If you have a child who harms themselves it can be very distressing. If you discover your child is hurting themselves or has tried to kill themselves try to keep calm when dealing with them. Although sadly, some children do go on to kill themselves, this is rare. Take a little time to think about your response and how you can offer help. You may need to consider whether you need professional help. It is very important not to ignore self-harming behaviour.

Types of Self Harm

Children can self-harm in many ways. By self-harm, most professionals are thinking about deliberate harming, where individuals are choosing to harm themselves. Although some young children do self-harm, this problem is mostly found in teenage children and young adults.

Cutting and Scratching

Commonly, self-harm takes on the form of cutting or scratching. This is often on the arms or legs, but can be anywhere on the body. This cutting is not usually an attempt to kill themselves, but a way of dealing with anxiety or expressing unhappy feelings about themselves or a situation.

The cutting distracts the child from the emotional pain they are experiencing. The cutting can lead to an adrenaline surge in the body, which makes the child feel better. Repeated cutting can become "addictive" and becomes an inappropriate and potentially dangerous way of dealing with anxiety and emotional pain.

Overdoses and Suicide Attempts

Overdoses of tablets or other dangerous substances is always worrying because of the risk of lowering social inhibitions, damaging organs in the body, or death. Many young people are not aware of how dangerous some medications are. For instance paracetamol, even in quite small doses, can be particularly dangerous causing serious liver damage and sometimes death.

Often people who overdose, or try other ways of suicide, are acting on the spur of the moment. Soon after, they may regret their impulsive act. A suicide attempt indicates deep unhappiness or depression. Some people say it is "attention seeking" but if young people are resorting to such behaviour, it is clear they need help and this behaviour should always be taken very seriously.

What to do right away if you find your child has overdosed?

Seek medical help. Try to find out what medication/substance has been taken. If your child is conscious, keep very calm and keep control of your feelings as well as you can. Ask them what they have taken, when they took it, and how much they have taken. If you see any tablets or medicine bottles/packets etc. keep them for the doctor/ambulance medic to see.

If they are unconscious, loosen any clothing around their neck and put them into the recovery position. If they have stopped breathing you should try resuscitation techniques. Attending a first aid course will prepare you for such an eventuality and others.

Depending on what state your child is in, you can take them to hospital or call for an ambulance. If you ring for an ambulance, keep calm and speak clearly. Answering their questions calmly will help them decide on the best course of action to take when they arrive. Tell them clearly what has happened and what medication/substance has been taken. If you have any doubt about what to do, always phone for an ambulance.

If your child is taken into hospital after an overdose or suicide attempt of some other sort, they should be referred to a psychiatrist for psychological assessment. This does not always happen, but it should - ask for it if it doesn't. Hospital staff, or the psychiatrist, may refer you on to a child and adolescent mental health service for more in-depth help. This can take many forms but will usually involve some family and individual therapy.

Remember you may be in a state of shock after such an event and may need some help for yourself.

What to do after the event?

These types of behaviours often indicate anxiety and distress in the young person's life. Have a think about what might be happening in your child's life. Areas to think about are:

• School or college.
• Relationships with friends, boyfriend/girlfriend difficulties.
• Stresses and tensions at home between family members, illness etc.
• Complications over contact arrangements after separation/divorce.
• Any recent upsetting events such as bereavement.
• Any stresses coming up such as important examinations.

If there are difficulties at home, you need to think about the pressures these may exert on your child and examine whether there are any changes that need to be made between other family members rather than just in your child. Is the impact of any handicap your child may have becoming more pronounced and causing emotional and social difficulties? You can also talk to friends and adults involved in their lives such as teachers or other family members. In life, it is rarely one event, but a number of events coinciding that leads to depressed feelings.

Talk to your child. Don't brush it under the carpet for fear of making matters worse. Keep calm. If you are lucky they will tell you what their difficulties are and you may be able to help through talking and maybe planning some sort of action together to resolve the difficulties. Be aware that some forms of self-harm have a peer group basis. For instance, cutting and scratching can be a uniting behaviour amongst a group of friends. One thing I have found recently is a lot of minor cutting in young boys and girls who belong to the "Goth" culture.

When talking to your child, find the right time and place to do it. Be patient and let your discussion express your concern in a way that is positive towards your child. If they will not talk to you ask them about getting some professional help and make them aware that many colleges offer confidential counselling services. If they have chosen to see an individual counsellor rather than talk to you, try not to be too disappointed or critical because they will not talk to you. It is much better that they talk to someone about their feelings rather than continue on in the same dangerous way. Sometimes other family members can help too.

Common Sense Stuff

Of course, it is important to keep dangerous medicines and other harmful substances locked safely away. This may sound obvious, but it is important, especially if there has been an overdose or threats of overdose. Where there is a pattern of self harm or suicidal behaviour always seek help from your doctor - even if only for reassurance. Tragedies do happen and in order for you to cope better afterwards, it is important that you do what you think is right at the time - which may mean you need help for yourself as well as your child. Remember the impact of a suicide attempt or self harm can cause great distress to brothers and sisters, as well as the adults - they will need talking to and reassuring as well.

Prevention

Sadly some children do go on to kill themselves. Tragically this can be accidentally. If your child really wants to kill themselves it is difficult to stop them, particularly as they get older. Most children who attempt suicide are responding to an immediate crises and with some help do not go on to try it again. For others who may have been experiencing concerns and anxieties for a long time and have not received any help or relief from them, a longer and more intensive period of help may be required. For others who have developed serious mental health difficulties and have not responded well to help, and for those who have drug and alcohol difficulties, the future may not be so bright. These individuals will need long term support and help from family and professionals.

However, there are nearly always some signs before. A child may have talked to a friend, a teacher or brother or sister about their feelings or frustrations, so it is useful to ask around the family to see how your children are coping and feeling generally. Depression is often associated with self-harm and suicide. Depression can be hidden by children, or masked by difficult and defiant behaviour. For this reason, developing a good relationship with your child will help you be aware of how they are feeling generally. It is not necessarily the case that people who are depressed will self-harm or attempt suicide, but it raises the risk of such behaviour. Things to look out for in children are:

• Withdrawal from friends, interests and activities.



• Difficulty getting off to sleep and waking very early or during the night.



• Lack of concentration and difficulties at school



• Increased difficulties in handling relationships.



• Loss of appetite or over eating.



• Moody and irritable behaviour.

If this is the case try to talk to them and find out what is happening in other areas of their life as well as at home.

One of the most difficult things for any person to endure is social isolation and loneliness. Feelings of social isolation and low-self worth can be very strong in teenagers and young people generally. If these are combined with alcohol abuse and drug taking, the risk of suicide increases. By developing a healthy, open relationship with your children, through regular talking and activities together, you can help them feel more connected during their lives - particularly when they are experiencing difficulties in their peer relationships and in developing their wider social lives. You cannot take away all their difficulties and pain, but you can provide a place for them to talk about their fears and worries. The skill is in providing this whilst respecting their rights to independence and self-discovery. It is better to make mistakes at trying to achieve this balance, rather than not trying at all.

By Mr Dennis Neill, BA(Hons), CQSW