Non Suicidal Self Injury

Agenda What is Self Injury? Responding to Self Injury Supporting Self Injury Cessation Contagion and Prevention Best Practice Guidelines for BSD Resources and Questions L

Self Injury Basics L Ask questions to participants. What dos self injury mean to you?

What is it? Terms: self-harm, cutting, self-mutilation, & non-suicidal self-injury (NSSI) NSSI: “the deliberate destruction of one’s own body tissue without the intent of death” (Taylor, Peterson, & Fischer, 2012).

Self Injury Facts The majority of young people use multiple methods to self injure In many cases, self injury can become an addiction 1 in 5 young people will injure themselves more severely than they expect to Parents and youth serving providers underestimate the number of lifetime incident and methods used Habituation/addiction can make it very hard to quit even when someone wants to. Needing to injure more severely for same effect. Injuring without triggering incident. Importance of early intervention (to prevent addiction) and framing self injury as addiction can inspire compassion and patience

Myths Only females self Injure Self injury is a suicide attempt or failed suicide attempt Only teenagers self injure Self injury is just attention seeking People who self injure are manipulative Self Injury is untreatable P

More Myths All people who self injure have borderline personality disorder People who self injure only cut themselves People who self injure enjoy the pain or can’t feel it There’s nothing I can do to help All people who self injure have been abused Someone who self injures is a danger to others

WHO? If we were to base our assumptions on media representations, most of us would assume Self Injury is the domain of middle and upper class white girls.

•Initial self-injurers •Most predictable demographic of self-injurers •No single profile •Gender differences Numbers Type of injury Setting •Initial self-injurers •Most predictable demographic of self-injurers •Related challenges •Rates of college students, secondary students

Why do People Self Injure? Emotional regulation Social communication Why continue? P Coping, numbness, etc

Detection- What are we looking for? 1. Direct observation Wounds, scars; Other signs 2. Direct verbal disclosure 3. Indirect verbal disclosure Useful information: recency, chronicity, lethality P

Responding to Self Injury First Aid Assessing for suicide L

Differentiating between Suicide and Self Injury Suicidal Behavior NSSI Reaction of others Most others express concern and support; move towards protection Ongoing NSSI may be condemned, judged negatively Restriction of means? Often an important preventive intervention Often ill-advised, counterproductive

Responding Respectful Curiosity Probing Questions

Responding Liability Parent/Guardian communication Linkage to support services and follow up Document

Group Activity? Discuss challenges and strategies for communicating Self Injury to parents/guardians Prepare to share L

Why Change? Understanding the Recovery Process The most essential ingredient in stopping NSSI is wanting to stop and being ready to find other ways of coping. L

When it will end depends on: Frequency Number of reasons for injuring Level of psychological distress (feeling chronically high levels of depression and/or anxiety makes it harder to stop) L

Other ways of coping with emotion (more ways of coping makes it easier to stop) Recognizing that it is a problem in life (makes it easier to stop) Feeling socially supported (makes it easier to stop) Having a sense of meaning in life and/or having higher levels of life satisfaction (makes it easier to stop)

STAGES OF CHANGE 1. Precontemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance It’s important to note that the stages of change are non-linear. Any movement is a sign of progress.

Supporting Self Injury Cessation. •Being here Supporting Self Injury Cessation •Being here! •Allow autonomy •Empathy, compassion, patience •Understand reasons for SI •Take NSSI behavior seriously P

Cont Cessation •Assess & respect readiness for change •Clear expectations •Support cognitive flexibility •Focus on strengths •Celebrate success! P

Supporting the Growth Mind Set •Foster hope •Foster love of learning •Reframe experiences •Encourage service to others ?

Prevention & the Importance of School Culture

Prevention Teach students more adaptive coping skills Decrease self-injury by educating students and the school community about risk factors, clinical implications, and outcomes associated with self- injury. Encourage help-seeking among students – either for themselves or on behalf of a friend. Help school staff make the key distinction between self-injury and suicide

Coping Skills Cognitive Flexibility Tolerate Negative Emotions Identify Feelings Regulate Impulse Control Connectedness Service L

Controlling Contagion •Divide & assess individually •Identify “alpha” students •Be clear about expectations/boundaries •Protocols for alerting parents •No groups—deal with students individually P

How Do We Do This? DO Connect with calm, compassion Understand coping skills Refer Discover student’s strengths P

How do we do this? (cont) DON’T Tell the student to stop SI Act shocked, overreact Cause guilt, shame Agree to hold SI behavior in confidence

District Guidelines – Self Harm Determine if First Aid is necessary Assess for suicide Develop plan with student for parent/guardian contact Recommend outpatient mental health treatment to guardian, if not engaged. Social Worker can help with this Have guardian and/or student sign Release of Information for therapist Communicate concerns with therapist! Be available and follow up with student Communicate to teachers, as appropriate Document L & P

Table scenarios or other discussion? Small group – What will you do differently in your practice to prevent and support those who self injure? L

Questions? PD needs Resources: http://www.selfinjury.bctr.cornell.edu/resources.html The Cornell Research Program for Self-Injury Recovery contains a wealth of handouts for counselors, psychologists, teachers, parents, self-injuring individuals, friends