Workforce Guidance: Self Harming Behaviours
This guidance is not intended for use in circumstances where there is an immediate threat to life or risk of significant physical harm.
If you have serious and immediate concerns regarding the safety of a child or young person due to self-harm, suicidal ideation or other significant risk issue then contact the emergency services by dialling 999.
Worried about a child?
Anyone can make a referral if you are worried about any child and think they may be a victim of neglect or abuse, whether as a member of the public or as a professional.
Please use the North Yorkshire Self-harm and Suicidal Ideation Pathway at the beginning of this document to
identify the appropriate support available.
Professionals in all agencies have a responsibility to refer a child to Children’s Social Care when it is believed or suspected that a child:
- Has suffered significant harm and /or;
- Is likely to suffer significant harm and/or;
- Has developmental and welfare needs which are likely only to be met through provision of family support services (with agreement of the child’s parent).
If you are worried about a child or a young person under the age of 18, you should contact the children and young people’s service through the Customer Service Centre. If your concern is outside of normal office hours, you should contact the emergency duty team.
During Office Hours
By Phone: 01609 780 780
Outside Office Hours
Emergency Duty Team (for evenings, weekends and bank holidays): 01609 780 780
Further details can be found at the following address:
- www.northyorks.gov.uk/social-care-out-hourssupport or
Making a referral
Before making a referral to the North Yorkshire Children and Young People’s Service Service you should contact the Customer Service Centre on the number above. A written confirmation of the referral must be completed and submitted within 24 hours. Where possible, the North Yorkshire Children and Young People’s Service request that you use their ”Universal Referral Form” to ensure that all relevant information is provided to ensure that the referral can be progressed as effectively as possible the North Yorkshire Safeguarding Children Partnership’s website contains a broad range of information, signposting and referral guidance in relation to children who may be vulnerable or at risk.
This booklet offers guidance for staff working with children and young people in North Yorkshire under the age of 18 (under 25 for those with disabilities or for care leavers) who self-harm or feel suicidal. It is not aimed at people who work within the mental health sector; instead it is targeted at people who work with children/young people in a wide range of settings such as schools, youth work or community groups. Everyone
can play a part in helping children and young people at risk.
This website sets out key principles and ways of working but does not prescribe how to act in individual situations. It is not intended to override individual organisational or professional guidelines where they exist. It can however be used as a prompt for discussions about organisational approaches to working with self-harm
and suicidal intent, or to highlight individuals’ skills or training needs.
“People look at you weird, like you tried to kill yourself when you didn’t, they look at you in disgust, I just
want to cope”
Self-harm and self-injury are ways that some young people cope with difficult and distressing feelings. This
can be putting themselves in risky situations but also can be injuring themselves in some way. Sometimes
this can be simply experimenting in risk taking behaviours in the same way as experimenting with drugs and
alcohol and may not always be a sign of difficult and distressing feelings. It is not usually about ending their life,
however sometimes young people feel unsure whether they want to die or not.
Some young people do have suicidal thoughts and feelings and sometimes they harm themselves in ways that are very dangerous, and it is possible that they could accidentally kill themselves.
Some examples of how young people may self-injure include:
- Cutting or burning.
- Taking an overdose of tablets (whether these are prescribed or not).
Self-harm can include anything that causes an injury but can also be about taking risks. It can also involve using alcohol or drugs excessively – though many young people do not see this as self-harm or self-injury. Recognising these behaviours can be as important as those that are obvious such as cutting.
“When I self-harm it is me telling the outside world what I feel inside, which I can’t express in words. Often it is an alternative to me attempting to kill myself, and all that I really want is someone to hug me and let me talk to them”
Self-harm may be on-going and well managed by the young person and not that physically dangerous. One example of this is superficial cutting. This may not require an immediate response but it is still probably a sign of emotional distress and the young person still needs support. As a member of staff you may wish to
get advice and support to help you work with the student to access services.
Further information regarding the pathway of support for children and young people who deliberately self-harm can be found: www.northyorks.gov.uk/mental-health
The National Institute for Health and Care Excellence (NICE) have published numerous pieces of guidance for self-harm as well as pathways and quality standards.
For guidance please visit:
Self-harm in over 8s: long-term management: www.nice.org.uk/guidance/cg133
Self-harm in over 8s: short-term management and prevention of recurrence: www.nice.org.uk/guidance/cg16
For the NICE Pathway please visit: pathways.nice.org.uk/pathways/self-harm
For the NICE Quality Standard please visit: www.nice.org.uk/guidance/qs34
For NICE shared learning please visit: www.nice.org.uk/guidance/conditions-and-diseases/mental-health-and-behavioural-conditions/self-harm/products?Status=Published&ProductType=SharedLearning
Paradoxically, self-harm can be a coping mechanism to dull mental distress with the aim to preserve life, which can be a difficult concept to understand. Despite this clear distinction, young people who self-harm are known to be in a high risk group for future suicide; however suicidal feelings are likely to originate from the issues behind the self-harm rather than the self-harm itself. In some cases death occurs as a result of self-harm but is not the intention.
Suicide is still a rare event in young people; attempted suicides are uncommon in childhood and early adolescence, but increase markedly in the late teens and continue to rise until the early 20s. Nevertheless all people working with children/young people must be aware of the potential for someone to complete suicide and must work together to ensure that no child/young person feels suicide is their only option.