Judy Furnivall, a consultant at CELCIS, talks about the difficult issue of self-harm in residential care and explores the feelings and experiences that lead young people to hurt themselves as well as identifying what support workers need to help young people as sensitively as possible.
It’s obvious really, isn’t it? Hurting yourself is wrong! So the caring, loving thing to do is to try and stop a young person from harming themselves in any way we can.
Taking away anything sharp, checking for cuts or burns, telling them they need to stop - maybe even imposing ‘consequences’ to stop the behaviour. It all makes sense and if this doesn’t work then clearly they have some kind of mental health problem and we need to find a specialist who can fix them.
But hang on a moment… this weird behaviour may not be as weird as we think. How many of us have habits or make choices that harm us in some way? Whether we are smokers, drink rather a lot, enjoy our food a little too much, or work too hard, most of us do something that we know affects our health in a negative way, yet it is really difficult for us to stop. Indeed, many of us have a knee-jerk reaction to increase that behaviour if someone attempts to control us for our own good.
We often explain away these behaviours to ourselves and others because they help us cope with stress. In no way am I attempting to trivialise self-harm. Whether it is the first or hundredth time that a young person hurts themselves, the act has enormous meaning.
We now know that deliberate self-harm is actually relatively common in the general adolescent population. Around fifty percent of young people in residential care have hurt themselves in this way, and for most of them self-harm is a way of coping with the overwhelming distress evoked by past trauma, current pain or both.
Young people may say that it reduces stress, helps to externalise the emotional pain or provides them with comfort. Although it may help them to communicate their pain, it is very rarely a device for seeking attention. Importantly, for many young people, who may have had little control over their lives, and in some cases have had others exert brutal control over their bodies, the act of self-harm gives them a sense of control that is very precious to them.
If we then attempt to exert control over this behaviour we run the risk of alienating the young person and forcing them to hide their self-harm, so that it becomes impossible to talk about. A few young people also tell us that, if they did not self-harm, they would kill themselves - for them this behaviour is literally a way to stay alive.
Our job is to care for and protect young people. However much we can understand with our heads what may be happening, often our hearts rebel and we just want them to stop. What is important, though, is that we see and respond to the pain and distress behind the act rather than focusing on trying to control the behaviour.
If we are able to connect with young people in this way then we can support them to deal with their distress, and, in their own time, find alternative ways of managing stress that do not involve causing harm to their own bodies.
From this position we are also better able to engage in conversations with young people about the dangers of different kinds of self-harm, and work with them to minimise the risks they take. It is, for example, never safe to take an overdose, and ligatures present an immediate risk to life, yet the most common self-harming behaviours such as cutting or burning, are rarely life threatening.
Knowing that a child is hurting themselves, however, is overwhelmingly painful and frightening for the adults caring for them. It not only evokes feelings of concern and sympathy, but also guilt, anxiety, and at times despair.
Moreover, there is the ever-present worry that something will go wrong and blame will fall on the individual, team or organisation responsible for caring for the young person. No-one should be managing this burden of responsibility alone and unsupported.
In residential teams we need to be talking about our values, our policies, our practices and our pain. We also need quick and easy access to other professionals, such as mental health specialists, for consultation, or in an emergency.
Right now these supports are rarely in place. This leaves everyone vulnerable - especially the young people we love and care for. It is essential that we find a way to navigate this complex issue so that children’s distress is recognised and soothed, workers are given emotional support to stay connected to children’s pain, and organisations create policies and procedures that liberate good practice rather than constrain it.