Self-harm and children and young people with SEND

What is self-harm?

Self-harm is where someone does something to deliberately hurt themselves when they find things difficult to cope with.
It can include behaviours such as:

Cutting
Overdosing
Hitting (self and others)
Burning or scalding
Picking or scratching skin
Pulling hair
Ingesting toxic substances
Head banging
Biting own skin
Eating disorders

Self-harm in children with Special Educational Needs and Disabilities (SEND) should be approached in the same way as for those without additional needs:

With compassion and non-judgement
Adults should seek to understand the purpose of the behaviour – it is usually a communication of distress
Do not assume that it is part of the child’s SEND

Why do people self-harm?

People self-harm for lots of different reasons. Sometimes this is because they feel bad about something that has happened to them but often there is no known cause. Self-harming behaviours may have the following functions:

To communicate distress to others
To relieve unbearable feelings
To provide soothing and comfort by releasing tension and gaining care from others
To feel alive if they feel numb due to life experiences
To punish themselves as they feel shame and self-blame
To control things in their life when everything feels out of control

In addition children with SEND may have additional reasons:

Difficulty articulating feelings due to communication difficulties
Avoidance; trying to escape difficult feelings
To get attention: there may be an unmet social or emotional need. They may feel isolated and not able to communicate/engage
Frustration; difficulty in communicating their views and needs. Difficulties understanding the world
Sensory stimulation; seeking sensory stimulation or pain
Sensory avoidance: they may self-harm to manage feeling overwhelmed and seek relief from sensory overload.

Some self-harming behaviours in children and young people with SEND may be linked to sensory or environmental overload or communication difficulties, however, self-harming behaviours in these instances still serve to relieve unbearable feelings or communicate distress. Whilst the intent is the same (relief from difficult feelings) the thought process linked to this may be different. For example a young person with complex SEND may pick their skin if feeling overwhelmed by a learning task to gain some relief from uncomfortable feelings however, another young person may pick their skin to relieve feelings associated with self-loathing. Self-harming behaviours in these situations have the same intent, a relief from painful thoughts/feelings/ but they may be coming from a slightly different place.

What can the school do?

Undertake a risk assessment and create a ‘safety’ plan

Listen to the young person
Explain about duty of care and confidentiality
Have an awareness of your own feelings and need for safe support
Document concerns and actions to be taken – within whole school approach/policy/protocol
Ensure Child Protection lead is aware and work within Safeguarding frameworks
Refer to school policy regarding Safe Handling and be aware of Deprivation of Liberty guidance (DOLS)
Unless there is a good reason not to, discuss and share concerns with parents/carers

Understand the behaviour

Work with parents to identify patterns of when the child is hurting themselves and begin to recognise triggers. Learn to recognise urges and distract from the urge to self-harm in the short term.
Look and observe repetitive behaviours to break a pattern before it becomes a compulsive behaviour. It may help to keep notes or a diary around this.
Rule out any medical or dental causes of pain in the body – use a body outline for the person to mark pain if possible. Pain scales may also be helpful.
Consider what might be going on for the child outside of school e.g. has there been a change or loss.
Speak to CAMHS if you need further support unpicking the ‘intention’ of the behaviour – is this self-harm or is the young person communicating an unmet need? Call the SPA and ask to speak to CAMHS clinician – 0330 0245 321.

Strategies/interventions

Include sensory breaks if over stimulated/give sensory involvement if under stimulated.
Increase level of structure and routine to give stability to reduce anxiety.
Timetables, including visual timetables may help. If a young person is feeling in control, the risk of harming decreases along with their anxiety. Social stories, comic strip conversations also may be helpful.
Using communication tools maybe be helpful for some young people, but this will depend on their communication abilities.
Rather than talking, sit alongside and be available/ present. For example, complete a puzzle together.
Young people with autism may be able to communicate on their specialist subject extremely articulately but unable to express feelings and thoughts – increase emotional literacy and include feelings and thoughts in all visuals including (PECS).

Things that don’t help

Showing disgust or anger
Telling the young person what they are doing is wrong.
Telling them how dangerous it is/what a stupid thing to do.
Constantly asking if they have done it again.
Asking to see the self-harm/scars.
Asking lots of questions.

How can staff look after themselves?

Think about your own boundaries and responses.
Seek additional support from others and share safeguarding concerns.
Do not feel personally responsible for stopping the young person from self-harming. Stopping might not be the right thing for that young person at that moment.
Be mindful of the impact on yourself.

For further support and signposting see our guide –Self-harm guidance for school staff.

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