm – talking about the problem will not encourage more self-harm. Therefore, it is essential when a child or young person makes a disclosure it is not dismissed and is taken seriously.

DO: First Aid, Communicate, Make a Plan & Refer

First Aid

Management of physical injuries

• Keep calm and follow first aid guidelines for cuts, wounds or burns.
• If you have a medical emergency e.g. worrying effects of an overdose, serious physical injuries are present, or the young person is unconscious or having difficulty breathing call an ambulance (Dial 999).
• If an overdose is suspected the young person will need to be taken to hospital straight away for tests and possible treatment.
• Always ask the young person if they are in pain – they may have needed to feel physical pain at the point of self-harm but this doesn’t mean they want to feel pain afterwards.
• Involve the school nurse/matron/first aider where possible to assist with management; they may be able to give pain relief.

If someone is actively suicidal: they are clear they want to die, they have a plan and intend to act on that plan immediately, make sure someone stays with them – you still have time to seek advice as long as they are kept safe with someone. If the person has already taken an overdose - or if you suspect have might have - get them to the nearest hospital emergency department for medical assessment and treatment for the poisoning.

Communicate

Speak with the young person – invite them to tell you about the self-harm and any problems or worries they might want to share - this should be an invitation and not a demand to share everything, it may take a few invitations to talk before the young person feels able to risk sharing with you - the most important thing you can do it offer to listen

Don't tell them to “just stop doing it” the self-harm will always be of great importance to the young person and may be their only coping mechanism - so just stopping might leave them more at risk.

You may be the first to notice that a young person has been self-harming. This can be distressing and it can be hard to know what to do. However, it is important that you don’t ignore signs of self-harm. If you suspect self-harm, let the young person know that you have noticed a difference in their behaviour and be open about your concerns in an empathetic and caring manner. Young people will respond best if your reaction is calm, non-judgmental, and understanding. Your Safeguarding Policy will underpin all the actions. General guidelines are:

Do:

• remain calm, approachable and receptive
• listen carefully, without interrupting
• acknowledge you understand how difficult this may be
• make it clear that you are taking what is said seriously
• reassure them that they have done the right thing in telling you
• let them know that you'll do everything you can to help them

Don't:

• promise confidentiality
• ask leading or probing questions
• investigate
• repeatedly question or ask them to repeat the details
• discuss the disclosure with people who do not need to know

Share with someone – always speak to appropriate colleagues and consider referral e.g to your local CAMHS team: your local safeguarding protocol will also mean you may have to share with a parent or carer. Be clear with the young person why you are doing this and give them choices about how you might tell parents.

How to approach the young person - Helpful questions and statements:

To understand why a young person may be self-harming it is important to have an open conversation about their reasons. Start with sharing your concerns about their wellbeing and encouraging them to open up. It can be helpful to convey that you understand some of the functions of self-harm to encourage the young person to open up.

E.g. “I’ve noticed that [state the changes you have observed in their behaviour e.g. becoming withdrawn or irritable/angry] and I am wondering if maybe things are difficult for you at the moment?”

“Thank you for trusting me enough to tell me...” “I care about you, you deserve...” “How can I help you now that I know?”

“I wonder what are the sorts of things that make you feel like harming yourself?” There are more specific questions about self-harm included in other appendices (e.g. ❺c).

Within the School or other Setting

A2.4

Make a Plan:

• Make a plan - this might be as simple as making another time to listen or the plan might be to make a referral on - what is important is that you and the young person discuss and (ideally) agree the plan
• Act – do what you have agreed – even the best plans don't always go to plan - but do what you can as soon as you can
• Update - Let them know what you have done and what you haven’t managed to do yet, and why
• Stay in the loop - if the local CAMHS or Social Care start work with the young person – school still has a great deal to offer – it is important for the young person that schools and specialist services continue to communicate and work together in the interest of the young person

Refer:

Follow your local policies to share your concerns with, and seek further advice and support from your safeguarding lead or nominated mental health lead and follow the referral routes in this document. This might include referral to CAMHS / Community School Nurse / GP. Appendix ❽a-c

Seek advice from MASH on 01908 253 169 if there is an underlying or emerging Child Protection concern. You can also email children@milton-keynes.gov.uk

Charlie Waller - Supporting Young people who self-harm booklet can be downloaded here. 

National Self-harm Network leaflet on Common Misconceptions can be downloaded here. 

National Self-Harm Network leaflet on Basic First Aid can be downloaded here.

Developing a School (or Setting) Self-harm Policy

Introduction

Whilst the resources and templates provided in this toolkit can be used in isolation, alongside the Safeguarding Policy, all schools should ideally have a self-harm policy to act as a framework. Having a solid self-harm policy in place can help promote effective working with young people that self-harm, uphold best practice in relation to self-harm, and define clearly the interventions and steps that should be taken to support a young person that is self-harming.

The policy should inform the staff of what is expected of them, and be a document that helps staff to contain and respond to a situation fairly and responsibly with the best interests of the young person, in mind. Your policy should provide a clear set of protocols for dealing with any issues that may arise surrounding self-harm, including the response flowchart and how this will work in your setting.

Please use this guidance to help you consider what factors you wish to include in your policy and ways to implement it effectively. Other appendices in this toolkit provide information that can be inserted into your policy and detail where to access training, information and support.

Settings other than schools may wish to develop a specific self-harm policy or may ensure that their existing safeguarding policy, staff and volunteer training and risk assessment processes would cover basic awareness of self-harm and key principles relevant to the setting.

Every establishment is different and the policy you create will be unique to your school or other setting in order that it best serves your staff, pupils and parents.

For staff Headteachers, Setting leaders, designated leads and/or Governing Bodies

• Appoint one or more designated key staff to be responsible for all incidents relating to self-harm.
• Ensure that all designated staff undertake full and appropriate training and are fully confident with the procedures to follow including how to risk-assess and manage a co-produced ‘safety plan’.
• Ensure that all other adults in the setting are made aware of, and understand, the self-harm policy and procedures and have an understanding of self-harm and how to deal with a disclosure or incident. Provide information/training on how to:

• recognise the warning signs that someone may be self-harming;
• broach the subject of self-harm to a pupil they suspect of deliberately hurting themselves (if appropriate);
• react positively if a pupil comes to them to disclose or discuss their self-harm
• access information and support for themselves or others (e.g. staff support services; online resources)

(e.g. by using the booklet, “Young People who Self-harm. A Guide for School Staff” and forms and aids in this toolkit)

• Provide practical and emotional support for staff members who are dealing with a self-harming child or young person ;
• Provide clear and standard guidelines for all staff in contact with the young person;
• Review what special permissions could apply for pupils who self-injure, for example time out of the classroom during emotional distress and permission to wear long sleeves for sports.
• Create a procedural policy in case of self-injury incidents occurring at school/in the setting.
• Be clear about what behaviour will not be tolerated and ensure all pupils are aware and understand your rules (for example, self-harming in front of other pupils, posting photos on social media or threats to self-harm as part of bargaining).

For any child/young person/pupil who has self-harmed or is at risk of future self-harm:

Include what immediate actions will be taken if there is an incident in school (or your setting) and the actions and general principles you will employ to support them in the short and longer-term. Adapt the templates and resource in this toolkit e.g.;

• Immediately removing them from the group situation e.g. lessons, if their remaining there is likely to cause further distress to themselves or their peers
• how you will apply the risk assessments and plan for the young person’s care and management, to include assessing their unique and individual needs
• Develop a co-produced long-term plan of action for continued support, assistance and monitoring;
• how best to support their safety plan, their access to self-help, on-line or phone support and distractions/coping strategies during the school day
• assist in building their confidence, self-esteem and emotional wellbeing;
• your expectations of them whilst in school/the setting
  
  For parents/carers
• Make parents and carers aware of the self-harm policy (or for non-school settings, any overarching policies) ;
• Signpost to resources so they can understand self-harm and/or put on information sessions
• encourage them to discuss the subject with their child;
• Consider parental consent

If their child is self-harming:

• work closely with the school/setting and take an active role in deciding the best course of action for their child;
• keep the school/setting informed of any incidents that they feel they should know about;
• acknowledge they may need support to deal with their child’s self-injury; remind about support resources

For other children/young people

• Identify other friends or peers who are in close contact with the individual and/or potentially at risk and provide practical and emotional support to them
• Implement a harm minimisation strategy to prevent the spreading of self-injury within the school;
• provide education and awareness campaigns for pupils within the whole-school emotional well-being approach
• consider using peer leaders/mentors, trained to encourage their friends to identify and engage with a trusted adult and to use coping resources.
• communicate about available mental health and well-being support and signpost to school, local, online, telephone and text resources

Model Self harm Policies and guidance are available online from:

The Harmless Policy Guide to Working with Young People who self-harm, provides a complete overview of current research and good practice. Purchase and then download the Guide at http://www.harmless.org.uk/store/Resources/Merchandise-Books/Harmless-Policy-Guide

Lifesigns: Creating a School Self–Injury Policy (this is copyright free for educational establishments to use or reproduce) http://www.lifesigns.org.uk/wp-content/uploads/2015/02/schools-self-injury-policy-v2.pdf

Self-Harm Policy: https://www.tes.com/teaching-resource/self-harm-model-policy-6116951# This policy, developed as part of an Institute of Psychiatry programme, is designed to help school staff prevent and support eating disorders and self-harm.

The Lifesigns and Institute of Psychiatry policies are a little out of date in terms of the

background information, but many schools have developed policies and these examples can be found by searching ‘Self-harm school policy’.

Self-Harm Policy – Suggested Headings

1. Introduction

Recent research indicates that up to one in ten young people in the UK engage in self-harming behaviours, and that this figure is higher amongst specific populations, including young people with special educational needs. School staff can play an important role in preventing self-harm and also in supporting students, peers and parents of students currently engaging in self-harm.

2. Scope

This document describes the {school’s} approach to self-harm. This policy is intended as guidance for all staff including non-teaching staff and governors.

3. Aims
4. Definition of Self-Harm
5. Risk Factors

The individual, family and social risk factors, particularly in combination, that may make a young person particularly vulnerable to self-harm. Of particular note are depression, anxiety, bereavement (particularly by suicide) in the family and/or being bullied or rejected by peers; drugs and/or alcohol use.

6. Warning Signs

Be aware of warning signs which indicate a person is experiencing difficulties that may lead to thoughts of self-harm or suicide - Suicidal ideation is a warning sign that should always be taken seriously..

7. Staff Roles in working with students who self-harm

Disclosure, confidentiality, designated teacher or other appropriate adult; short term and longer term actions; referral routes to support services, health professionals and mental health referrals.

8. Further Considerations

Logging incidents and meetings; recording dates and times, concerns, decisions and actions; Details of anyone else who needs to be informed; resource signposting; where this information will be stored.

9. Supporting self-care and reducing self-harm risk

Minimum self-harm awareness requirements for all adults working or volunteering in your setting

10. Useful resources and professional support in your setting

Key points:

• Confidentiality is important to young people
• It is important to talk about what you can and can’t keep confidential
• Don’t make promises of confidentiality that you can’t keep
• Work on a need to know basis
• Involve parents wherever possible
• Parents may contact the school/organisation and requests that the information is only shared with certain staff. Their wishes should be followed wherever possible.

Confidentiality is very important to young people but staff must remember that they cannot promise that confidentiality. Each statutory agency must comply with the confidentiality and Information sharing documentation according to their own professional code of conduct.

Information sharing is essential for effective safeguarding and promoting the welfare of children and young people. It is a key factor identified in many serious case reviews, where poor information sharing has resulted in missed opportunities to take action that keeps children and young people safe. In view of the known increased risk of suicide in people who self-harm this is particularly important.

If you are aware that a student/young person in your care is self-harming, you are obliged to share this with your school’s/organisation’s designated safeguarding lead. This information would usually be shared with parents/carers too, unless this would post risk of greater harm. A discussion with the young person about the need to tell patents/carers should follow and their fears and concerns discussed. There is a specific section for young people about confidentiality and advice to support them to tell someone in Appendix ⓬e.

The following guidance has been outlined with reference to The Confidentiality NHS Code of Practice and Supplementary Guidance: Public Interest Disclosures (2010); and Information sharing: Advice for practitioners providing safeguarding services to children, young people, parents and Carers (July 2018)

Confidentiality

A duty of confidence arises when one person discloses information to another in circumstances where it is reasonable to expect that the information will be held in confidence. It :

1. is a legal obligation that is derived from case law;
2. is a requirement established within professional codes of conduct; and
3. must be included within employment contracts.

You may, in certain circumstances, override your duty of confidentiality if it’s done to protect a person’s best interests or the interests of the public. This means you may override your duty if:

• You have information that suggests a patient or client is at risk of harm.
• You have information to suggest that a patient or client is posing a risk of harm to someone else.
• You should view confidentiality in this situation on a need to know basis, which means that you only share information when it’s necessary and with people who need to know.

Disclosing confidential information & The Health & Social Care Act 2001: Section 60

The disclosure and use of confidential patient information needs to be both lawful and ethical. The key principle within ‘The Common Law of Confidentiality’ is that information confided should not be used or disclosed further, except as originally understood by the confider, or with their subsequent permission. It is extremely important that consent is sought from the young person and they are aware why and what information needs to be shared between different organisations in order to provide them with high quality care.

There are exceptions to the duty of confidence. Section 60 of the Health and Social Care Act 2001 which makes it lawful to disclose and use confidential information in specified circumstances where it is not currently practicable to satisfy The Common Law Confidentiality obligations.

Processing this must still be for a lawful function, but does mean that the confidentiality obligations do not have to be met, e.g. consent does not have to be obtained. Even where these powers apply however, the Data Protection Act 1998 also continues to apply.

Self-Harm related resources on Confidentiality

The Mix website has useful advice for young people about what to consider and how to tell someone about their self-harm, and what that person then needs to do around confidentiality: https://www.themix.org.uk/mental-health/self-harm/confidentiality-and-self-harm-5685.html

Useful resources and external organisations

• https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data /file/721581/Information_sharing_advice_practitioners_safeguarding_services.pdf
• https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data  /file/200146/Confidentiality_-_NHS_Code_of_Practice.pdf
• https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data  /file/200147/Confidentiality NHS_Code_of_Practice_Supplementary_Guidance_on_Public_Int  erest_Disclosures.pdf
• The Information Commissioner’s Office (ICO) website
• Practice guidance on sharing adult safeguarding information

Other relevant departmental advice and statutory guidance including: Working Together to Safeguard Children (2018); Keeping Children Safe in Education (2019); What to do if you're worried a child is being abused (2015).

Information sharing 7 Rules: (July 2018)

Online and in-house self-harm and mental health training, information and lesson planning resources (see also Appendix ❼a for younger children)

Self-harm training

Highly recommended: MindEd: www.minded.org.uk free e-learning and workshop resources for professionals on children and young people’s mental health - applicable across the health, social care, education, criminal justice and community settings. It is aimed at anyone from beginner through to specialist to understand mental health problems in children and young people:

Within the MindEd ‘Suicide and Self-harm prevention, Skills for Schools’ training suite there are a series of e-learning modules for schools that can be used for personal learning or workshop-based sessions for staff. There are downloadable teaching aids throughout the sessions providing extra information, some reflections and learning points as well as learning objectives and skills development tips.

Charlie Waller Memorial Trust (CWMT)aims to equip young people to look after their mental wellbeing and help people to recognise the signs of depression in themselves and others so they know when to seek help. Free online printable and video resources about young people’s mental health, for parents, school staff and young people. Topics include self-harm, depression, wellbeing during GCSEs (exam well-being guides), and social media. Their ‘Well-being action plan” booklets are a good starting point for older primary school children and Years 7 and 8

CWMT have developed ‘No Harm Done,’ three short films, co-created with young people, parents and professionals, reflecting their real-life experiences of self-harm. The films provide hope and practical support to those affected by self-harm and counteract the negative and frightening messages widely available online. The accompanying digital packs, also co-created by young people, parents and professionals, dispel myths, answer frequently asked questions, provide practical advice and signpost to further help and support.

CWMT deliver evidence-based training to schools and other youth settings to motivate, inform and provide practical tools. (also available for colleges, GPs and workplaces).

The PSHE Association have multiple mental health lesson plans and information. Several are specifically based on case studies of self-harm. (KS3 Lesson 4: Unhealthy Coping Strategies); or when to recognise mental ill-health (KS4, Lesson 3)

For younger children, their PSHE Lessons in key stage 1 and 2 include teaching about:

• Identifying and talking about feelings
• Understanding how feelings affect behaviours
• Strategies to manage feelings
• The link between mental and physical health; activities for mental and physical health (e.g. PSHE Association Lesson plans)
• Managing transition to secondary school
• Life events and circumstances: How it might affect someone and their feelings. What could help?

Service Six Provide Self Harm Awareness training for professionals. The training looks at what Self Harm is, how to spot signs that children and young people are potentially self-harming, how to deal with a disclosure that someone is self-harming and how to support the individuals. For further information regarding costings and tailoring the training package to your needs, please contact Katie Marsh, Milton Keynes Service Manager for Service Six on 07850 916600 or email Katie.marsh@servicesix.co.uk

Harmless: Harmless is a user-led organisation that provides a range of services about self-harm and suicide prevention including support, information, training and consultancy to people who self-harm, their friends and families and professionals and those at risk of suicide.

Harmless have developed a workbook in collaboration with service users, therapists and the Institute of Mental Health to provide a tool that can be used to promote recovery and self-reflection amongst people that self-harm, encouraging alternative methods of coping. The Harmless Workbook, available in either electronic or hard copy. 

Mentally Healthy Schools  is a free website for primary schools, offering school staff information, advice and practical resources to better understand and promote pupils’ and staff mental health and wellbeing. Links to other organisations self-harm resources including videos and training.

Mental Health training and resources

The Samaritans and Mind can provide resources and support for training and developing mental health and suicide prevention, campaigns and policies for communities, schools and workplaces through their local offices.

Mind’s local branch covers Bedfordshire, Luton and Milton Keynes (Mind BLMK) or via the main website to check out training programs or courses.

The Samaritans have online lesson resources and can provide talks into schools. DEAL (Developing Emotional Awareness and Listening) is a set of free online teaching resources, including lesson plans, handouts, digital resources and teacher training activities. It is aimed at education professionals who work with young people aged around 14 and over. The resources have been quality assured by the PSHE association and included in their Character Education toolkit.

Young Minds: offer training courses covering a variety of CYP-specific mental health subjects, including self-harm (charges apply). The Young Minds resources library has useful toolkits, publications, reports and policy information about children and young people's mental health. There is a 3600 Schools Community,

for the whole school approach to mental health. https://youngminds.org.uk/what-we-do/360-schools-hub/we-support-pupils-parents-and-the-wider-school-community

The Royal College of Psychiatrists: The College produces a range of materials for mental health professionals and the public including reports, toolkits and leaflets plus a series of factsheets for parents, teachers and young people entitled ‘Mental Health and Growing Up’.

RCPsych self harm

Connecting with People: largely aimed at professionals, this site includes free online training materials, articles (including lived experience) plus clinical practice tools covering Mental health

The Anna Freud National Centre for Children and Families

The Centre has resources for parents and carers, professionals and schools, including ‘Schools in Mind’ a free network for school staff and allied professionals which shares practical, academic and clinical expertise regarding the wellbeing and mental health issues that affect schools. The network provides a trusted source of up-to-date and accessible information and resources that school leaders, teachers and support staff can use to support the mental health and wellbeing of the children and young people in their care.

Mental Health First Aid - Provide Youth Mental Health First Aid (MHFA) courses. These are for everyone who works with, lives with or supports young people aged 8-18. They teach the skills to listen, reassure and respond, even in a crisis - and even potentially stop a crisis from happening.

Suicide Prevention

The Zero Suicide Alliance is a National collaborative promoting free suicide prevention training which is accessible to all. The aims of this training are: to enable people to identify when someone is presenting with suicidal thoughts/behaviour, to be able to speak out in a supportive manner, and to empower them to signpost the individual to the correct services or support. It takes about 30 minutes.

In Milton Keynes the Public Health “See the Signs, Save a life” training and information is available via https://www.milton-keynes.gov.uk/social-care-and-health/public-health/see-the-signs?chapter=4

Checked January 2020. This list is not comprehensive and new on-line resources, training and apps are being developed all the time. If you know of anything that you think we should include in this list, please pass on the details to us at: public.health@milton-keynes.gov.uk

The following sections and forms can be used as templates to lead and record incidents, meetings and discussions. Adapt the questions according to the young person’s needs. Forms can be modified to use in your setting, alongside existing protocols and added to the local self-harm policy.

Appendix 4a Responding to a Self-harm disclosure or incident in school – For all staff

Disclosure of self-harm might be to anyone in the school or setting, in public or private, from the individual themselves or someone acting for them or concerned about them.

The following ‘ABCDE’ template can be used to rapidly assess whether the situation poses an immediate risk to the individual, yourself or others and what the first actions should be, based on the flow diagram in Appendix 1. The primary question is, “Does the young person require medical attention?”

In the case of an acutely distressed child or young person, their immediate safety is paramount and an adult should remain with them at all times.

Rapid Risk Assessment

Do:

• remain calm, approachable and receptive and listen carefully, without interrupting
• acknowledge you understand how difficult this (disclosure) may be for them
• make it clear that you are taking what is said seriously
• reassure them that they have done the right thing in telling you
• let them know that you'll do everything you can to help them
• make a written record of exactly what has been said and done
• report the disclosure promptly to the lead person/team nominated in your self-harm policy, if applicable (this may be the Safeguarding lead if there isn’t a specific policy in your setting)
• look after yourself and seek support if the disclosure or incident has affected you

Don't:

• promise confidentiality
• ask leading or probing questions or ‘investigate’
• repeatedly question or ask them to repeat the disclosure
• discuss the disclosure with people who do not need to know

Form 4a: Action taken to record self-harm incidents (or intervention) in school and required medical/external intervention or treatment

(use alongside your local incident form which should include details of witnesses or those directly affected, who may therefore need support and follow-up)

For nominated staff to record incidents and/or disclosures with the young person

Specific staff may be identified as lead for a particular student or as a nominated role for a number of students or young people e.g. a mental health lead, head of year or self-harm lead. This assessment form provides prompts to allow an initial assessment with the young person to guide decisions and next steps.

Communication is key to the assessment;. When a child or young person tells you or hints they have self-harmed, seek to understand and communicate this understanding to create a beneficial and trusting alliance.

Often, it is not the young person who first asks for help from professionals, but parents and carers. However the disclosure or information is received it is still vital to see the young person and gain information from them directly. This will help inform your assessment as well as any referrals.

Assessment aims

• Establish a rapport with them
• Clarify the nature of their difficulties
• Begin to understand the underlying reasons for self-harm
• Establish what help might be needed

Consider the following:

• Be clear about confidentiality.
• Remain calm and non-judgmental. Listen and respect their story.
• Think about how the young person looks and behaves as well as what they say.
• Use scaling questions to explore how the young person is feeling and whether they feel hopeful.
• Does anyone else know?
• How? When? Where? How long (duration)? How often (frequency)?
• Is a multi-agency assessment required?
• Does a referral need to be made to CAMHS for a more specialist assessment?
• Are there safeguarding concerns?
• How well are they self-managing and/or using support resources? e.g. on-line forums, messaging e.g. Childline.

A ‘body map’ diagram (not included) may be useful to record the position of injuries e.g. if safeguarding concerns, but should be used at the discretion of the staff-member, as some young people have reported they find the use of these distressing.

This form is available in the Appendices, Part 3 and can be downloaded and revised for local use. Linked appendices are given (e.g. ❿a)

Form 4b Self-Harm Incident or Disclosure: Brief Assessment Meeting Form (sample with prompts)

For nominated staff supporting a child/young person back to school or setting after a self-harm disclosure or incident (or suicidal behaviour)

(Linked appendices for parents and young people are given e.g. ❿)

Before the child or young person returns to school following a disclosure or incident, meet with them and, depending on the circumstances, their parents or carers.

Pre-meeting checklist

• Ensure confidentiality: be clear about what the young person has agreed can be shared with their parents/carers.
• Ensure staff unfamiliar with self-harm have understood the basic details and how they can support a young person e.g. by reading ‘Young people who self-harm - A guide for school staff’, University of Oxford (Ob), undertaking online training or reading the school’s self-harm policy (if available).
• Prepare a selection of age-appropriate hard copies of self-harm resources and details of on-line organisations, apps and helplines (❿a) for parents (Q) and the young person (⓬). In younger children, generic support for emotional wellbeing may be more appropriate. (0)
• Provide the young person with Appendix ⓬g – “Thinking about what might help to support you in school”
• Advise the parents/carers and young person that you will need to undertake a risk assessment of the school environment, subject areas and other considerations so that their safety and that of other pupils and the school community is assured. (❺b)

When you meet you should explore what support is in place, and also what further support the school can provide – ask the child/young person what they need.

Aims

• Establish a rapport with the parents/carers and young person
• Provide a safe and understanding environment to jointly understand the nature of an incident and the triggers and reasons for self-harm
• Establish what professional advice has been given and how the school/setting can support any plans
• Establish what additional help and support might be needed in and out of school and how that can be provided
• Begin to develop a safety plan and/or well-being action plan to support the young person
• Ensure all parties understand the ‘safety plans’ and what actions would and would not be tolerated in the school/setting
• Provide information to support a detailed risk assessment for the school setting (Health and Safety at Work RA)

Even if the self-harming incident is considered to be a ‘one-off’ or low risk, and/or they may not currently be self-harming or suicidal, self-harm may still be a risk for them, or become an option again in the future.

Further support options for school to consider:

• Time Out card with allocated space and staff member
• Ensure they know who they can access medical and first aid treatment from if needed in future
• Daily check-in/check-out in school with staff member that the student feels comfortable talking to
• Establish what on-site triggers and situations may require specific coping measures
• Use of helplines or Apps in a defined setting in school time
• Which coping strategies, ‘safe spaces’ and options are available during lessons/at break times/before and after school
• Support from school counsellor / mentor or external agency
• Provide all peer group with information about support services / resources e.g. on-line forums, messaging e.g. Childline. and how to support friends.
• Consider initiating a Multi Agency Referral Form (MARF)

If appropriate, consider referral to:

• CAMHS for a more specialist assessment
• to other local services including with GP
• MASH

Copies of all embedded forms are available in Appendices Part 3 and can be downloaded and revised or formatted for local use.

Self-Harm Re-admission Interview - form and checklist

To be used at a meeting with parents/carers and student prior to the student’s return to school following a self-harm incident or following disclosure of self-harm and parent/ carer involvement.

Management of Health and Safety at work regulations: General Risk Assessment – (rename to local convention used e.g. Form RA2)

Enhanced assessment of young people who self-harm if a higher risk is identified by other assessments

If you, or someone else, are in imminent danger call 999

It is important to gather information about self-harm and the young person's thought processes associated with their behaviours in order to understand if there is serious risk to the young person's health or wellbeing, of the risk of death by misadventure, or the risk of intentional suicide.

Always be aware of a potential suicide risk. For the vast majority of young people self-harm is a coping strategy intended to help them continue with life not end it, however statistics do show a strong correlation between self-harm behaviour and death by suicide. Young people who self-harm are at a higher risk of subsequently dying as a result of suicide than the general population

When assessing risk, the key is to establish the intention behind the actions and if there was an intention to end their life they need a full assessment by a mental health team.

Those children and young people with a higher risk tend to be ones with more complicated profiles – those who report frequent or long-standing self-harm practices, who use high lethality methods, and/or who are experiencing chronic internal and external stress with fewer positive supports or coping skills.

Other risk factors for young people include:

• Family factors like mental illness or substance misuse
• Childhood abuse or adversity
• Bullying, loneliness, physical health, mental ill-health
• Alcohol or drug misuse or other risk-taking behaviours
• Exam and school stress
• Young people who are bereaved (especially by suicide and/or approaching an anniversary)
• Looked after children
• Young people who identify as LGBTQ+ and/or may have questions over their sexual and/or gender identity

Usually, it is the lethality of the action which determines the level of risk: i.e. jumping from height or into moving cars, using a neck ligature or taking a potentially fatal overdose or a toxin. Every overdose warrants a medical opinion.

Starting the conversation

Starting a direct conversation with anyone about suicide can be difficult, but it can also be lifesaving.

There’s no easy way to ask someone if they intend to kill themselves; but it won’t make it more likely. At the same time, skirting around the issue won’t help. The best approach is to be sensitive yet direct by asking such questions as: Are you thinking about hurting yourself? Are you thinking about dying? Are you thinking about suicide? Remember, mentioning suicide to someone who’s already thinking about it will NOT encourage them to go through with it.

If the young person tells you that they intended to take their life by self-harming, you need to lead into direct questioning about suicidal thoughts, plans and intent. All people who have an intention to take their life need to be seen by a medical professional.

The level of risk also depends on the circumstances and psychological mind state etc. Ask about

current circumstances, including other current and recent problems, life events and worries, including any nearby dates that have special significance for the person. This information will help with assessing possible precipitating factors.

Assess the existence and specificity of any plans for suicide. Investigating the availability of means of suicide is very important at this stage. This information will help to assess suicidal intent. Cross-reference with other responses, your knowledge of the young person and other people who know the child or who have witnessed or spoken to the young person. Weighing up all of the information obtained through these stages will help you to judge how close the person is to their threshold for suicidal behaviour.

For Suicide prevention, training and support also see Appendices ❸c and ❿-⓬ or check the following Samaritan’s page https://www.samaritans.org/how-we-can-help/support-and-information/worried-about-someone-else/ for what signs and situations to look for.

As well as training, The Zero Suicide Alliance have a specific booklet about how to open up the conversation about suicide: https://www.zerosuicidealliance.com/media/1095/zsa-talking-to-someone-who-might-be-suicidal-booklet.pdf

Six questions anyone can use

The following questions can help establish whether someone intends to take their life or are at higher risk of doing so. The first five questions are about a person’s feelings over the past month. These questions can be asked of people ages eight and older. They need to be included within an empathetic conversation indicating concern for the person, and asked in a non-alarming, matter-of-fact manner. If the person answers “yes” to question 2, ask questions 3, 4, 5 and 6. If the person answers “no” to question 2, go directly to question 6. If a young person has thoughts and/or plans to end their life, they will require assessment from a health care professional.

1. Have you wished you were dead or wished you could go to sleep and not wake up?
2. Have you had any thoughts about ending your life? If yes, how often do you have them?
3. Have you thought about how you might end your life?
4. Tell me about these thoughts; do you think you would act on your thoughts, if so how likely do you think you would be to act on them?
5. Have you started to work out or worked out the details of how you would end your life? Do you intend to carry out this plan?
6. Always ask question 6: In the past three months, have you done anything, started to do anything, or prepared to do anything to end your life? (e.g., writing a note to be found by someone after self-harming)

Online

Suicide-related internet use was reported in around 80 suicides by young people each year. This was most often searching for information about suicide methods or posting messages with suicidal content.

Phrases or themes to watch out for in social media updates and online messages include:

• I want to give up
• No-one would notice if I wasn’t here
• I hate myself

Not everyone who is struggling to cope will use these phrases, in fact some people might not be posting or messaging at all.

Actions following assessment as ‘Higher Risk’

Refer to the Flowchart ❶ for actions following assessment as high risk

Image

Sharing information without consent of the young person (also see Appendix ❸b)

There will be circumstances where it is clear that you must share information even if the child or young person does not want you to, this includes where there is high risk of suicide. Judging those occasions where actual or likely harm is serious enough to warrant breaking confidentiality is not always straightforward, however, and much will depend on your relationship with that person and your assessment of the situation. It is almost impossible to be certain that what the child or young person tells you is a true picture of their self-harm and whether your assessment allows you to make judgements about their future behaviour.

In terms of the law, whilst you must respect any request to keep a child or young person’s condition confidential, there are exceptions.

The Department of Health states:

“Where a competent child does ask you to keep their confidence, you must do so, unless you can justify disclosure on the grounds that you have reasonable cause to suspect that the child is suffering, or is likely to suffer, serious harm. You should, however, seek to persuade them to involve their family, unless you believe that it is not in their best interests to do so.” (Department of Health, 2001).

The Data Protection Act 2018 contains ‘safeguarding of children and individuals at risk’ as a processing condition that allows practitioners to share information. This includes allowing practitioners to share information without consent, if it is not possible to gain consent, it cannot be reasonably expected that a practitioner gains consent, or if to gain consent would place a child at risk.

It is important that the child has a Safety Plan: is a risk-management plan that details how the young person wants to stay safe if they self-harm. It is a plan that they have created with support. Safety planning is fundamental when working with self-harm behaviours. Having undertaken a risk assessment a support plan can now be developed to address some of the risks identified and to support the young person in the school setting.

It is essential that the plan is created together with the child not for them. The plan must be something that they feel they are able to agree to. Younger children might benefit from a well-being action plan that considers a broader coverage of emotional well-being, responses and resilience rather than concentrating on self-harm as such. (See ❼a)

The plan needs to be collaborative and involve the CYP and family at the Centre; created together with them, not for them. Plans should be individual, taking account of the young person and family’s needs and risks – it must be something that they feel they are able to agree to. Appendix ⓬g, “Thinking about what might help to support you in school” complements this one. Also use Parent and CYP resources e.g. ❿,⓬c, d.

The young person may already have a Risk Management Plan or Safety Plan in place, developed collaboratively with them by professionals involved in their care. If so, this can provide a basis for the plan in school and an opportunity to collaborate to support the young person and their family and ensure that the plan is consistent with the long-term treatment strategy. If they have a named CAMHS professional, it is crucial to involve them. ❽c.

Aim of the Individual Support/Safety Plan

The aim is to reduce the risk of repetition of self-harm and/or minimise its impact on the individual and those around them.

The plan should:

• address each of the long term and more immediate risks identified in the school’s/setting’s risk assessment,
• address the specific triggers and factors (psychological, environmental, pharmacological, social and relational) identified in the assessment as associated with increased risk,
• include a crisis plan outlining self-management strategies and how to access services during a crisis when self-management strategies fail

Support plan outline and considerations

The support plan headings for the young person are included in Appendix ⓬g.

In helping a young person to make a support plan, think with them about:

• Triggers – what might make them want to self-harm
• Warning signs – what they notice themselves and what other people could look out for. Could they use the NSHN Alert Card (❻b) to indicate this?
• Coping Strategies/distractions – what takes their mind off self-harming or calms them? ⓬c, d.
• Where their ‘safe places’ in school are for them; (link to the risk assessment as this may not be possible without adaptation)
• What positive reminders they can use to themselves for self-esteem
• People they can talk to in an emergency or when they need support
• Agencies, websites and apps they can use for support (❿) and when it is appropriate to use these at different times e.g. in certain lessons, at break times, etc.
• How they want people to help them?
• Who can the plan be shared with in school and outside school, including parents and friends? ⓬f

Other appendices in ⓬ can be used by the young person to understand their own triggers, coping strategies and what organisations and resources they can use for support and self-care.

Self-harm Safety Planning: Triggers, Behaviours and Adaptations in a school setting

A good Safety Plan always includes the following:

• Helpline numbers/text support/online counselling that are available and appropriate - including 24-hour helplines. e.g. Childline (❿) For someone already known to CAMHS this should include their crisis response numbers
• Other local ‘in person’ support services available. i.e. school mentor, support worker, youth services, after school activities, family support, children centres, specialist support services, Service Six, Youth Information Service
• Other Safety Contacts: people and organisations that they can contact when they feel they can’t keep themselves safe, including a safety contact for when they are at school.
• Key concerns/focus: e.g. anxiety, low mood, behaviours seen and the likely function of that behaviour, and some detail about cues, triggers and what coping strategy or alteration could be used to address this (see the table below).
• What alternatives to self-harm might work in different situations, including distraction techniques and coping strategies.
• Arrangements for regular ‘check-ins’ to see how they are doing and to check the plan is ok for them.
• The plan might also include professional support from a counsellor or therapist during school time and you should accommodate this within their timetable.
• One option might be agreement for access to an anonymous online forum or counselling service during school hours (such as Childline)

Be prepared to amend the Safety Plan based on the person’s needs; it is a live document and may change over time.

Other supportive actions

• Identify and encourage family and child or young person to have positive activities/events planned to look forward to.
• Discuss safe storage of medications and household chemicals with parents/carers.
• Consider on a case by case basis whether the removal of implements would be beneficial.
• The National Self-Harm Network provides further information regarding first aid and leaflets to share with young people and families ❷c,d ❻c ⓫c,d ⓬a,d (www.nshn.co.uk/downloads.html ).
• Harmless have developed a workbook, ‘Working through Self-harm’ - it can be used to promote recovery and self-reflection amongst people that self-harm, encouraging alternative methods of coping. http://www.harmless.org.uk/store/Resources/Merchandise-Workbook
• Service Six, a charity supporting young people in Milton Keynes, have a specific resource, Spectrum, the Opal Project journal, offering inspirational quotes and pages that feelings can be expressed through writing or drawing http://www.servicesix.co.uk/assets/spectrum-july-2016-small.pdf

The appendices of this toolkit have additional resources for young people to use for self-care and coping strategies. ❿⓫⓬

Harm minimisation

NICE (2011) defines harm-minimisation as not condoning or encouraging self-harm but aims to maximise safety at a time when stopping is not immediately attainable.

Harm-minimisation approaches accept that someone may need to self-harm at a given point and focus instead on supporting the person to reduce the risk and damage inherent in their self-harm. If someone is going to harm, it is safer to harm with information than with none. The capacity to engage in harm-minimisation might vary. The level of risk must be reviewed regularly, and the safety plan should be altered accordingly.

Some harm-minimisation approaches may be useful to implement in the school as part of a safety plan.

• Reinforce existing coping strategies and develop new strategies as an alternative to self-harm, where possible.
• Advise the person that there is no safe way to self-poison (medication/chemical/fluids).
• Provide the person with first aid advice and basic anatomical information about the body’s structures
• Discuss how they will access medical attention
• Discourage the use of cutting with the same implement time after time, as this can encourage infection. Instead discuss the following: using clean implements, keeping wounds clean and having access to a first aid kit and medical care.

National Self-harm Network - Self-harm Report Card

The National Self-Harm Network self-harm Report Card can be downloaded here.

Self-harm in primary school age children is uncommon. The National CAMHS Workforce Programme in their Children and Young People who Self-harm Handbook (March 2011) quote a survey of more than 10,000 children found that the prevalence of self-harm among 5-10 year-olds was 0.8% among children without any mental health issues and only slightly higher for those with any form of mental health condition.

It is unusual for children of primary school age to engage in self-harming behaviours, but it is not unknown. Self- harm can be easily missed or misdiagnosed in this age group. If a primary school child is found to be self-harming this is often a sign that there are difficulties in the child’s environment or a health problem.

Behaviours may include:

• Small shallow cuts
• Hair pulling
• Head banging against hard objects
• Deliberate self-grazing or scratching
• Hitting/punching themselves

Avoid using labelling a primary age child as 'self-harming'

Self-harm’ is a term that is now commonly used but without a clear definition can lead to misunderstanding. Avoid using the label 'self-harm' in a primary age child and instead reframe a child's behaviour as the demonstration of distress and/ or help seeking behaviour; seek clarification from others who use the term to find out exactly what they mean

Once the term ‘self-harm’ is accepted in children under 10 years and the child has been labelled in this way, it can then be reinforced by other practitioners. As a result the label is seen as fact and further analysis is not undertaken to ascertain if there is another cause, including abuse.

Furthermore, where the label of ‘self-harm’ is used, recording of what the child is alleged to have done to themselves, or the injuries sustained, is not detailed or robust.

Understanding and responding effectively

Always be mindful of the underlying factors which may lead a child or young person of any age to self-harm. It is important to recognise that this behaviour is an indicator of emotional distress and the child will need support to address this. Don’t focus on the self-harm or trying to get the child to talk, but set up the environment that will allow for a supportive response, should the child disclose.

Primary school teachers are particularly familiar with supporting children who are showing distress and a child that is self-harming should be supported with the same positive behaviour strategies they would use with a child showing other distress (such as crying).

Where information suggests that a primary age child has self-harmed, serious consideration must be given to whether there are other underlying factors, including abuse. Be mindful that if abuse is occurring, rather than self-harm, that a child may have been coached to say they are self-harming.

If the child does want to talk about self-harm, some of the resources available may be suitable for them: Childline’s Self-harm pages at https://www.childline.org.uk/info-advice/your-feelings/self-harm/self-harm-coping-techniques/ use simple language and have some straightforward coping strategies that might be useful to explore.

Keep clear records of what the child is reported to have done, or the injuries they have sustained, and the impact this has had rather than simply saying the child ‘self-harms’.

Use chronologies and genograms to provide clarity to all involved of the extent, pattern and severity of concern and to support any referrals e.g. to Children’s Social Care.

Maintain professional curiosity - and look for the evidence to support or disprove potential hypotheses and triangulate evidence.

Be aware that what may have started as a hypothesis has become fact along the way - reflect on and analyse historical records and assessments to understand whether or not a different hypothesis may be a better fit.

Toolkit appendices given below are referenced as e.g.⓫

Supporting self-care and sense of self-worth

• Boost the child’s self-esteem and sense of belonging in the class by focusing on things they are good at
• Consider any stresses in the school environment that can be changed, for example more support around learning difficulties/bullying
• Establish and promote peer relationships such as their circle of friends
• Maintain routines, boundaries and positive behaviour management strategies while being aware that the child is having a difficult time
• Provide positive encouragement if they show safer ways of expressing feelings
• Devise age-appropriate calming and coping activities e.g a (positive, affirming) message to self; distractions and coping ideas and discussing activities for good mental and physical health ⓬c, d and h
• Make sure the children know there are anonymous sources of support if they are worried about anything e.g. Childline (Q⓬and discuss how they could contact them (for example if they don’t have access to a phone or computer)
• Remember school can be a safe haven for children to get away from their problems
• Liaise with parents and carers; share information with them or direct them to some of the organisations listed in this toolkit. 

CAMHS is available for advice and support or if there are concerns about a child’s emotional/mental health. 

A common assessment (MARF) might be appropriate. This process will help the school to work alongside the family and other professionals to support and protect the child.

Developing an individual support plan – The ‘well-being action plan’

For younger children, rather than a specific self-harm support or safety plan, it may be useful to work through an individual action plan that can support constructive conversations and allow the child to be actively involved in devising coping and safe options and to work towards finding a solution for an underlying issue that could be causing their distress.

This ‘Wellbeing action plan’ has been piloted with individual children across Milton Keynes by a number of professionals working with children and young people in a one to one setting. It is one of the Charlie Waller Memorial Trusts’ most popular resources and has been designed with those children who need a little more support in mind. It is most suited for children in Key Stages 2 and 3, but also has benefits for those in Key Stage 4.

CWMT do not recommend that you give it out to all pupils in your setting or year group. Instead, they suggest it is used to guide conversations with a pupil to help them identify their strengths and manage their wellbeing when they feel things are tough. This ensures safe and supportive conversations, while also safeguarding against any unhelpful thoughts which would otherwise not be picked up by an adult. It can also aid communication with parents and carers, and consistency of support between home and school.

The plan can be downloaded or up to 100 hard copies can be ordered directly from CWMT.

https://www.cwmt.org.uk/schools-families-resources

Supporting emotional health and well-being of younger children

The CNWL CAMHS service has a Cope-ometer to help younger children understand the link between stresses and mental health – but it applies to all of us! Also check out the resources and links in the child-focussed appendices ⓬b&c and ⓬h, ’Taking care of myself’. Other toolkit appendices will be suitable for parents and some children of primary school-age so it is worth exploring these.

Lesson plans and information suitable for use with younger children (also ❸c)

1. PSHE Association https://www.pshe-association.org.uk/content/guidance-and-lessons-teaching-about-mental-health

PSHE Lessons in key stage 1 and 2 include teaching about:

• Identifying and talking about feelings
• Understanding how feelings affect behaviours
• Strategies to manage feelings
• The link between mental and physical health; activities for mental and physical health (e.g. PSHE Association Lesson plans)
• Managing transition to secondary school
• Life events and circumstances: How it might affect someone and their feelings. What could help?

2. Young Minds: Primary School and younger child relevant information including school transition, support networks, positive mental health messages)

https://youngminds.org.uk/resources/school-resources/?f2=10144&f3=10151#listing

3. Anna Freud National Centre for Children and Families - You’re never too young to talk mental health animation and lesson plans https://www.annafreud.org/what-we-do/schools-in-mind/resources-for-schools/talking-mental-health-animation-teacher-toolkit/ Information for parents is also available: https://www.annafreud.org/media/7228/tmh-parent-leaflet-final-all-approved-laid-out-for-web.pdf

This "Talking Mental Health" animation aimed at primary school pupils, was developed in collaboration with children. The Anna Freud Centre has developed a Teacher Toolkit for school staff to use alongside the animation which includes:

• A lesson plan
• An Assembly PowerPoint
• An accompanying Assembly Plan
• Tips for talking for parents and carers booklet
• Various resources and classroom exercises

Also join their ‘Schools in Mind’ network for other mental health resources and training.

4. Childline: Topics include changing school, coping with bullying etc. https://www.childline.org.uk/info-advice/school-college-and-work/school-college/school/

Note: This Appendix is in development, but in the meantime we have included some links to on-line resources here – If you know of any resources or have developed these and/or have an existing summary you can contribute please notify MK Together at Milton Keynes Council on MKTogether@milton-keynes.gov.uk

Self-harm and self-injury resources

‘The Hidden Pain?’ is a self-injury research project that looked at the perspectives of people with learning disabilities who self-injure. This is the first time a study has actually asked people with learning disabilities throughout the UK about their own understandings of their self-injury and what would help them.

Resources available from the project are free for people with learning disabilities

• A DVD of people with learning disabilities talking about their experiences of self-injury
• A workbook for people with learning disabilities who self-injure, to help them think through and address their self-injury.
• An information booklet for family members/supporters or people with learning disabilities who self-injure
• https://www.selfinjurysupport.org.uk/self-help-resources-for-people-with-learning-disabilities resources (‘Hidden Pain’) for people with learning disabilities, carers and supporters.

NB This organisation has an alert on their web-site that indicates that due to lack of funding they may need to cease in early January 2020. It might be a good idea to order some of these resources now.

About half of autistic people engage in self-injurious behaviour at some point in their life, and it can affect people of all ages. Find out about the possible causes, The National Autistic Society has a wealth of pointers about possible causes, things you can do when it happens, and ways you can try to prevent self-injurious behaviour.

The role of the GP

• If the young person (or indeed anyone) is experiencing mental health problems for the first time and need emergency treatment or advice during office hours, then you should first try to contact the young person’s GP. They will be able to refer you to the most appropriate mental health service in your area. Most practices have a Duty Doctor. If you don’t know the young person’s GP, or he/she is not working that day, ask to speak to the Duty Doctor
• GPs can refer patients to CAMHS (Child and Adolescent Mental Health Services) however the best person to refer the patient to CAMHS is the person who knows the child or young person best. This is often the school. CAMHS also accept self-referrals from young people. If there is confidential information regarding the patient or their family which is in the young person’s best interests to share with CAMHS the GP can still do this, and ‘back up’ a school referral.
• GPs should have been made aware of any hospital attendances, (but may not have if the hospital’s records are out of date)
• GPs should have been sent a copy of the CAMHS initial assessment and a summary once discharged from CAMHS
• GPs may have nurses who can do simple wound care / dressings, often the same day if asked.
• Doctor-Patient confidentiality may often mean that the GP cannot give you information regarding a young person’s treatment, or even confirm if they are receiving treatment / being seen by CAMHS etc. However if you have information that you feel the GP would benefit from, please do let him / her know as they will want to know, and have a professional obligation to act on that information.

The role of the hospital

• The hospital will provide emergency medical treatment
• All overdoses will require medical assessment, this may be through GP/111, however most overdoses need to go to hospital to enable blood tests to be done and for assessment and possible treatment; all young people who attend A&E with self-harm or following an overdose will have access mental health assessment.
• Access Milton Keynes Emergency Department (A&E) for medical treatment and mental health assessment by MK CAMHS LIST (Liaison Intensive Support Team) Every under 18 year old who goes to Milton Keynes Hospital with self-harm or following an overdose will have a mental health assessment from MK CAMHS LIST.
• In many hospitals, Social Care will be informed about every child or young person presenting with self-harm.
• A busy hospital Emergency Department is not always the best

environment, psychologically, for young people who have self-harmed. An alternative option may be an urgent appointment with CAMHS or the GP or to discuss with NHS 111.

The role of the Milton Keynes School Nursing Service

The Milton Keynes School Nursing Team Service provides health, advice, health screening and support to school-age children and young people School Nurses are qualified nurses who hold an additional post graduate qualification in Specialist Community Public Health, which is recordable with the Nursing and Midwifery Council. School Nurses support the holistic assessment of health and wellbeing of school aged children; through health promotion, ill health prevention and early intervention strategies. School Nurses support individual children and families through either direct support or referral to another service or profession. The School Nurse is supported in their role by Registered Nurses and Health Care Assistants.

The school nursing team can support with children and young people with the following:

• Healthy lifestyle; including weight and healthy eating
• Body changes, puberty and hygiene
• Support and advice regarding health conditions such as asthma, anaphylaxis etc
• Reassurance about a health worry
• Stress at home or at school, including bullying
• Poor sleeping patterns
• Concerns regarding vision and hearing
• Bedwetting/Continence issues
• Mental and emotional health and wellbeing
• Information regarding smoking, alcohol and drugs
• Relationships and sexual health
• Information about immunisations
• Information about other services and where necessary refer to other health professionals or services. Please note this is not an exhaustive list.

How can someone be referred?

• Referral can be made by schools, other practitioners, families and young parents
• For all queries please contact the service on 01908 725100. This number provides single point of access for people to contact Milton Keynes Children's Universal Health Services, including our Health Visiting Service and School Nursing Service.

Service times

Services are available from 0009.00–17:00, Monday to Friday year round

Telephone: 01908 725100

Address: Shipley Court, Marsh End Road, Newport Pagnell, MK16 8AE

CAMHS Child and Adolescent Mental Health Services

CAMHS (child and adolescent mental health services) is for children and young people aged 0-18. CAMHS helps them and their families with emotional, relationship and behavioural difficulties when they are finding it hard to cope with family life, school or the wider world.

How do I get help from CAMHS?

Where there are significant concerns about a young person’s welfare, for example

serious self-harm, you can call 01908 724228 during office hours to discuss (between 9am and 5pm Monday to Friday) or take them to the Emergency Department at Milton Keynes University Hospital NHS Foundation Trust (or any other Hospital).

Telephone: New referrals and advice line 01908 724228

Existing patients should call 01908 724544

Referral: Parents, teachers, the GP, or the young person if old enough, can refer for an assessment with CAMHS. Also CYP being supported by social care, a youth offending team or a service at the school, could also refer.

It's important to include as much information as you can so the young person can get the help they need.

12. Consider a range of external agencies prior to referring
13. Make sure that whoever makes the referral, i.e. School, GP, is best placed to do so
14. Phone the Duty Worker at CAMHS on 01908 724228, if you have concerns at any stage and / or before making a referral.
15. Complete a detailed MARF and send to MASH: children@milton-keynes.gov.uk

Address:

MK Specialist CAMHS, Eaglestone Health Centre, Standing Way,

Eaglestone, Milton Keynes, MK6 5AZ

Milton Keynes CAMHS: www.cnwl.nhs.uk/service/milton-keynes-camhs/

Also See the ‘CAMHS and me’ leaflet in Appendix 8c Website: www.camhsandme.org

Adult Mental Health Services AMHS (for over 18 year-olds)

If this is the first time you need help for a mental health crisis - during office hours

If someone is experiencing mental health problems for the first time and need emergency treatment or advice during office hours, then they or you should contact their general practitioner (GP). They will be able to refer the person to the most appropriate local mental health service. Outside office hours call NHS 111 (111 from any phone).

If you/they already use CNWL Mental Health services, the first point of contact should be the person that they usually see (e.g. their care coordinator, or named lead professional). The contact details of their care team, are contained in their care plan and on their Crisis Card. (During office hours - 9am to 5pm, Monday to Friday)

If an adult needs help for a Mental Health crisis out of office hours

The Central and North West London NHS Trust (CNWL) Out-of-Hours Urgent Advice Line 0800 0234 650 provides advice, support and signposting to people living in Milton Keynes for anyone experiencing a mental health crisis out-of-hours.

If the person already uses CNWL Mental Health services, this number is also on the Crisis Card given to them by their care coordinator or named lead professional. (5pm-9am, Monday to Friday; and Saturdays, Sundays and Bank Holidays).

CNWL Out-of-Hours Urgent Advice Line 0800 0234 650 (or 18001 0234650 for text support – interpretation also available)

There is also the CNWL crisis card available to download – you can fill this in with details about what helps and who to contact during a crisis.

Other statutory services link with each of these organisations and individual children and young people and/or their families may be receiving support with a named case-worker.

Other Services in Milton Keynes

YiS, the Youth Counselling Service are a charity providing 1-2-1 counselling for young people in Milton Keynes with some schools and areas providing local, direct access. Young people can self-refer. https://www.mkyis.org.uk/home

Referrals for counselling should only be made if the young person wants counselling and knows what it is. YiS are unable to see young people who do not want counselling and will cancel sessions if the young person says they do not want to be there or are being forced to come.

Address: Margaret Powell House 401-407 Midsummer Boulevard, Milton Keynes MK9 3BN Phone: 01908 604700

Service Six (S6) - A charity providing 1-2-1 support and group work programmes aimed at increasing levels of happiness and wellbeing in disadvantaged communities and for young people in Milton Keynes. All of the work provided is needs-led by the young person. The programme runs on a 6 week basis after which cases are reviewed are further support can be offered. http://www.servicesix.co.uk/youth-starz-project.html

Service Six can also run informal education sessions in schools for groups of students or in community settings; including for self-harm awareness.

For further information please contact Katie Marsh Milton Keynes Service Manager for Service Six on 07850 916600 or email Katie.marsh@servicesix.co.uk

S6 have a specific self-help journals including for bullying, sexuality, on-line safety, anger management and Spectrum, the Opal Project journal, offering inspirational quotes and pages that feelings can be expressed through writing or drawing.

Image

CNWL (MK CAMHS) regularly update a leaflet for Parents and this is currently being updated. It will be available through the CNWL website. In the meantime please use https://camhs.cnwl.nhs.uk/young-people-adolescents/mental-health-problems/ or access details of Milton Keynes Services via their main webpages.

This appendix will be included in the final version distributed to schools.

Recent national and local developments in MK CAMHS will ensure that there are more direct mental health services available within and for working alongside schools to support self-harm. Appendix 8c will detail how this will work in practice.

(February 2020)

This appendix will be included in the next version and distributed to schools.

Recent national and local developments in MK CAMHS will ensure that there are more direct mental health services available within and for working alongside schools to support self-harm. Appendix 9 will detail how this will work in practice.

The public health team at MK Council lead for the multiagency suicide prevention strategy and self-harm response forms part of this. Recent amendments to the national guidance on how to respond to suicide and self-harm clusters will be taken into account in this chapter.

In the meantime, should you have any queries on how the school can develop its suicide prevention plan or respond to a cluster of cases of self-harm please contact public health on 01908 252026 or public.health@milton-keynes.gov.uk.

(February 2020)

Getting help in an emergency

If you need support in a crisis, get immediate help:

• Call 999 and ask for an ambulance, or go to any hospital emergency department - ED (sometimes known as the A&E or casualty department)
• Or ask someone else to contact 999 for you or take you to a hospital immediately
• Or contact the CAMHS crisis team if you are already a patient with them
• If you have mental health problems for the first time your GP may give you an emergency appointment -They are open from Monday to Friday during the day (hours vary)

If you don’t know who your GP is, or they are not working that day, ask to speak to the Duty Doctor.

Tell the person who answers the phone that you need an emergency appointment, are worried about your mental health or what you have done (if you have self-harmed or taken an overdose).

• You could call Childline to speak to someone about what's happening - Call 0800 1111 or get in touch online https://www.childline.org.uk/ It’s free.
• Text the Young Minds Crisis Messenger (called SHOUT) - Text YM or SHOUT to 85258 - A text service for anyone in crisis anytime, anywhere for free, 24/7 support

Calls to these will be free from most providers. Depending on the situation these organisations will ensure you get help, or a face-to-face appointment if you need one or give you self-care advice.

Finding help and support if it’s not urgent

In the longer term it is important that you learn to understand and deal with whatever is affecting you and making you feel anxious, stressed or unhappy. The support of someone who understands and will listen to you can be very helpful in facing difficult feelings. You can talk to your parents or carers or anyone else who you trust.

-           At home: parents, brother / sister or another trusted family member

-           In school: form tutor, teacher, school nurse, a teaching assistant or school counsellor

-           Outside school: your sports coach, your scout or guide leader, or a youth worker.

If you don’t need help urgently but you want to some support for any health issue or if you would like to talk to someone about how you feel, the following options are available to you:

Your GP Your GP is your family doctor, the doctor you would normally see if you are ill or have any health concern. It is useful to know their number, as part of your own self-care. You can talk to your doctor about your difficulties. They will be able to help you and refer you to the most appropriate service in your area. Not sure how to talk to your GP about mental health? Check out the award-winning Doc Ready app http://www.docready.org/#/home

NHS 111 Get help or advice 24/7 for any health problem or if you’re not sure what to do to get help: go to www.111.nhs.uk or call 111 (18001 111 on a textphone or use the NHS 111 British Sign Language (BSL) interpreter or translator services)

YIS This is a counselling service in Milton Keynes called the ‘Youth Counselling Service’ (there is more information later)

Self-Harm Support

Selfharm.co.uk: https://selfharm.co.uk is a moderated site for sharing positive experiences of coping where young people can post video footage or stories about their life and self-harm; the overall aim is to support others in helping recovery. Young person friendly. Includes advice on on-line abuse, LGBTQ+ support and Alumina forum. Selfharm also has dedicated areas for parents and professionals

National Self Harm Network: http://www.nshn.co.uk/ Support individuals who self harm to reduce emotional distress and improve their quality of life, support and information for family and carers of individuals who self harm, Raise awareness of the needs of people who self harm, dispel myths and combat discrimination, Empower and enable those that self harm to seek alternatives to self-harm and further help where appropriate

NSHN Online Support Forum: Closely monitored, available 24/7, the forum provides crisis support, information and resources, advice, discussions and distractions.

LifeSIGNS – Self-Injury Guidance & Network Support http://www.lifesigns.org.uk/ A user-led small charity creating understanding about self-injury, aimed at all age-groups; provides factsheets for friends, parents, teachers, health professionals and others and supports people as and when they choose to make changes in their lives.

MIND: Advice on suicidal feelings, self-harm and supporting someone else: www.mind.org.uk/information-support/a-z-mental-health/?letter=s and Tel: 0300 123 3393, info@mind.org.uk Text: 86463.

Apps

NHS-endorsed Apps offering self-harm support include Calm Harm, BlueIce and distrACT

Calm Harm (app): https://calmharm.co.uk/ or via usual app sources. Calm Harm provides tasks to help the user resist or manage the urge to self-harm. The user can make it private by setting a password, and personalise the app if they wish, track their progress and notice change.

BlueIce (app) https://www.nhs.uk/apps-library/blueice/ for young people aged 12-17 years to help them manage their emotions and reduce urges to self-harm. It is designed as to be used alongside to face-to-face therapy. There is a mood wheel to track your mood to see patterns and identify triggers and lets you add notes on how you're feeling or what you're doing. It offers a personalised set of activities designed to reduce distress including a music library, photo library, physical activities, relaxation and mindfulness exercises, and spotting and challenging negative thoughts.

If you want to talk, the app allows you to click on one of three options to either talk to a selected person in your phone contacts, ChildLine or 111.

Suicide Prevention Support

For anyone concerned about their own or someone else’s suicidal thoughts or actions

Papyrus: https://www.papyrus-uk.org/help-advice charity helping to prevent youth suicide, for children, teenagers and young people up to the age of 35 who are worried about how they are feeling, or anyone who is concerned about a young person. Website, information and publications

HOPELINE UK is Papyrus’ specialist service Phone: 0800 068 41 41 SMS: 07786 209697 Email: pat@papyrus-uk.org Hours – Monday to Friday 10am to 10pm, weekends 2pm to 10pm, bank holidays 2pm to 5pm. Text 07860 039967 (for people under 35).

Samaritans: Call 116 123 always open and there to listen; or email jo@samaritans.org

The Samaritans help people of all ages in distress, including those who are suicidal, through telephone or email support: www.samaritans.org The Samaritans also have local offices in Bedford, Milton Keynes and Luton with opening hours for drop-in callers to receive 1-2-1 support. Also local telephone numbers - details via main website.

As well as training, The Zero Suicide Alliance have booklets to download about starting a conversation about suicide or for people with suicidal thoughts: https://www.zerosuicidealliance.com/resources

Suicide prevention training

The Zero Suicide Alliance is a National collaborative promoting free suicide prevention training which is accessible to all. The aims of this training are: to enable people to identify when someone is presenting with suicidal thoughts/behaviour, to be able to speak out in a supportive manner, and to empower them to signpost the individual to the correct services or support. It takes about 30 minutes. https://www.zerosuicidealliance.com/

In Milton Keynes the Public Health “See the Signs, Save a life” training and information is available via https://www.milton-keynes.gov.uk/social-care-and-health/public-health/see-the-signs?chapter=4

Advice for Young People

National Self-harm Network Advice for Young People leaflet can be downloaded here.

Online Safety: Samaritans - Guidance on staying safe online, co-designed by young people with lived experience of self-harm and suicidal feelings and experience of supporting others at risk

Self-Help and self-care

Self-care is about the things we can do to look after our own health. If you’re struggling or worried about something there are lots of options to get support without having to see a professional.

There are lots of services for children and young people that can provide you with help and advice by text, phone or online. You may have heard of some of them at school. This can be anonymous if you want (you don’t need to tell them your name).

You don’t have to have a problem to use any of these; you may just have a question or be looking for ideas about how to keep yourself healthy. Some have forums where young people support each other and most have pages with topics and suggestions. They shouldn’t cost you anything to call or text.

Childline: https://www.childline.org.uk/ Tel: 0800 1111. Offers you online advice about anything affecting you through an app or desktop site, with coping strategies, message boards, “ask Sam” feature, online 1-2­1 Counsellor and helpline for young people up to the age of 19. 24/7

The Mix: https://www.themix.org.uk/ or 0808 808 4994. online support service. Information, 1-2-1 support, apps & tools, ‘crisis messenger’, social media or confidential helpline. Wide coverage of issues including money, study, work, mental health, homelessness & drugs (for under 25s)

YoungMinds (YM) https://youngminds.org.uk for young people with mental health problems, with useful information and resources: Crisis Messenger Text YM to 85258 for free, 24/7 crisis support (provided by Shout – see above)

Mental health Apps @ NHS Apps Library https://www.nhs.uk/apps-library/ Free or low cost apps for all ages, including for anxiety, stress. Just search the apps for any health topics of interest. Suggested Apps include Chill Panda, Catchit and Thrive, BlueIce and CalmHarm.

The Anna Freud Self Care page: https://www.annafreud.org/on-my-mind/self-care/, is an online self-care resource, with around 90 different thing to try with hobbies, distractions, crafts and other options ; they were helped to make this by young people.

Other services in Milton Keynes you may hear about or be referred to What is Counselling?

Counselling is a way of helping you with your problems. Counselling is based on building a trusting relationship between you and your counsellor. It can help you talk about your experiences and make sense of them. Counselling can help to express difficult feelings and learn how to manage them in a helpful way.

Counsellors are trained to listen thoughtfully and carefully to your problems without judging or criticising. They do not give advice but support young people to make positive decisions for themselves. Some schools have counsellors.

YiS, the Youth Counselling Service are a charity providing 1-2-1 counselling for young people aged 11­21 in Milton Keynes, with some schools and places providing local, direct access close to where you live. You can request this yourself. https://www.mkyis.org.uk/counselling

Referrals for counselling should only be made if you want counselling and know what it is. YiS are unable to see young people who do not want counselling and will cancel sessions if the person says they do not want to be there or are being forced to come.

Service Six- https://www.servicesix.co.uk/ Is a charity working in some schools and parts of Milton Keynes, providing 1-2-1 support, the Youth-starz project and group work programmes aimed at increasing levels of happiness and wellbeing. There might be a project being run in your school or community.

There are also some useful self-help resources http://www.servicesix.co.uk/self-help.html

including the Opal Project, with a Self-harm journal that offers users inspirational quotes and pages to write

or draw on to express feelings http://www.servicesix.co.uk/assets/spectrum-july-2016-small.pdf and

What is CAMHS?

CAMHS (child and adolescent mental health services) is for children and young people aged up to 18. This is at the hospital and it is a place you can go to speak to someone (like a Doctor or a Nurse) about how you feel.

How do I get help from CAMHS?

Someone, usually your parents, teacher, GP, or yourself if old enough, can refer you for an assessment with CAMHS to see what help you could get. If you're being supported by social care, a youth offending team or a service at your school, they might also be able to refer you. It's important to tell the person referring you as much as you can so you can get the help you need.

Most CAMHS have a website where you can look up how to get access to their service.

For Milton Keynes this is: https://www.cnwl.nhs.uk/service/milton-keynes-camhs/ There is a leaflet available for children and young people on this website with more information – it’s called “CAMHS and Me”.

If you want to speak to someone in Milton Keynes CAMHS service you can call 01908 724228 between 9am and 5pm Monday to Friday. Young people aged 16 and 17 can call for themselves but anyone under 16 will need to ask an adult to refer them e.g. a parent, GP or teacher.

Young Minds have a beginner's guide to the NHS's Child and Adolescent Mental Health Services (CAMHS) for young people and parents, who's who in mental health services and who you can call if you need to talk to someone ‘Your Guide To Support’: https://youngminds.org.uk/find-help/your-guide-to-support/

Compiled by Public Health, Milton Keynes Council

This version (V3) updated and checked: January 2020

Distributed to Milton Keynes Healthy Young People’s Network and via Educate and included as an Appendix (10a) of the Milton Keynes MK Together Self-harm Toolkit (in preparation 2020)

This list is not comprehensive and new on-line resources and apps are being developed all the time. If you know of anything that you think we should include in this list, please pass on the details to us at: public.health@milton-keynes.gov.uk

It can be a really difficult time to find out that someone you care about is harming their selves. As a parent/carer you may feel angry, shocked, guilty, scared and upset. These reactions are very normal, however the person you care about really needs support from you.

They need you to stay calm and listen to them when they want to talk.

The reason someone self-harms is to help them to cope with difficult feelings that have built up and they don’t know another way to express them.

What is Self-harm?

Self-harm is a coping strategy used by people from all walks of life. It is where someone hurts themselves to cope with difficult emotions.

How common is Self-harm?

Self-harm is very common and affects more people than you might think. In young people SH is more common among girls than boys. A recent UK survey found that 30% of girls and more than of 10% boys aged 15-16 years had self-harmed in the previous year. Much of self-harm is ‘hidden’ - only 1 in 8 of those who self-harm present at hospital.

This means it’s likely that at least two young people in every secondary school classroom have self-harmed at some time.

Is it just Attention-Seeking?

There are many factors which lead people to Self-harm, including a desire to escape, to reduce tension, to release built up feelings.

Self-harm is a way to express a strong sense of despair and needs to be taken seriously. It is not attention-seeking behaviour.

Why do people harm themselves?

All sorts of upsetting events can trigger self-harm. Some examples are: arguments within the family/friendship groups, the breakup of relationships, failure in exams or bullying.

Children and young people who have emotional or behavioural problems or low self-esteem can be particularly vulnerable to self-harm.

Suffering a bereavement or serious rejection can also increase the risk.

Sometimes children and young people try to escape their problems/situations by taking drugs or alcohol. This only makes the situation worse.

For some people self-harm is a desperate attempt to show others that something is wrong with their lives.

Some people you can contact for help, advice and support are:

• Your family Doctor /GP
• Charlie Waller Memorial Trust (CWMT) aims to equip young people to look after their mental well being and help people to recognise the signs of depression in themselves and others so they know when to seek help. Free online resources about young people’s mental health,including for parents. Topics include self-harm, depression, wellbeing during GCSEs (exam well-being guides), and social media. https://www.cwmt.org.uk/resources .
• Coping with Self-harm – A Guide for Parents and Carers. Available from the Charlie Waller Memorial Trust https://www.cwmt.org.uk/schools-families-resources (also see Appendix 11b)

Young Minds for parents: https://youngminds.org.uk/find-help/for-parents/ and a Parents Helpline: 0808 802 5544 (Monday to Friday 9.30am – 4pm)

Samaritans: Helps people of all ages in distress, including those who are suicidal, through telephone or email support: www.samaritans.org Telephone 116 123. Email jo@samaritans.org . The Samaritans also have local offices in Bedford, Milton Keynes and Luton with opening hours for drop-in callers to receive 1-2-1 support. Also local telephone numbers - details via main website.

The Opal Project http://servicesix.co.uk/the-opal-project.html

Papyrus: charity helping to prevent youth suicide, for children, teenagers and young people up to the age of 35 who are worried about how they are feeling, or anyone who is concerned about a young person. Website, information and publications. https://www.papyrus-uk.org/help-advice

HOPELINEUK is Papyrus’ specialist service staffed by trained professionals who give non-judgemental support, practical advice and information (set hours) Phone: 0800 068 41 41

SMS: 07786 209697 Email: pat@papyrus-uk.org Mon-Fri 10:00 am to 10:00 pm, Weekends 2:00 pm to 10:00 pm, Bank Holidays 2:00 pm to 10:00 pm

MIND: provides information on a range of mental health problems, where to get help in your own area, medication and alternative treatments and advocacy. Advice on suicidal feelings, self-harm and supporting someone else: www.mind.org.uk/information-support/a-z-mental-health/?letter=s Tel: MIND infoline 0300 123 3393, info@mind.org.uk Text: 86463.

CAMHS Milton Keynes: A Single Point of Access for all new referrals to Milton Keynes Specialist Child and Adolescent Mental Health Service (CAMHS) is on 01908 724228 and cnw-tr.mkspcamhsspa@nhs.net . Young people aged 16 and 17 can self-refer. Existing patients call 01908 724544.

More information is available at https://www.cnwl.nhs.uk/service/milton-keynes-camhs

Confidentiality

Families, children and young people have a right to confidentiality. However, if there are any concerns that the child/young person is at risk we will follow the Milton Keynes Safeguarding Children Board’s procedures. See www.mkscb.org

Sometimes more than one professional may become involved in your child’s care and thee professionals may work with other organisations that can help you and your child, for example health, education or children’s social care services.

You can find out more about confidentiality, self-harm and what it means for a child or young person at: https://www.themix.org.uk/mental-health/self-harm/confidentiality-and-self-harm-5685.html or via Childline https://www.childline.org.uk/about/confidentiality-promise/

Coping with self-harm: a guide for parents and carers

Charlie Waller Memorial Trust guide for parents and carers document can be downloaded here.

Advice for Friends and Family

National Self-harm Network Advice for Parents and Carers leaflet can be downloaded here. 

Common Misconceptions

National Self-harm Network Common Misconceptions leaflet can be downloaded here

Distractions that can help

National Self-harm Network Distractions leaflet can be downloaded here.

Making Telling Someone a little easier

Sharing what’s bothering you

Sharing what’s bothering you can help to make it feel more manageable. If you feel that the problems you’re having are too big for you to deal with by yourself you may want to get in contact with your GP, someone from school/college or someone else you trust.

If you’re finding it hard to talk to people you know about how you feel, contact Childline for some advice

• Not sure how to start a conversation with your GP about mental health? Check out the award-winning Doc Ready site
• Have a look at ChildLine’s short video about depression for young people
• Check out the Thinkuknow guide to internet safety For all ages, parents and professionals

Know your rights about confidentiality

Confidentiality means not telling anyone the things you’ve told them or they’ve told you. It means you can trust that they will keep it private.

Telling someone about self-harm is hard, and whoever you tell should respect your right to privacy. However, there are times when they may have to let other people know if they are really worried about your or someone else’s safety.

If you talk to someone who you know through their professional role, they’ll need to ensure you get the support you need to help you to get on top of things. They’ll tell you that they can’t keep confidentiality. Breaking a young person’s confidentiality is not something people do unless they have to. And they should always try to talk to you about it first if they can.

You can talk to them about who needs to know what – but try to remember it’s a good thing that people understand what’s going on so they can help you, though it might seem a bit scary at first.

There’s no reason for you to deal with things all on your own; if you’re really worried about talking to someone face-to-face, you can call, email, or even text a professional support group or helpline anonymously and confidentially. See the end of this page for organisations that can help.

Think about what you want to happen next

It’s a big step to ask for help and it usually means that on some level you’re ready for things to improve. Do you have any idea of what you might like to happen as a result of the conversation you’re planning? This might include:

• Support to tell your parents or a friend
• First aid or medical help for injuries
• Support to help you talk through and overcome underlying issues
• Referral for specific treatment that you’re already aware of
• You’re not sure, you just can’t carry on with how things are

Even if you’ve gone looking for help, it can be hard to accept it – but try. Have faith in the person you’ve confided in to help you to take the first steps to make things better. They won’t be able to fix everything all in one go, but they can work with you to start to make things change.

Who can I talk to about self-harm?

Telling anyone about your self-harm is a massive and brave step, so confide in someone you feel comfortable with. Perhaps ask a friend to be with you? Talking to a trained health professional such as your doctor (GP), a counsellor or support organisation is a safe move because they should listen calmly and offer you objective advice. It might also be easier to open up to someone you’re not emotionally close to because you can relax and not worry about upsetting them.

What does confidentiality actually mean when it comes to self-harm?

Different people have different rules of confidentiality if you open up to them about self-harm. We talk you through the confidentiality guidelines of the main people you may turn to.

What if I’m under 18?

If you’re aged 16 or 17, the law sees you as an adult when it comes to confidentiality and consent to treatment. Therefore, if you’re 16 and you want a health professional to keep your treatment confidential then that should be respected.

Will my doctor tell anyone I’m self-harming?

In most cases, no. All staff working for the NHS have a legal duty to follow the NHS Code of Practice on Confidentiality. This means they must ask for your consent before passing information to anyone else – this is part of their duty of care and applies whatever age you are.

When will a doctor tell anyone I’m self-harming?

In most cases, never. However, there are exceptions to this rule This is normally when they feel you don’t have ‘mental capacity’, i.e. when you may not be able to make certain decisions because they feel you won’t understand the advice, or your physical or mental health is likely to suffer unless you receive treatment or support.

This also applies where there are issues around child protection; when they are worried you may harm yourself more seriously than you meant to; if you’re expressing suicidal feelings; you’re being sexually or physically abused; or your self-harm will lead to permanent damage.

If they do decide to contact someone else, then they should let you know they are going to do that first.

Can a doctor or a therapist tell my parents I’m self-harming?

Parents don’t have an automatic right to know what is said during your treatment with a mental health professional, even if you’re under 16 and if they’ve given permission for you to have the treatment in the first place.

There are some exceptional circumstances when a doctor can disclose information about you without your consent, even if you have mental capacity and are considered ‘competent’. An example of this is if the doctor is concerned that you are going to kill yourself – it wouldn’t necessarily be that they would tell your parents (if they do they must tell you they will do this), but they may talk to another professional such as psychiatrist or social worker.

Will my parents or doctor be told if I go to A&E for self-harm?

If you’ve been to an emergency department because you’ve self-harmed, a very brief letter will go to your GP which states why you came in and what investigations you had. There is a confidentiality policy, but this doesn’t exclude doctors talking to each other where it’s helpful they know about self-harm. If you really object to this then it’s down to the health

professional to decide if this should be respected.

What if I tell a teacher I’m self-harming? Will they tell someone?

Teachers have a legal duty not to keep certain things to themselves. If you confide in a teacher, they should refer you to an experienced counsellor or health professional who knows how best to help and support you. “We can’t keep anything confidential in terms of self-harming or abuse, and we do have to refer it,” says Jo, a secondary school teacher. “But it won’t necessarily be to your parents, but within the school, such as the school’s designated Child Protection officer, the school nurse, or the head teacher.”

How do I get help from CAMHS?

( Milton Keynes Specialist Child and Adolescent Mental Health Service - CAMHS)

Someone, usually your parents, teacher, GP, or yourself if old enough, can refer you for an assessment with CAMHS to see what help you could get.

If you're being supported by social care, a youth offending team or a service at your school, they might also be able to refer you.

It's important to tell the person referring you as much as you can so you can get the help you need.

How do I get in touch with CAHMS?

CAMHS in Milton Keynes have a Single Point of Access for all new referrals is on 01908 724228 and cnw-tr.mkspcamhsspa@nhs.net . Young people aged 16 and 17 can self-refer. Existing patients call 01908 724544.

CAMHS in Milton Keynes have a website where you can look up how to get access to their service. More information is available at https://www.cnwl.nhs.uk/service/milton-keynes-camhs

Sources: The Mix https://www.themix.org.uk/mental-health/self-harm/confidentiality-and-self-harm-5685.html and Childline https://www.childline.org.uk/about/confidentiality-promise /

Supporting others - I'm worried about a friend

If one of your friends or group is in trouble, upset or showing signs of self-harming it’s important that you feel supported to help them. Friends can worry about betraying confidences so you need to know that self-harm can be very dangerous and that by seeking help and advice for a friend you are taking responsible action and being a good friend. You should also be aware that your friend will be treated in a caring and supportive manner.

Friends and family can play a huge role in helping people get the support they need – it’s not always down to them to do it.

Two thirds of young people with a mental health problem say that fear of judgement has stopped them telling a friend. Getting support from parents, teachers and professionals is important, but having a mate in their corner can make a big difference too. If you’re open about mental health, you can show your friend that it’s ok to be open and talk about mental health problems.

My Friend is Self-Harming – How can I help them?

• You can really help by just being there, listening and giving them support when they need it
• Be open and honest. If you are worried about your friend’s safety, you should tell an adult. Let your friend know that you are going to do this and you are doing it because you care about them
• Encourage your friend to get help, for example from their GP. You can go with them for support
• Your friendship may change. You may feel bad that you can’t help your friend enough or guilty if you tell an adult. These feelings are common and doesn’t mean that you have done something wrong

Tips:

Just being there for your friend can make a big difference, and you don’t have to be an expert to help your friend

If you’re worried about a friend, consider telling an adult – someone who can be there for you, and happy to talk about things and support you if it becomes too much.

You could do some research online (e.g. Young Minds or Childline) and find out more about the condition that your friend is experiencing – this will help you to build confidence talking with them.

Watch the get some tips from the ‘Time to Change 'In Your Corner’ films, to show how big a difference it can make for you to be there for your friend.

There are a few things you can do to help:

• Offer to listen
• Keep an open mind
• Help them to manage their problems
• Offer to go with them to get help
• Don’t treat them any differently from normal
• Be prepared and ask someone to support you too:
• It can be difficult to look after someone who is having difficulties. It is important for you to find an adult to talk to, who can support you. If you’re finding it hard to talk to other people contact Childline for some advice.
• You may not always be able to be there for your friend and that's OK.
• Your friendship may be changed by the problem. You may feel bad that you can't help your friend enough or guilty if you have had to tell other people. These feelings are common and don't mean that you have done something wrong/not done enough.
• Your friend may get angry with you or say you don't understand. It is important to try not to take this personally. Often when people are feeling bad about themselves they get angry with the people they are closest to.

Remember, you don’t need to understand why they self-harm. The key is simply to listen, help them find the support they need and most importantly, don’t make them feel ashamed or embarrassed by it.

• You can really help by just being there, listening and giving support.
• Be open and honest. If you are worried about your friend's safety, you should tell an adult. Let your friend know that you are going to do this and you are doing it because you care about him/her.
• Get information from telephone helplines, websites, the library etc. This can help you understand what your friend is experiencing.
• Encourage your friend to get help. Explain that by sharing what’s bothering them can help to make it feel more manageable.
• You can go with them or tell someone they want to know.

These links might also be helpful:

• Not sure how to start a conversation with a GP about mental health? Check out the award-winning Doc Ready site
• Have a look at ChildLine’s short video about depression for young people
• The CAMHS service has a Cope-ometer to help younger children understand the link between stresses and mental health – but it applies to all of us!
• Check out the Thinkuknow guide to internet safety and how to deal with social media - For all ages, parents and professionals

Thinking about what might support you in school (Safety Plan)

If the school knows about your self-harm they will work with you to understand how they and others can support you. One of the things that might be suggested is a support plan (also called a ‘Safety Plan’). It is essential that the plan is created together with you as it details how YOU want to stay safe. The plan must be something that you feel you are able to agree to. If you haven’t told anyone in school, you can still use this as a way to support yourself to be safe in and out of school.

Making your support plan

You may want to consider the following statements or questions and answer them, perhaps with help, so that you can agree how you can be supported in school, at all times, but particularly when you are finding things difficult.

I might feel like self-harming if...

My warning signs are...

Who or what can distract me?

I can... (Distractions, coping strategies, what takes my mind off things?)

If I need a safe place I can go to...

I will tell myself that... (positive affirmations)

Who can I ask for help?

How will I show or tell them I need help?

I’d like people to help me by ...

I can also access support from (agencies, apps, websites, text messaging) I agree this plan can be shared with...

Taking care of myself – tips and hints for good mental health

Sometimes it seems like we have little or no control over what we think and how we feel. But, there are things that you can do that will help you to feel better.

Diet

Food can affect your mood! There is a link between what we eat and how we feel so it’s important to have a healthy, balanced diet for both your body and mind.

Eating well doesn’t have to be expensive. Try these sites for brain food on a budget:

• Change4Life: easy tips and recipes
• NHS Choices: healthy eating for teens
• Royal College of Psychiatrists: linking eating well and mental health

Exercise

Everyone knows that exercise is good for your body – but it’s also important for your emotional wellbeing. Scientists have discovered that exercise causes your brain to release chemicals that make you feel good. There is evidence to show that exercise can help raise self-esteem, help sleep problems, improve memory and concentration, takes your mind off negative thoughts, as well as reduces feelings of anxiety and depression.

Try these sites for more ideas:

• NHS Choices: physical activity for teens
• Young Minds: exercise and mental health

Improving your self-esteem

Self-esteem is how you think and feel about yourself. Having healthy self-esteem makes it easier to cope with life’s ups and downs. If you have low self-esteem, the thoughts and feelings you have about yourself tend to be negative. This can make you more prone to mental health problems.

Try these sites for some different ways to boost your self-esteem:

• Mental Health Foundation: wellbeing and positive thinking podcast
• Young Minds: top tips on how to boost self-esteem
• Young Minds:  using Social Media in a supportive way

Taking time to relax

Regular relaxation is beneficial for your mental health. If you make a regular time each day to practice some of the techniques below you will get better and better at relaxation and notice your day-to-day stress levels are lower. You will also become able to use relaxation at the times you need them most.

Young Minds: Nine Great ways to relax

Improve relaxation, reduce stress and anxiety by changing the way that you breath:

• Try these relaxation techniques from NHS Choices Breathing exercises
• Explore the internet for videos and information about 7-11 breathing or deep muscle relaxation like this one: Every Mind Matters
• And this quick podcast from the Mental Health Foundation: Quick-fix breathing exercise

Another great way to relax is to practice mindfulness. This is the focusing of attention and awareness on the here and now, and is often used to reduce anxiety, stress and depression. It has its roots in Buddhism, though is used widely by people of all ages from all different backgrounds with all sorts of problems.

This information from Mind might help you relax and improve your sense of wellbeing: about mindfulness

Sharing what’s bothering you

Sharing what’s bothering you can help to make it feel more manageable. If you feel that the problems you’re having are too big for you to deal with by yourself you may want to get in contact with your GP, someone from school/college or someone else you trust.

If you’re finding it hard to talk to people you know about how you feel, contact Childline for some advice

These links might also be helpful:

• Not sure how to start a conversation with your GP about mental health? Check out the award-winning Doc Ready site
• Have a look at ChildLine’s short video about depression for young people
• The CAMHS service has a Cope-ometer to help younger children understand the link between stresses and mental health – but it applies to all of us!
• Check out the Thinkuknow guide to internet safety For all ages, parents and professionals

Source: With thanks to CNWL CAMHS website – updated references and links Feb 2020