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Working With Young Women Who Self Harm

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  1. Working With Young Women Who Self Harm Dr Sandeep Ranote Consultant Child & Adolescent Psychiatrist 5BP DSH Group Network Lead Associate Medical Director

  2. Adolescent Self Harm

  3. Adolescent Self Harm What? ‘Self-harm is a term used when someone injures or harms themselves on purpose. Common examples include ‘overdosing' (self-poisoning), hitting, cutting or burning oneself, pulling hair or picking skin, or self-strangulation. It can also include taking illegal drugs and excessive amounts of alcohol. Self-harm is always a sign of something being seriously wrong.’

  4. Adolescent Self HarmWhy? Self-injury is a way of dealing with very difficult feelings that build up inside… anger, tension, desperation Self-injury helps to relieve the tension Self-injury helps to feel more in control Self- injury is way of punishing oneself Self-injury is a way of feeling more connected and alive/ way of coping

  5. Adolescent Self HarmWho’s at risk? • Argument with parent or close friend • Abuse, neglect or rejection (bullying) • Depressive disorder • Eating disorder • Substance misuse • Bereavement • School/ work pressures • Financial pressures Most do not have a major mental illness

  6. Adolescent Self HarmHow Common? • Self-harm – F:M = 3:1 (suicide > in older males) • 1 in 10 young people affected • U.K. rates highest in Europe (Truth Hurts, 2006) • 1 in 3 first timers repeat within 1 yr • 3 in 100 who self harm over 15yrs old go on to suicide

  7. Adolescent Self HarmWhat do we do? NICE (2004)…… • No robust evidence to report that a particular therapy is better than another !

  8. Adolescent Self HarmWhat do we do? NICE (2004) • Appropriate assessment in A+E • Admitted overnight (Paediatrics) • CAMHS assessment (Parental Consent) • Multi-agency input & joint working • Risk assessment KEY

  9. Adolescent Self HarmWhat do we do? NICE (2004) • Advice to carers – risk reduction • Follow-up within 1 week • Individual therapies (problem solving) • Developmentally appropriate group therapy • Supportive services - Self-help / voluntary sector/ social services/ education

  10. Adolescent Self HarmWhat did Wigan do? Some evidence (Wood et al)………… To suggest that adolescents who had group therapy following repeated self harm were less likely to become repeaters…… which lead to the ASSIST TRIAL

  11. Adolescent Self HarmWhat did Wigan do? ASSIST – Assessment & treatment of suicidal teenagers • Multi – centre RCT (Manchester) • Effectiveness of group treatment for adolescent repeated self harmers • Data now complete • Await formal report 2008

  12. Adolescent Self HarmWhat did Wigan do? • Established group June 2006 • First Non-Research group • Training & support – Manchester • CBT / Problem Solving model (manual) • 2 Therapists / 1 observer (regular supervision) • Covering adolescent themes • Open – ended & free-flowing • Weekly for 1 hour

  13. Adolescent Self HarmWhat did Wigan do? • Offers support in crisis • Also long- term approach • Task-orientated • Group rules • Emphasis on stopping self harm • Inclusive, Encourage YP empowerment • Consistent, Contained, Confidential • Feedback to parents/carers • YP can leave at any time

  14. Adolescent Self HarmWhat did Wigan do? Adolescent Themes : • Relationships • Bullying • Family problems • Anger • Depression & self harm • The future

  15. Adolescent Self HarmWhat did Wigan do? • Young Person assessed by CAMHS • Internal referral to group • > 12 yrs old • 2 or more self harm episodes in 12 mths • Screening & buddy system

  16. Adolescent Self HarmWigan Results? 8 people included in group & data collected using: • MFQ – Young Person • Suicidal Ideation Questionnaire • Staff Questionnaire • Casenote NICE audit tool 1 Young person dropped out

  17. Adolescent Self HarmWigan Results? 7 Young people included in results • MFQ scores consistently decreased • Thoughts to self harm went from ‘twice/wk down to once/mth’ on average through the group over the 12 mths • No A+E presentations for SELF HARM • No paediatric admissions • Repeated self harm episodes in 1 case

  18. Adolescent Self HarmWigan Results? Staff Questionnaire • 15 responses • 100% rated the group as helpful • 100% felt the service was accessible • Evidence- based approach felt to be important • Parent support group?

  19. Adolescent Self HarmLimitations? • Group Numbers • Age • Gender • Moving young people on • Confidentiality • Conflicts IN/OUT of group • Adherence to group rules

  20. Adolescent Self HarmWhat Next? • Await ASSIST paper • Young person feedback/voice • Develop Parent/carer Support Group • Develop trustwide clinical network • Continued Supervision & training • Training to set up groups across trust • Audit/research

  21. References • NICE clinical guideline 16. Self Harm (2004) National Institute of Clinical Excellence: London • ‘Truth Hurts’ : National Inquiry, Mental Health Foundation, 2006 • www.youngminds.org.uk • www.selfharm.org.uk • www.rcpsych.ac.uk

  22. Adolescent Self HarmAny questions? ‘…. Cutting was always a very secretive thing….something to be ashamed of……What helped was having someone to talk to who was reliable, did not rush me and really listened’ ‘….more drop-ins & Facilitated groups please! ’