Marc Fennell:        
G’day, my name is Marc Fennell and welcome to the MindMatters spotlight on Self-harm. Now, before we get into what I’m hoping is going to be a very practical discussion, this can be a very confronting topic. So if you’ve had a personal experience of this, we’d like you to take full advantage of support services, they have amazing staff who are very experienced, professional and genuinely helpful. But for now, allow me to introduce our panel; we have Associate Professor Penelope Hasking from Curtain University. We have Helen Barrett from the Department of Education Tasmania, Andrew Fuller from Resilient Youth Australia and Professor Margaret McAllister from the Central Queensland University. Welcome to you all. All right, for many years I remember when I was younger people used to talk about self-harm as a way of attention seeking. Is that an accepted reason why people do it? Or is that just simply not true?

Helen Barrett:    
I think it’s a derogatory term. You hear it a lot. I tend to turn it around and say its attention needing because there is actually a need underneath that attention. There’s a real reason why they’re feeling that way and that they’re often feeling distressed or feeling isolated or alone, and there’s a reason for that attention.

Margaret McAllister:    Yeah I would agree with that because self-harm can be a symptom of a range of disorders and some of them are really quite complex, and they would need to be assessed by a qualified mental health professional. A self-harm action is a powerful way of saying to people, I need help.

Marc Fennell:        
And it’s worth noting here that there can be a relationship between suicide, but not always. It can be its own thing as well, is that a reasonable assessment?

Penelope Hasking:    
Yeah, so they do go hand in hand sometimes and sometimes they’re completely different, and that makes it quite a challenging area to work in.

Marc Fennell:        
Margaret, walk me through the mental process of why somebody might self-harm?  

Margaret McAllister:    
There might be different motivations for different life groups but I think the common element is the person is feeling a strong emotion, that’s painful, difficult to bear and so some people act inwardly to maybe get rid of that strong emotion. Also, I think that we could look upon the issue of self-harm as an issue that occurs in adolescence, and not just be reacting to it but being proactive by emphasising young peoples’ strengths and building those up, and validating to young people that they probably have the strength within them.  

Marc Fennell:        
Andrew, once someone starts self-harming, do they stop ever?   

Andrew Fuller:    
Self-harm is one of the most contagious of the sort of negative psychological acts really. So we see groups of young people take it up for a short period. The other group who basically continue on though, are probably more troubled and may then resort, unless they learn alternative ways to cope with whatever is going on, they may resort to it throughout their lives as Margaret said.

Helen Barrett:    
So just building on what Andrew was saying, I think there’s lots of things that schools can do proactively as well. So explicitly teaching social and emotional learning is really important, so kids are learning about how to understand their emotions, regulate their emotions, deal and communicate with others, problem solve. All of those skills are really giving them good foundational skills and ways of coping. I think also schools can promote positive help seeking so that it’s not a shameful thing that you go and seek some help. Promote the counsellors within the school or the other services that are around, and also promote that with parents as well.

Marc Fennell:    
Any other particularly good examples you’ve seen of strategies or programs that schools have used that you’d like to see more of?

Penelope Hasking:    
There are a few guidelines around for schools in terms of how to minimise the risk of contagion. And these tend to include guidelines around discussing self-harm in a public forum. So as a teacher, the role would be to be familiar with those policies. The second thing I was going to say is that given that important role and given that teachers do have other jobs to do, and do need to look after themselves, that schools need to have a policy on self-harm separate from their suicide policy. That may include having one or two point people who can sort of take that initial referral, and that everybody in the school knows what that policy is and understands what their role is in that and then teachers can then refer to those point people. And I think it’s also important then to have a feedback loop, so that if teachers do refer somewhere else, they find out what happened with that student. And the same if a student refers. As far as I’m concerned, all school staff have an important role to play in the wellbeing of our young people, whether that’s teachers, admin, the principal or the mental health team. And that the way that these people, including teachers, interact with students who self-harm, can be absolutely paramount in whether that young person seeks out help in the future when they need it. So being able to respond with that empathic, supportive but neutral not over reacting demeanour is really really crucial.

Margaret McAllister:    
If you see a young person is acting differently, if they’re isolating, if they look to be distressed then show concern. And you don’t have to have the answers but if you just say “I’m here to listen” and then perhaps try to connect them to somebody else in the school, whether it be a productive peer - You know, a positive peer. The school support office, the school chaplain. So try and invite them to make those connections.

Marc Fennell:    
Penny, where’s the line? When should you bring in an external professional do you think?

Penelope Hasking:    
Again, it’s a tough call to make because it will be a case by case basis depending on what the needs of that particular student are. If we’re talking about self-harm, I think if there are some severe underlying issues or there is increased risk of suicidal behaviour then absolutely there should be a referral to an external psychologist. A lot of the policies that we advocate will have one or two people as sort of a point team who are capable of doing that assessment. So as a teacher, the role would be to be familiar with those policies to respond to the young person in that moment with an empathic but neutral and supportive tone and refer to that point person who can then do that assessment and work with the young person to then work with the family as well. And one other thing to bear in mind in working with family is the young person may well be quite distressed at the idea that somebody has discovered their self-harm, and notifying the family may well exacerbate that for them. So it’s important to balance the needs of the student with duty of care, and in many cases that’s going to be on a case by case basis with the mental health staff if available within the school, who know the student and know the family situation.

Marc Fennell:    
Andrew how do you tackle it when you have to deal with conversations like that?

Andrew Fuller:    
It’s more going “you know, I’m concerned about your young person, they seem to be very kind of distressed in various ways and I’m wondering, and I wonder whether you’ve picked up, whether you’ve seen any signs that they’re taking that out on themselves? Are they hurting themselves in some way? Or are they more prone to accidents?” there’s a number of ways of self-harming that aren’t slashing and cutting. And so there’s a number of ways then of just sort of gently, I suppose as much as we can, ease into the conversation a concern. And I find parents then feel included without being accused.

Marc Fennell:    
Helen, one useful tip for a teacher watching now?

Helen Barrett:    
I think one thing is to help young people to understand that even though they’re going through this emotional distress and it can feel really physically painful, that they will get through this and they will come out the other end and it won’t feel like this forever. I think that’s really important. Teachers are in unique positions, they can be that significant other, they can be the protective factor for a young person. I think the other thing, if I could quickly just say, I think teachers need to look after themselves too and they need to get debriefing and EAP programs are in schools to look after staff as well because it can be quite confronting.