To what extent should self-harm be treated as a child protection issue? (original) (raw)
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School children and self-harm: Staff perspectives and concerns
Purpose: The aim of this study was to describe the experiences, understandings and concerns elementary school staff have of self-harm among Norwegian elementary school children (6-13 years). This is an independent research project which received no funding. Method: Data were collected through face-to-face interviews using a semi-structured interview guide and through an online survey designed by the authors. Data analysis was informed by both the thematic approach and Interpretative Phenomenological Analysis (IPA). Participants: Elementary school staff in Norway. 63 staff members responded to the survey and 15 additional staff members were interviewed. All interview participants had some prior experience or knowledge of children who self-harmed. Results: Three themes resulted from the analysis: 1. Participants’ understandings of self-harm, 2. social learning of self-harm, and 3. a call for more knowledge. Staff tend to dichotomize between what is serious and what is not and express uncertainty about what behaviors should be labeled self-harm. Self-harm is frequently understood as an emotion regulation strategy or as a “cry for help” where the self-harm is seen as a clear signal of a child in distress. Staff expressed concern of social learning effects if self-harm is introduced as a topic for children. Staff appraisals of their own competence to manage children who self-harm were low, and many expressed a desire to receive outside help and to gain more knowledge of self-harm. Findings were supported by survey data. Conclusion: School staff are in a privileged position to uncover self-harm among children and provide help and early intervention. The authors suggest that staff must be provided with more knowledge on self-harm to increase visibility and understanding, and that all children who display warning signs must be spoken to individually. Increased knowledge will help staff feel more secure in dealing with children who self-harm and may increase their efficacy and promote positive attitudes. A counselor should be available at all elementary schools to provide an alternative to the external helping system which is generally less available.
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The Effects of Self Harming Behaviours of Youth in Child Welfare Care
First Peoples Child & Family Review, 2020
This paper considers the clinical issue of self-harming behaviours, defined as intentional self-injury that results in tissue damage. It is distinct from a suicide attempt, as self-harm does not occur within the context of a conscious wish to die. Self-harming behaviours among children and youth is a recent area of research. To date, studies indicate that in community samples, self-harming behaviours occur in as many as 35% of youth who are sampled (Gratz, 2001). Alarmingly, very little is known about self-harming behaviours among children and youth within the child protection system. This study, drawing from data gathered through a government-mandated reporting procedure of all children and youth in care,attempted to explore self-harming behaviours of children and youth in welfare care. While analyses did not focus explicitly on Aboriginal children and youth, it does consider differences in self-harming behaviours among minority and non-minority children and youth in care of the Chi...
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Managing risk and self-harm: Keeping young people safe
Clinical Child Psychology and Psychiatry, 2019
Suicide is the second leading cause of death among adolescents worldwide, yet adequate mental health services for children and adolescents are lacking across the globe. Likewise, youth who engage in non-suicidal self-injury (NSSI) are at heightened risk for suicide, but few pediatric settings have established protocols for screening and responding to youth who engage in NSSI and/or endorse thoughts of suicide. In this article, we highlight similarities and differences of managing suicide and NSSI across cultures, including persisting stigma associated with youth at risk for self-harm. We summarize current guidelines for screening youth at risk for suicide and NSSI across services, consider the use of online and telehealth services, and offer recommendations for a multidisciplinary approach to treating youth who engage in self-harming behaviors as well as how healthcare professionals can communicate with each other using common, non-stigmatizing language. We conclude with a discussio...
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Social Psychiatry and Psychiatric Epidemiology
Background Very little is known about self-harm in children. We describe the characteristics and outcomes of children under 13 years who presented following self-harm to five hospitals in England. Methods We included children under 13 years who presented after self-harm to hospitals in the Multicentre Study of Self-harm in England. Information on patients’ characteristics and method of self-harm was available through monitoring of self-harm in the hospitals. Area level of socioeconomic deprivation was based on the English Index of Multiple Deprivation (IMD). Results 387 children aged 5–12 years presented to the study hospitals in 2000–2016, 39% of whom were 5–11 years. Boys outnumbered girls 2:1 at 5–10 years. The numbers of boys and girls were similar at age 11, while at 12 years there were 3.8 girls to every boy. The proportion of study children living in neighbourhoods ranked most deprived (43.4%) was twice the national average. 61.5% of children self-poisoned, 50.6% of them by i...
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Should self-harm be allowed? A case against the prevention of self-injurious behaviour
It is often agreed amongst medical professionals and philosophers that self-injurious behaviour (otherwise termed NSSI, short for nonsuicidal self-injury) should be prevented, even if this involves coercing the individual engaging in such behaviour. This dissertation aims to prove that there are no firm ethical grounds on which to base justifications for the systematic prevention of self-injury, and does so by examining whether individuals who self-injure are autonomous, what ethical problems are posed by letting them self-injure without taking any coercive measures, what can be gained from letting them engage in such behaviour, and ultimately concludes that in the majority of cases, in order to respect the individual’s autonomy and welfare, self-injurious behaviour should be allowed to continue (with supervision when appropriate).
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BMJ (Clinical research ed.), 2017
To examine temporal trends in sex and age specific incidence of self harm in children and adolescents, clinical management patterns, and risk of cause specific mortality following an index self harm episode at a young age. Population based cohort study. UK Clinical Practice Research Datalink-electronic health records from 647 general practices, with practice level deprivation measured ecologically using the index of multiple deprivation. Patients from eligible English practices were linked to hospital episode statistics (HES) and Office for National Statistics (ONS) mortality records. For the descriptive analytical phases we examined data pertaining to 16 912 patients aged 10-19 who harmed themselves during 2001-14. For analysis of cause specific mortality following self harm, 8638 patients eligible for HES and ONS linkage were matched by age, sex, and general practice with up to 20 unaffected children and adolescents (n=170 274). In the first phase, temporal trends in sex and age ...
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