Wednesday 16 May 2018
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.
Externalising the pain
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.
What then are we to do?
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.
How WE react
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.