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Title: Prevention of Self-Harm and Suicidal Ideation Conference 26th March 2015


1
Prevention of Self-Harm and Suicidal Ideation
Conference 26th March 2015
2
David Loyd-HearnCommissioning Manager Children
and Young PeopleEmotional Health and Wellbeing
Welcome
  • Emma Grinham
  • Young Person Chair of the Mental Health Anti
    Stigma Programme

3
Prevention of Self-Harm and Suicidal Ideation
Conference
  • Setting the Scene
  • Self Harm and serious Case Reviews lessons
    learnt
  • Acute self harm
  • Break
  • Northamptonshire Community Toolkit
  • The real story in school
  • TaMHS Mental Health in Schools - setting up an
    Emotional Health and Wellbeing Team
  • Action planning
  • Closing summary

4
Setting the Scene Self-Harm
SymptomsSelf-harm across the spectrum
5
Why is Emotional Well Being and Mental Health for
Children important?
Emotional wellbeing underpins being successful at school, making and keeping friendships and making the most of life. Approximately 50 of lifetime mental illness starts before the age of 14 and it is estimated that potentially half these problems are preventable.
Self Harm can sometimes be a coping mechanism or fashion, but it can also lead to significant harm and occasionally suicide. It is not the act that matters, but the intent. Around 1 in 10 children and young people may have a mental health problem at any one time. Referrals have increased by 27 in Northamptonshire over the last 3 years with 6.5 of all children getting support
Self-harming admissions are higher in Northamptonshire than the national average. Research suggests self-harming behaviours are average. In adulthood half of all women, and a quarter of men will be affected by depression at some stage in their life.
Recent Northamptonshire Public Health assessment suggests local wider costs 1347 million due to mental illness When it comes to children and young people, 1 in 10 children self-harm, with suicide accounting for 20 of deaths in young people between the ages of 15-24.
6
Key Findings from CYP Survey (775 Responses)
Unmet needs continue to feature which do not fit in defined Specialist CAMHS criteria e.g. challenging behaviour, self harm as a coping mechanism. We are working together to resolve. 73 of a significant sample of young people have body image concerns, this increases to 90 of the sample of CAMHS users. Young people suggest this is sometimes a cause for self-harm.
Behaviour Issues account for 52 of paediatric referrals and a significant number of CAMHS referrals. If untreated, sometimes these cases may lead to self-harm. Anxiety and Depression is the number 1 reason for referral (and can lead to eating issues or self harm as a coping mechanism). Young People increasingly find self harm is an acceptable coping Mechanism.
We are a national outlier for self harm due to the adherence of NICE guidance, though we are about average in presentation numbers by NHS estimates. There is a significant lack of knowledge of services, what is available and how to access. If in doubt, visit www.asknormen.co.uk
7
What is self-harm?
  • Self-mutilation
  • Self-destructive behaviours (compulsively
    pursued acts that causes self-harm e.g. head
    banging)
  • Self-harm without suicidal intent
  • Attempted suicide
  • Minority who self-harm attend AE departments or
    specialist services
  • Most are supported in the community
  • Most young people who self-harm do not continue
    with this into their 20s

8
How many young people self-harm?
  • Rarer in pre-teens (but locally this is growing)
  • 10 of adolescents in the UK self-harm
  • At 14yrs 25 Females 14 Males experience
    suicidal ideation
  • Only 2-3 present to medical services
  • Huge number remain unknown (behaviour self harm
    has been anecdotally estimated at 50)
  • Self Harm is not the issue, it is the cause and
    intent that matter most. Less than 4 of self
    harmers go on to have enduring mental health
    needs.

9
National and Local Statistics
  • 72 of people who seek help for depression are
    female
  • 75 of people who take their own lives are men.
  • National rates of self-reported self-harm are 7
    for 11-16 year olds but several times higher in
    those with
  • emotional disorder (28)
  • conduct disorder (21)
  • ADHD (18).
  • Applying national rates to Northamptonshire would
    mean that 2940 11-16 year olds would report
    self-harm. Our actual figure is lower, though in
    schools anecdotal evidence suggests the rates
    could be as many as 50.

10
Northamptonshire AE Admission Rates for Self Harm
Locality Inpatient Admissions of 0-19's in 2009-10 Inpatient Admissions of 0-19's in 2010-11 Inpatient Admissions of 0-19's in 2011-12 Inpatient Admissions of 0-19's in 2012-13
Western Northampton 51 60 64 55
Kettering 35 51 40 49
East/Southern Northampton 30 48 55 40
Central Northampton 44 43 55 28
East Northants 15 19 20 26
Daventry North 28 30 23 23
Corby 29 28 24 25
Wellingborough 15 21 14 20
Daventry South 14 17 18 17
Oundle Wansford 1 0 1 4
Not coded 19 15 23 12
Total 281 332 337 299
11
Hospital Admissions (Approx)East Midlands 2010
  • Under 10 yrs Low figures
  • 10-14 yrs 350
  • 15-19 yrs 1500
  • 20-24 yrs 1300
  • 25-29 yrs 1000
  • 30-34 yrs 800
  • 30-39 yrs 1100
  • 40-44 yrs 1200
  • 45-49 yrs 700
  • 50-54 yrs 550
  • 55-59 yrs 300
  • 60-64 yrs 170
  • 65-85 yrs figures reduce

12
Under 18s Hospital Admissions by PCTEast
Midlands 2010
  • Derbyshire 210
    12.4
  • Derby City 104
    17.4
  • Nottinghamshire 164 9.2
  • Nottingham City 118 17.3
  • Northamptonshire 220 12.8
    Per 10,000 area population

  • Leicestershire 199 12.2
  • Leicester City 91
    11.2
  • Lincolnshire 155
    9.8
  • East Midlands Total 1261 12.0

13
What are we doing about self-harm? Short Term
  • The conference highlights the new self- harm
    toolkits for Northamptonshire on
    www.asknormen.co.uk
  • Web resources for young people by young people
    available on http//www.talkoutloud.info/how-do-yo
    u-feel/self-harm.aspx
  • We have redefined the acute self harm and
    suicidal ideation pathway
  • We are actively working with Northampton and
    Kettering Locality Forums to embed action plans
    with excellent examples of best practice at
    schools such as Northampton Academy Kettering
    Buccleuch Academy.
  • Auditing Urgent Care Admissions
  • Developing questionnaires for acute
    self-harmers

14
What are we doing to reduce self-harm? Long Term
  • The 2014-17 Children and Young People Emotional
    Wellbeing and Mental Health Strategy looks at
    improving emotional resilience
  • The Partnership are working to improve outcomes
    relating to challenging sexualised behaviours,
    drug and alcohol misuse, parental mental health
    and interpersonal violence
  • Initiatives to improve family relationships,
    resilience and coping strategies
  • Five to Thrive
  • Targeted Mental Health in Schools (TaMHS)
  • Talk Out Loud Anti Stigma Programme
  • Working with School Nursing as a part of the
    National Call to Action
  • Support of adults with mental health concerns or
    harmful behaviours
  • Developing the Childrens Community Health
    Services

15
Priorities for the 2013-17 Emotional Wellbeing
and Mental Health Strategy
  • The promotion of positive emotional wellbeing and
    early intervention
  • Improved integration in targeted and specialist
    services including a single point of access
  • Better support for children and young people who
    are chronically or acutely unwell
  • Strengthened thresholds and pathways for
    behavioural and neurological developmental issues
  • Focus on key groups of vulnerable children and
    young people to prevent poor emotional wellbeing
    outcomes and ensure there are appropriate
    interventions when they require additional support

16
  • Northamptonshire Children and Young People
    Community Health Transformation Programme

17
When to make Referrals
18
Integrated Children Young Peoples Specialist
Health Service
Countywide offer delivered in Localities
ADHD ASD
Childrens Specialist Nursing
19
Dealing with Child and Young People presentations
within local settings
  • Doing Well expected that universal services
    engage e.g. the Talk Out Loud Anti Stigma
    programme/TaMHS work in schools to promote
    mindfulness
  • Doing alright or with a single issue. Targeted
    Services to cover (largely NCC services) Self
    Harm as a behaviour may fit into this. School
    Nursing or Health Visitors may be appropriate
  • Where professionals are uncertain, it may be
    worth contacting the CAF Co-ordinator and
    attending complex case meetings
  • SOME NOTICEABLE PROBLEMS in more than one area.
    Variable functioning with sporadic difficulties
    or symptoms in several but not all social areas.
    Disturbance would be apparent to those who
    encounter the child in a dysfunctional setting or
    time but not to those who see the child in other
    settings. Targeted Plus services to cover e.g.
    Counselling services or some services by NCC
  • If the presentation is largely effecting children
    within school settings, it may be worth using the
    pupil premium to commission any support such as
    family support or education psychology services.

20
When to make a referral to the Referral
Management Centre for CAMHS/Paediatrics?
  • Specialist Services (e.g. CAMHS) to cover -
    OBVIOUS PROBLEMS moderate impairment in most
    areas or severe in one area - Moderate degree of
    interference in functioning in most social areas
    or severe impairment functioning in one area,
    such as might result from, e.g. suicidal
    preoccupations and ruminations, school refusal
    and other forms of anxiety, obsessive rituals,
    major conversion symptoms, frequent anxiety
    attacks, frequent episodes of aggressive or other
    antisocial behaviour with some preservation of
    meaningful social relationships.
  • SERIOUS PROBLEMS major impairment in several
    areas and unable to function in one area Major
    impairment in functioning in several areas and
    unable to function in one of these areas, i.e.
    disturbed at home, at school, with peers or in
    the society at large, e.g. persistent aggression
    without clear instigation markedly withdrawn and
    isolated behaviour due to either mood or through
    disturbance, suicidal attempts with clear lethal
    intent. Such children are likely to require
    special schooling and/or hospitalisation or
    withdrawal from school (but this is not a
    sufficient criterion for inclusion in this
    category).
  • If uncertain, there is a CAMHS PROFESSIONAL
    CONSULTATION LINE
  • Monday to Friday
  • 9.30am1.00pm
  • Tel 0300 1111 022

21
When issues are treated as urgent?
  • Highly Specialist Services (e.g. Crisis
    team/Inpatient) - SEVERE PROBLEMS - unable to
    function in almost all situations - Unable to
    function in almost all areas, e.g. stays at home,
    in ward or in bed all day without taking part in
    social activities OR severe impairment in reality
    testing OR serious impairment in communication
    (e.g. sometimes incoherent or inappropriate).
  • VERY SEVERELY IMPAIRED -considerable supervision
    is required for safety Needs considerable
    supervision to prevent hurting others or self,
    e.g. frequently violent, repeated suicide
    attempts OR to maintain personal hygiene! OR
    gross impairment in all forms of communication,
    e.g. severe abnormalities in verbal and gestural
    communication, marked social aloofness, stupor,
    etc.
  • EXTREMELY IMPAIRED - constant supervision is
    required for safety Needs constant supervision
    (24-hour care) due to severely aggressive or
    self-destructive behaviour or gross impairment in
    reality testing, communication, cognition, affect
    or personal hygiene.Working as a self- harm team,
    consider peer support/supervision and
    confidentiality issues.

22
Websites and Links
  • Northampton Young Healthy Minds Gateway-
    www.asknormen.co.uk
  • CAMHS- http//www.nhft.nhs.uk/main.cfm?typeCONTEN
    TCAMHS
  • Northampton Youth Forum- http//www.northampton.go
    v.uk/info/200124/forums/329/northampton_youth_foru
    m
  • Northamptonshire Parent Forum Group-www.northantsp
    fg.co.uk
  • Out There- http//www.thelowdownevents.info/new-yo
    uth-group-out-there/
  • Shooting Stars- http//www.northantspfg.co.uk/shoo
    ting-stars/
  • Talk Out Loud www.talkoutloud.info
  • Young Minds- http//www.youngminds.org.uk/ 
  • Youth Space - www.youthspace.me
  • Northamptonshire CAMHS Review http//www.neneccg.
    nhs.uk/cyp-services/

23
Websites and Links Youth Counselling
  • Youth Counselling across the county -
    http//www.servicesix.co.uk/
  • Northampton - http//thelowdown.info/
  • Daventry - http//www.time2talk.org.uk/
  • Kettering and Corby - http//kyi.org.uk/
  • Oundle - http//www.oundle.gov.uk/oundle-town-coun
    cil-properties/courthouse/chat/
  • Wellingborough - http//www.servicesix.co.uk/
  • ADHD Support - http//www.autismconcern.net/index.
    php?optioncom_contentampviewarticleampid195
    new-adhd-a-as-dual-diagnosis-provision-in-northam
    ptonshire
  • Prevention of Self-Harm and Suicidal Ideation
    Toolkit http//www.asknormen.co.uk/self-harm-and-s
    uicidal-ideation-conference-resources/
  • And new for supporting training in 2015/2016
    https//www.minded.org.uk/

24
Self Harm and serious Case Reviews lessons
learnt Case Vignette Maggie Beer
25
(No Transcript)
26
Who was she? She was bright, capable and
articulate. She had experienced significant
neglect in the first 5 years of her life and had
been looked after since then. She took her own
life just before her 18th birthday.
Was her death predictable or preventable?
27
What did we learn? History was not shared and
therefore her journey was not understood. Agencie
s did communicate but it was limited and not
followed through. As an articulate young person
she was able to keep people away but her
voice was not present.
Who was she? She was bright, capable and
articulate. She had experienced significant
neglect in the first 5 years of her life and had
been looked after since then. She took her own
life just before her 18th birthday.
Was her death predictable or preventable?
28
What have we done?
What did we learn? History was not shared and
therefore her journey was not understood. Agencie
s did communicate but it was limited and not
followed through. As an articulate young person
she was able to keep people away but her
voice was not present.
Who was she? She was bright, capable and
articulate. She had experienced significant
neglect in the first 5 years of her life and had
been looked after since then. She took her own
life just before her 18th birthday.
Was her death predictable or preventable?
29
What have we done?
  • Self-harm pathway developed
  • Challenged National protocol for leaving care in
    terms of the information shared when young people
    subject to leaving care legislation move from one
    area to another.
  • Reiterated the need to access young peoples
    history this is a recurrent theme from local
    serious case reviews, where for adolescents or
    infants.

30
Is it suicide?
  • 27 different definitions and Coronial process
    apply rules subjectively across country so
    different rates-affects ONS data
  • Small numbers of suicides in each local centre so
    learning impaired

31
Nottinghamshires Experience
  • 2012 audit
  • Majority of deaths were unpredicted
  • Minority were high levels of previous emotional
    health concern/deliberate self harm/child
    protection
  • So how do we PRECICT risk and learn?

32
Self-Harm the acute story
  • Julie Quincey
  • Named Nurse Safeguarding Children
  • Northampton General Hospital

33
Young person up to 18 years presents at AE
following Deliberate Self-harm act
Triaged in AE, and if no medical treatment is
required, transfer to ward (Child or Adult
setting) with child self-harm pathway
documentation started by AE staff
Patient refuses treatment and absconds from
Hospital
Clerked on the ward and medically assessed
  • Ward ring Child and Adolescent Mental Services
    (CAMHS) to request risk assessment
  • Prior to 12.00 midday Mon Fri 9 5 call CAMHS
    Newland House, 01605 656060
  • Between 17.00-22.00 the CAMHS CRISIS team can be
    contacted for consultation via Berrywood hospital
    reception on 01604 682682

Inform police (999) and ask for welfare check
clearly record the incident number in the patient
record
Police return with patient - continue with pathway
If patient admitted out of hours, they should be
kept in overnight and CAMHS informed next working
day
Patient refuses to return, inform GP and refer to
childrens social services and ask them to
consider referral to CAMHS
CAMHS undertake mental health risk assessment. If
safeguarding concerns request ward contacts
social care for joint assessment and inform
Hospital Safeguarding team
Ensure Paediatric Liaison Form is completed and
copied to school nurse and GP, or if Interagency
referral to social services has been completed, a
copy of this will be sent to GP and School Nurse.
Ensure Safeguarding team is copied in. DOCUMENT
EVERYTHING IN THE PATHWAY, COMPLETE SAFEGUARDING
CHRONOLOGY.
Once assessment is completed, and medical review
taken place, the patient can be discharged home.
If there are safeguarding concerns then a joint
discharge planning meeting with childrens social
services should ensure safe discharge.
34
Why do we assess the next working day
  • As per NICE guidelines we do the following
  • First they need to be medically stable
  • Secondly they need time out to sleep, to reflect
    and to rest
  • Then CAMHS will come and assess

35
Catherines Story
36
Catherines story
  • Catherine was admitted to NGH having taken an
    overdose of 24 paracetamol, 8 ibruprofen, 3 nytal
    and her fathers anti-depressants 15 tablets were
    missing
  • I was present when Catherine was admitted she had
    come via ambulance
  • She was in secondary school, looked very thin,
    nicely dressed and otherwise looked well looked
    after
  • She came with her older brother, her father and
    her step-mother
  • Her father and step mother were distressed and
    were struggling to come to terms with Catherines
    actions, her brother seemed detached

37
The treatment
  • Catherines paracetamol levels were high and
    therefore she required a parvolex drip and stayed
    in over night
  • We weighed her and checked her eating pattern
    though thin she had a normal BMI and we observed
    her eating well on the ward
  • The next morning she was pronounced medically fit
    for discharge
  • CAMHS attended and did their assessment they felt
    she was not mentally ill but would follow her up
    in the community

38
Catherine and her family tell their story
  • I told Catherine she could go home but she
    refused she said her brother was hitting her and
    she was not going to go home anymore, she had not
    shared this with the CAMHS worker
  • As the safeguarding nurse I needed to understand
    more
  • It took the next three hours to unpick the story.
    Catherine had originally lived with her birth
    mother who struggled with mental health problems
    both children suffered emotional abuse and after
    a case conference were placed with their father
  • Catherines step mother was very calm and
    understanding but had found Catherine emotionally
    shut down and non-communicative

39
Catherine and her family tell their story
  • Catherine shared that her brother Toby was really
    hard to live with as he had behavioural problems
  • I had observed Toby for a number of hours and he
    struck me as being on the autistic spectrum, I
    discussed this with his father and step-mother
    and they agreed to a referral to CAMHS to have
    him assessed, I later found out he had been
    diagnosed with high functioning autism
  • Catherine agreed to go home once she knew Toby
    would get help

40
Catherine
  • With the parents agreement we referred Catherine
    as a child in need to social services, the family
    were assessed and were eventually signed posted
    to a life story worker who worked with Catherine
  • Though Catherine was not mentally ill she was
    struggling to make sense of her world as was her
    brother
  • The family had been through a lot of trauma they
    needed time and help to make sense of the many
    changes
  • To my knowledge Catherine did not self-harm again

41
Jacks story
42
How Jack came to hospital
  • Jack was seen by the police he was standing
    outside his girlfriends house at 3 am in the
    morning it was snowing heavily, his head and
    shoulders were covered in snow
  • Jack was not making sense when the police spoke
    to him his words were slurred and his eyes looked
    dilated, he eventually admitted to the police he
    had taken an overdose
  • The police brought him to AE and he was admitted
    to the childrens ward, he was 17 years old
    effectively homeless and sofa surfing he
    originally was from out of county

43
The treatment
  • Jack also required a parvolex drip
  • He had also self harmed through cutting and
    required steri-strips to his arms and the cuts to
    his legs were cleaned up
  • He appeared to have a chest infection and bloods
    were taken
  • During the night Jack slept deeply
  • The next morning he was ready to see CAMHS

44
Jack takes his leave
  • I was rung by the ward, Jack was refusing to stay
    as he was worried about his girlfriend
  • We managed to calm Jack whilst we waiting for
    CAMHS Jack started to tell me that he had stood
    every night for the past week outside his
    girlfriends house, she and her mother didnt
    know. He felt it was the only way he could keep
    her safe and he felt compelled to do it
  • Jack appeared to be highly distractible and
    appeared to be listening to something, I shared
    my concerns with the CAMHS worker I was beginning
    to wonder if Jack was manic or indeed psychotic

45
CAMHS assessed
  • CAMHS agreed that Jack was showing pressure of
    speech, had distorted thinking he believed his
    mobile was sending him messages but his mobile
    was completely dead and had been for a number of
    days
  • He was also stating if he left the hospital he
    would jump from a building
  • The CAMHS worker explained to Jack he was ill
    and said he needed to be admitted to psychiatric
    hospital

46
Jack ran
47
Jack
  • Jack was returned to the ward by the police
  • Eventually Jack was transferred to psychiatric
    hospital by the police and the AMHP worker under
    section 3 of the mental health act
  • I do not know the outcome of Jacks story

48
Kelsies story
49
Kelsies story
  • Kelsie had over 20 admissions to NGH in a three
    month period in her late teens
  • She allegedly took overdoses however the tox
    screen never showed toxic levels in her blood
  • She frequently self-harmed by cutting, burning
    and using ligatures
  • Kelsie during this time became looked after by
    social services
  • As her story slowly unfolded it was discovered
    she had been sexually exploited
  • Kelsie has learning difficulties

50
Kelsie to date
  • Kelsie has been very hard to help
  • Though she is not mentally ill she does use
    self-harming behaviour to express her feelings
  • She frequently disappears from her foster carers
  • She will return to her mothers and then go
    missing again
  • She is potentially at risk when she does not
    engage
  • Kelsie is now a young adult and continues to be
    admitted to NGH with self-harm

51
What can we learn
  • These cases are pretty typical
  • Catherines was due to the effect of coping with
    emotional abuse
  • Jack had developed bi-polar
  • Kelsie has a troubled background, learning
    disability and is at risk of sexual exploitation

52
Catherine
  • Catherine had had many changes, her new school
    was aware of the troubles she had experienced
    with her birth family, but as Catherine was quiet
    and a good student it was assumed both by school
    and her parents that she was coping
  • Catherines history is a high risk for
    vulnerability to self harm
  • Parental mental illness
  • Child protection proceedings
  • Brother with emerging developmental disorder
  • Mentoring at school may have helped

53
Jack
  • Jack was homeless and only became known to
    services after admission
  • Though his girlfriends mother knew Jack was
    troubled he had hid the homelessness from her and
    his girlfriend agreed to keep quiet
  • The police responded really well, Jack has got an
    early diagnosis and if he follows his medical
    regime he should have better outcomes

54
Kelsie
  • Kelsie had been permanently excluded on more than
    one occasion
  • She was well known to social services
  • Her learning difficulty had never been formally
    diagnosed
  • Her mother rarely reported her missing
  • Kelsies vulnerabilities made her ideal for men
    to sexually exploit
  • All workers should be familiar with the CSE
    toolkit to spot the risk factors and take action
    sooner

55
Break
56
The Community Schools Pathway and Toolkit
  • Cazz Broxton
  • CAMHS Community Liaison Lead
  • Mike Simons
  • Senior Educational Psychologist, NCC
  • Lead for Northamptonshire TaMHS Programme
  • Annie Head
  • Counsellor, Northampton Academy

57
What is Self-harm?
  • Self-harm in the literature is used to cover
    deliberate acts of injury which may or may not
    involve a wish to die.
  • One example is that of physical mutilation e.g.
    cutting the skin, repeatedly banging a part of
    the body etc.
  • Most people who injure themselves in what they
    call self-harm do not intend to intentionally
    risk their lives

58
Why do young people Self Harm ?
  • Act of self-harm or self injury can be symptoms
    of distress
  • The importance of the act is meaningful to the
    individual who carries it out
  • It is important not to generalise about young
    people who self-harm
  • It can be a way of coping with many different
    emotions

59
Explanation from people who Self-harm
A sense of control
To be able to feel anything
The pain proves your human
For the physical pain to overtake the emotional
pain
It is like an addiction
To let the anger out
A way of punishing myself
To break numbness
I like watching the blood run
60
Cycle of self-harm
Negative emotions Sadness, anger and
despair Tension Inability to control emotions,
maybe using dissociation to cope with tension
Self- harm act Cutting, burning etc Positive
effects Endorphins released, tension and
negative feelings dispelled for a short
period Negative effects Shame and guilt over
self-harm act
61
Definition
  • Self-poisoning or self-injury, irrespective of
    the apparent purpose of the act
  • NICE, 2004

62
The Two Pathways
  • The Community School pathway and acute pathway

Community School Pathway
If necessary, Acute Pathway
63
(No Transcript)
64
The Community School Pathway
  • Improved communication home, school and other
    agencies
  • Self- harm team
  • CAMHS consultation through liaison line
  • Checking with safeguarding protocols
  • Consideration of informing parent/carer
  • Risk assessments and forms

65
The Toolkit
  • Toolkit has been developed by Northamptonshire
    Multi-agency pathway development team and also
    includes guidance from other national and
    regional organisations
  • Guidance for schools to support children, young
    people and families at an individual and systemic
    level
  • Bringing a national perspective into the local
    framework including example policies for schools
  • Tools can be used in either a preventative or
    supportive capacity
  • Toolkit contains both practical and theoretical
    evidence based approaches to helping and
    supporting young people

66
Using the Toolkit and Pathway
  • Scenario....
  • You are approached by a young person who attends
    your organisation e.g. school/ community group
    who has indicated that they have self-harmed by
    cutting them self. They have shown you the cut on
    their forearm.
  • For five minutes on your tables, discuss how you
    would use the
  • pathway and toolkit to help you to support this
    young person
  • and decide on a plan of support...

67
Key aspects to consider
  • Working as a self- harm team, consider peer
    support/supervision and confidentiality issues.
  • Informing parents and use of scripts for
    telephone conversation/ letter to parents to
    arrange meeting
  • Any necessary further referral e.g. Safeguarding,
    CAMHS, Educational Psychologist, Community
    Support?
  • Tools that may be useful e.g. proactive support
    plan, script for talking to a young person,
    coping strategies and distractions, risk
    assessment, protective behaviours
  • Documenting the support- appropriately evidencing
    a plan of support in school and ensuring
    paperwork is clear and relevant should an ongoing
    referral need to be made
  • Consistent documentation to be handed over when
    relevant between the two pathways in order that
    all agencies recognise plans of support.

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Look after you-supervision and team support are
paramount!
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The Real Story in SchoolNorthampton Academy
  • Responding to Self-harm Through an Emotional
    Health Wellbeing Team
  • Annie Head
  • Counsellor
  • Northampton Academy

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The Pastoral Support Team
  • The aim of the Pastoral Support Team is to meet
    the Social, emotional and Mental Health needs of
    students. The team consists of two Pastoral
    Support Managers, a Counsellor and an Early
    Intervention Coordinator who works with families
    through the CAF process. The Team works alongside
    the SEND team within the Inclusion faculty and is
    part of a graduated response

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Responding To The Emotional Health and Wellbeing
of Students
  • Good referral policies and procedures are key in
    developing and maintaining a well-functioning
    team and should be revisited termly to be
    consistently good.
  • They allow containment for students, staff and
    families.
  • They remove reactionary behaviours and the risk
    of catastrophizing which can potentially increase
    stress and anxiety.
  • They allow good communication and discussion.
    Confidentiality is always adhered to, yet a
    degree of transparency is required in the best
    interest of the student.
  • They involve good record keeping, tracking
    referrals, both internally and externally. This
    allows us to identify emotional needs through
    trends and patterns of behaviour. Preventative
    work can then be tailored to meet the needs of
    students.
  • They ensure the work is allocated appropriately
    to the right person with the right skill set who
    will assess the needs of the student accordingly
    and be able to make good onward referrals if
    necessary.

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Self Harm Cases Presented To The PST 2013-2014
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Self- Harm Cases Presented To The PST 2013-2014
  • 92 students 7 (114) engaged in a form of
    self harm cutting, scratching, drug use,
    alcohol, group identity activities (99 scratches,
    ice cube challenge etc), sexual activity, risky
    behaviours, negative influences of social media
  • The most prevalent year group was 11 with 11
    (19) of the year group presenting. This is very
    much in line with national trends. Of this, 48
    were girls and 52 boys.
  • The second most prevalent year group was 9 with
    10 ( 110) of students presenting. Again this
    reflects national trends and thoughts about the
    developmental conflicts at this age self and
    identity. 87 were girls and 13 boys.
  • It is anticipated that figures for this academic
    year will be consistent with 2013-2014.

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Responding To Self Harm
  • To manage this challenge within school it was
    evident that in addition to the established
    referral procedures ,the efficacy of which had
    already been tested, a stringent self harm policy
    was required.
  • Following discussions with key staff in school,
    including the PST, the Lead Safeguarding
    manager, School Nurse and the NHS Nurse
  • A pathway of support was drawn up
  • The Self Harm toolkit, launched in October 2014,
    was tailored to meet the needs of the school
  • Both documents were presented as one policy to
    the Governing Body who ratified it as a working
    policy.
  • All staff were made aware of this new policy.

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A Case Study- Jane
  • Jane is 14 years old and is in year 9. Her
    friends took her to a member of staff as she had
    told them she had taken some tablets in school
    after her friends became concerned about her. She
    had become very anxious and was unable to catch
    her breath.
  • The member of staff followed the policy by
    immediately seeking medical assistance. Jane
    presented to the school nurse in an extremely
    agitated manner as her anxiety increased. Other
    students were present in the medical room. It was
    therefore important to contain any anxieties they
    may be experiencing.
  • Following immediate observations, the school
    nurse followed procedures by

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A Case Study - Jane
  • Requesting paramedic support
  • Contacting the PST
  • Contacting parents
  • Throughout this time, Jane was monitored and kept
    safe.
  • I attended the medical room to discover Jane in a
    very distressed state. She was however able and
    willing to inform us that she had taken some
    tablets from home from a family member. She still
    had the empty blisters packs on her. She also
    reported that she had disposed of some tablets in
    a bin in school. Jane was attended to by
    paramedics who once they had retrieved the
    tablets from school took Jane to NGH.
  • Janes friends were informed of events and
    supported, as was the member of staff who
    reported the event
  • Janes tutor, head of year, teaching staff,
    attendance, the Lead safe Guarding Manager were
    all informed.

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A Case Study - Jane
  • Jane was admitted to NGH and assessed by CAMHS.
    The school NHS nurse was referred to . On her
    return to school
  • A risk assessment was drawn up and agreed with
    Jane and her family, to be reviewed monthly.
  • A CAF was initiated to support the family. As
    issues came to light that were impacting
    negatively on Janes emotional well-being it was
    evident that the family needed support. Concerns
    were also raised regarding Janes risky
    behaviours and those of her brother, who is now
    also being supported by school. The case is now
    being taken to complex case.
  • Counselling was arranged for Jane in school.
  • Discussions were held with CAMHS who are
    supporting Jane.
  • Jane has a cohesive support plan in place and we
    hope that through this she will make good
    progress.

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Targeted Mental Health in Schools
  • A holistic approach to promoting MH addressing
    self-harm and other manifestations of child/young
    person distress
  • Capacity-building through training,
    consultation and coaching.
  • Evidence-based inc using learning from TaMHS
    Project 2009-11
  • Collaborative Multi-agency

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Building-Blocks of Provision for Building
Mentally Healthy Schools in Northamptonshire
As informed by Northamptonshire
January 2015
Targeted Mental Health in Schools Project
Programme 2009 - 2017
More Targeted Programmes or Support - Wave 3
focused
Drawing and Talking KS1-4
Emotional Health / Wellbeing Team to support
students in KS34
Home-Focused Practitioner Trained in ASD, 123
Magic, Solihull Approach Parenting, Theraplay
Targeted Programmes or Support
- Wave 2 focused
CBT based Group Work e.g. Growing
Optimism or RESPECT
Support for child experiencing Insecure
Attachment (inc Theraplay), Anxiety, Loss,
Bereavement, Separation, ADHD, ASD, Self-harm
Domestic Abuse
Peer Support KS12 Peer Mentoring KS34
Universal Programmes or Support- Wave 1
focused
Building Resilience thru Zippys Friends
KS1 FRIENDS KS2/3/4
Whole-School Behaviour Management Approach e.g.
123 Magic
Peer Massage or Relaxation Techniques
Well-Being Wheels - interactive resource
Building Exam Resilience
Mind-ful ness
Essential Foundation Programmes Approaches
County PSHE Prog inc SEAL. Healthy Schools Anti
Bullying (inc Cyber)
Shoe Box Mental Health Handbook
Headteacher Staff Well-being Programmes
Solihull Approach or Protective Behaviours
Solution Focused Approach
Mental Health Team or Lead Person in School
Parent Engagement Best Practice
Family SEAL
Mental Health Stigma Programme (MHSP) inc
Participation of Children Young People
Childrens Workforce Core Competencies (from
DCSF, ECM 2005)
Essential Underpinnings for work with children
For evidence base, see www.asknormen.co.uk
For enquiries, please contact tamhs_at_northamptonsh
ire.gov.uk
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A closing thought...
  • Remember you could be the one person who
  • makes a difference... But you dont have to help
  • alone!

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  • What will you do next?
  • Action planning

84
  • Closing Summary

85
  • Remember self-harm is only part of peoples
  • stories...it does not define them as a person.
  • For more information please see
  • www.asknormen.co.uk
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