1. Mental Health Matters in Bradford A Protocol Policy to address self harm in Bradford Schools Department of Children’s Services

2. Agenda 3.40-3.50 Introduction 3.50- 4.15 An overview of self harm 4.15-4.30 Introducing the policy 4.30-4.40 Introducing the recording protocol 4.40-5.00 Questions Department of Children’s Services

3. Mental Health in Schools Strategy Group: Aiming to Deliver a core offer across Bradford schools Harness and maximise existing resources Respond to local needs Build on evidence based practice and pilot and quality assure new initiatives Department of Children’s Services

4. Building on Evidence Based Practice and Good Practice Guidance A tiered approach, incorporating universal, targeted and specialist approaches Provide useful information about mental health difficulties and sources of support Normalising emotional distress Delivering support where children, young people and parents say it works best Department of Children’s Services

5. Group Membership Multi agency membership: education, health and voluntary sector, including school nurses, CAMHS, SEBD team, Barnados, EPT and Sharing Voices Terms of reference: identify rationale, core aims and strategic vision Report to Healthy Minds Group and Special Needs and Disability Partnership Department of Children’s Services

6. Mental Health Matters! Core Activities Self harm policy and recording protocol Mental Health Awareness Raising Assemblies delivered by schools nurses and MHSSG Mental Health Information Hubs in Secondary Schools pupils Department of Children’s Services

7. Mental Health Matters! Core Activities Getting Through Tough Times leaflets for secondary aged pupils Pilot Self Harm Group Intervention in secondary schools Planning Mental Health Matters Website for young people, parents and professionals Department of Children’s Services

8. This protocol policy means…… Vulnerable pupils receive appropriate support from confident staff There is a consistent approach to responding to pupils who self harm, and in monitoring self harm in school Department of Children’s Services

9. This protocol policy provides….. a structure for school staff, using good practice guidelines from the National CAMHS guidance on self harm reassurance to staff, and identifies relevant information, and where appropriate onward referrals

10. The Core Message The best prevention for self harm in young people is to have people who they can talk to and who will take them seriously National CAMHS guidance p 10 Department of Children’s Services

11. What is Self Harm? ‘Self harm happens when someone hurts or harms themselves…. Since we cannot answer the question definitively of what counts as ‘deliberate’ we define self harm as ‘what happens when someone hurts or harms themselves Department of Children’s Services

12. Types of self harm Overdoses Self mutilation ( e.g. cutting and scratching) Burning Scalding Banging heads or other body parts against walls Hair pulling Biting Department of Children’s Services

13. How Common is Self Harm? % of 11-15 year olds CASE 2005 % of 11-15 year olds WHO 2013 18.8% of 11-15 year olds diagnosed with depression 9.4% of 11-15 year olds diagnosed with anxiety 7.5% of 5-10 year olds with conduct/ hyperkinetic disorder Department of Children’s Services

14. Young people who self harm explain they self harm because …..it’s a way of dealing with unbearable feelings or unbearable stress …..it’s a way of carrying on living ….. people can come to depend on self harm as a coping strategy

15. Young people explain the self harm to… Punish themselves Relieve tension or stress Communicate their distress to other people Take control when they feel powerless Make themselves feel real, if they feel numb and remote from the world Nurture themselves, through caring for the wounds

16. Safeguarding and confidentiality Young people anonymously report a much higher rate of self harm ….from this we can infer the importance of confidentiality and the wish to control their own situation…. ‘those young people who spoke to an adult said that once they had done this all decision making and control were taken from them’ Truth Hurts 2008 Department of Children’s Services

17. Myths and Stereotypes Self harm is manipulative? It is a form of revenge? It’s attention seeking? It’s a cultish teen behaviour? It’s a failed suicide attempt and the person should be placed on suicide watch? Evidence of a borderline personality disorder?

18. The cycle of self harm Negative emotions Tension Self harm act Positive effects ( endorphins and tension released) Negative effects

19. A continuum of self harm ‘it is most helpful to consider self harm as a continuum from behaviour which has a strong suicidal intent ( e.g. some overdoses) to behaviour which is intended to help the young person to stay alive.’ Coleman 2004

20. The Continuum Mental Mental health distress health illness difficulty

21. Good reasons for early intervention Early intervention may tackle the cause of the emotional pain, or offer alternative ways of coping Some people may want to stop self harming, but they need advice and/ or encouragement Early intervention can prevent escalation

22. How can we help our children through tough times? Normalise feelings of despair Teach and / or model coping skills Improve the situation Teach strategies to reduce tension Identify positive and physical activities Teach / model self talk – rehearse this Promote belonging and sense of connectedness

23. Alternatives to self harm Self harm websites usually have lots of ideas about alternatives to self harm. These include: Clenching ice cubes ( make them with fake blood) Draw red lines on your skin Elastic bands on wrist Harmless pain – eating a chilli Looking at these together reduces shame and increases sharing and the feeling of being understood

24. Self Harm and Suicide Self harm is distinct from suicide, but a history of self harm significantly increases the likelihood of suicide Asking children whether they have suicidal thoughts does not increase risk of suicide but may help to put support in place

25. Children may find asking for help difficult because…… They want to believe it’s a one off event- they’ll learn to cope Don’t want to think about it Are worried their coping strategy will be taken from them Concerned they’ll lose control over the situation They’re worried they’ll be judged

26. When you find out about self harm Do Make sure they are safe Remove possible equipment Listen Show concern Debrief with colleagues and report Don’t Tell them to stop Encourage them to carry on Rush to tell parents – take care! Show fear, revulsion or panic Deal with it alone Feel responsible

27. Managing Self Harm in School Protocol for responding to self harm in schools: Brief overview Key components Resources Onward referrals

28. Recording Self Harm in Schools Rationale Process What happens to the data?

29. References National CAMHS Support Service ‘Self Harm in Children and Young People Handbook Report of the National Inquiry into Self- harm among Young People ‘Truth Hurts’ Royal College of Psychiatrists Self Harm fact sheets Young Minds

30. Questions

31. Thank You Dr Fameeda Ansari Clinical Psychologist, CAMHS, Bradford BDCT Dr Philippa Grace Specialist Senior EP (Mental Health) philippa.grace@bradford.gov.uk