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Self-harm guidance for professionals

Guidance on identifying the signs and risky behaviour in pupils.

Self-harm is when a child or young person intentionally damages or hurts their body. It can become addictive because of the natural pain-relieving endorphins that are released when people hurt themselves, which can give a temporary sense of relief.

Each child and young person’s relationship with self-harm is complex and different. It often happens during times of anger, distress, fear, anxiety, loss or depression.

Self-harm can also be a coping strategy for:

dealing with difficult situations
changing emotional pain into physical pain
communicating distress about something in a non-verbal way
attempting to relieve feelings of numbness, anger or aggression
attempting to gain a sense of a control in a world where they feel out of control

Self-harming and risky behaviours can also be a way for a child or young person to punish themselves for feelings or behaviour that they think are their fault, or because they have a very negative self-image.

The majority of children and young people who self-harm do not have suicidal thoughts while self-harming. However, self-harm can escalate into suicidal behaviours.

Identifying the signs

Self-harm can include:

self-cutting
burning
scratching
biting
hair pulling
head banging

Physical self-harm may be indicated by a careful covering of arms and legs, or changes in behaviour around clothing, for example an avoidance of activities that involve changing clothes, like PE lessons.

Risky Behaviour

Risky behaviour can sometimes be a form of self-harm, although it is often misinterpreted or overlooked. All children and young people will take risks and learning how to manage them is an important part of development. But when risk-taking is persistent, extreme, age-inappropriate, or compromises a child or young person’s safety and wellbeing, it can be a way of communicating distress.

It can highlight that a young person is struggling, and may be using risk-taking to lift their mood or distract or punish themselves in some way.

If you are concerned about a child or young person

If you are worried that a child or young person is at risk involve your designated safeguarding lead as a matter of priority, who will contact the parents or carers and other services as necessary. If the child or young person is at immediate risk, ensure that they are taken to their GP or A&E as a matter of urgency, depending on the severity of the concern.

Find out more about self-harm and risky behaviour

MindEd is a free educational e-learning resource for professionals on children and young people’s mental health. The following session aims to help staff better understand children’s self-harming behaviours.

Self-harm and risky behaviour, provides the background to self-harm in children and teenagers, common associated conditions and approaches to managing it.

What schools and further education settings can do

If you are at all concerned about a child or young person, you should always speak to your designated safeguarding lead as a matter of priority. They will be able to advise on suitable next steps, and speaking to them about any concerns should always be the first action you take, ahead of any of the suggestions on this page.

Although the suggestions on this page are broadly split into primary and secondary age groups, the majority of the advice can be applicable for all ages. All children and young people are different, and it’s important to understand the needs of the individual child and young person when looking for ways to support their mental health and wellbeing.

What primary schools can do

Although self-harm is more common in older children, primary schools should still be aware of the signs, and think about early intervention.

Inform your safeguarding team

If a child is self-harming, don’t deal with it alone. Self-harming behaviours should be taken very seriously, so you should follow your school’s safeguarding procedures carefully. Some children will need extra help either through school pastoral/counselling support or through referral to community-based support.

Explore emotions through lessons and programmes

Thoughts can really influence and affect our moods. However, many children may not be aware when this is happening to them. Through effective teaching of RSHE, schools can help children learn about their emotions and learn strategies for regulating them. A number of universal and targeted school-based programmes can also prevent children being overwhelmed by low mood and supports them to learn effective coping skills to manage life’s ups and downs.

Build positive relationships with pupils

Positive relationships in the classroom or school that are built on trust, safety and security promote pupil wellbeing and help children affected by sad or low mood – encouraging them to open up and talk.

What secondary schools and further education settings can do

Don’t deal with it alone

If you discover that a student is self-harming, speak to your safeguarding lead straight away. Then together you can make a plan to support the student.

Consider a specialist referral

If necessary, you may need to refer the young person for outside help – for example from a GP or specialist CAHMS. For advice before making a referral, schools can call their local CAMHS duty line.

Speak up

If you notice self-harming behaviour in a student, talk to them about it. Discuss your concerns with them and listen to them non-judgementally. Then you can create a plan together, which can be shared others in the school community – including the student’s parents/carers, if appropriate.

Speak to the student and involve them in your plan

Speak to the young person about your concerns and let them know what you have observed – once you have spoken with your safeguarding team. Listen to the young person and work together with them to make a plan, and then share this with the appropriate people. Keep the young person updated and involved with the plan continuously, so that they don’t feel that they are being excluded from the process.

Inform parents or carers

The young person’s parents or carers will need to be informed. School staff should not feel that they have to take sole responsibility for supporting the student, a parent or carer may have a better understanding of other factors impacting the young person.

Take a whole-school approach to self-harm

Often young people may know that their friends are self-harming, but may not know what to do about it. Develop a clear way that young people can seek help if they are worried about a friend, and ensuring all students know about this pathway.

Emergency Help and Help Lines

NHS Crisis line

If the young person feels their mental health problems have become much worse or are experiencing problems for the first time, they may need help quickly.

The young person can phone the mental health helpline for urgent advice: call 0808 196 9127 (free phone 24 hrs a day 365 days a year)

The team will offer advice, support and, if required, an assessment to understand how the young person is feeling. When calling the number, they can expect to speak to Mental Health Advisors and/or trained Mental Health Clinicians who will be able to listen to their concerns and help make appropriate plans with them to support.

Childline

Childline isn't just for young children, Childline offers a helpline, online chat and e-mail advice for anyone up to the age of 19 years.

Shout Crisis textline

Shout Crisis textline text for free 24/7 support across the UK if a young person is experiencing a mental health crisis. All texts are answered by trained volunteers, with support from experienced clinical supervisors. Texts are free from EE, O2, Vodafone, 3, Virgin Mobile, BT Mobile, GiffGaff, Tesco Mobile and Telecom Plus. Users should text ‘WOO’ to 85258

YoungMinds Textline

YoungMinds Textline offers a free, 24/7 text messaging support wherever they are in the UK. If the young person needs someone to talk to about how their feeling, they can text YM to 85258.

Useful links

The wellbeing and emotional support teams in schools service is designed to help children and young people ages 5 to 18 years access mental health and wellbeing support early on in educational settings. It's all about ensuring children and young people can get access to the right help as early as possible.

The Reach4Wellbeing team supports and promotes the emotional wellbeing of young people and parents of primary school age children through interactive online group programmes, using cognitive behavioural therapy (CBT) principles.

CAMHS WEST anxiety has a page with resources and support for children and young people who are experiencing anxiety.

Kooth is an anonymous and personalised mental health support for Children and Young People that is available to all young people in Worcestershire.

Young Minds A really good website with expert articles, advice and blogs and a crisis text-line.

Self-care tips for young people. Watch these videos on dealing with unhelpful thoughts, sleep, social media, anxiety, exercise and more

Happy Maps have produced reliable resources recommended by Parents and Professionals.

Ripple is an interceptive tool designed to present a visual prompt when a person searches for harmful keywords or phrases relating to the topic of self-harm or suicide. These phrases include any words or terminology which have been identified as displaying potentially damaging online content.

Worcestershire Young Carers provides a wide variety of mainly community focused support for people and are often described as the ‘glue’ between those at risk of social isolation and the wider mainstream society.

Barnardos protect, support and nurture the UK's most vulnerable children

Worcestershire Chat Health offers is a service where 11-19 years olds can text 07507331750 to speak to their School Health Nurse for confidential advice and support around a variety of issues, including bullying, emotional health, relationship problems, alcohol and drugs.

YoungMinds Textline offers you free, 24/7 text messaging support wherever you are in the UK. If you need someone to talk to about how you’re feeling, text YM to 85258.

Qwell is a free, safe and anonymous mental wellbeing support for adults across the UK and the link can be shared with families who can use the service