Self-Harm Awareness


As Self-Harm Awareness month draws to a close, Dr Fiona Pienaar, Place2Be's Head of Clinical Services, describes a problem that is on the increase and causing great concern to parents, teachers and mental health professionals around the world.

I first encountered self-harm 13 years ago when working in New Zealand. A 12 year girl asked, "Miss, can I show you something?" When she lifted her shirt to reveal criss-cross cuts on her chest and stomach, I was shocked - and showed it. Back then there wasn't much talk about self-harm.

But there is now and health professionals and teachers understand more about something that can affect young people anywhere, crossing borders, cultures and nationalities.

This silent expression of psychological distress, which typically seeks to bring relief to an anguished state of mind, is much more common in girls between 12 and 15; the girl-to-boy ratio is as high as five or six to one. Having said this, with the hidden nature of self-harm, we may never know the true ration and statistics. For parents, teachers and the children themselves, it can be very disturbing and shocking. 

Young people who self-harm - it's generally, but not exclusively, an issue among adolescents from 12 upwards - may feel very lonely and long to be able to talk to someone who understands. At the same time, they may struggle to disclose what's happening and to seek help, making it a particular challenge to mental health professionals.

What is Self-Harm?

Typically self-harm involves cutting or carving the skin on the arms, legs and stomach with sharp instruments such as knives or razors but there are also other forms.

Children in an adolescent study described it variously as, "a way of getting your emotions out" and "a focus on something else", with one explaining, "I felt as if I needed a way out but I couldn't find one. It was like I was looking for the light at the end of the tunnel but I couldn't find it because it was so dark everywhere."

Stress is a powerful factor, with self-harm being used as a coping strategy. In one study I was involved with, fewer than 25% of the children who were asked said they would tell their teacher if they were stressed. Part of the reason was that they perceived teachers as being stressed themselves. Lack of availability and awareness of significant adults can be a risk factor in young people's lives.

Depression and anxiety can cause a young person to self-harm. Some sufferers aren't doing well at school, are struggling with sexual orientation or have a history of physical or sexual abuse. Negative life events such as parents separating, divorcing or dying, discord or suicidal behaviour in the family, a parent having mental health or addiction problems, as well as bullying and interpersonal difficulties can all also trigger an episode.

Some young people, who self-harm may also misuse drugs and alcohol (which can be described as self-harm too), have low self-esteem or poor social and problem-solving skills. Impulsivity, perfectionism and a sense of hopelessness are also often noted characteristics.

How can we help?

Children need to have a range of coping strategies and we need to help them identify these, recognise what they find stressful and keep a watchful eye. Listening to music, phoning a friend and socialising can all help. They also need to be able to switch off and so electronic devices are best left outside the bedroom at night.

Spotting the signs early is vital and Place2Be's early intervention is key to this. In the safe space of the Place2Be room they can say, "I'm not coping and I need help," and learn that this is something that they can continue to say throughout  life without feeling shamed. 

Place2Be counsellors are trained in the knowledge and understanding of self-harm and how to recognise the condition. They have the skills to support young people affected and give them the help they need. Our counsellors follow academic and clinical developments closely, as well as Place2Be's own data on the topic.

Dr Fiona Pienaar

Dr Fiona Pienaar is Director of Clinical Services at Place2Be and has a PhD in Behavioural Science.

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