Mental health and self-harm

Learning outcomes

• Understand self-harm as a coping mechanism rather than attention-seeking
• Respond calmly to self-harm and provide first aid
• Ask directly about suicide and assess immediate risk
• Escalate to CAMHS, GP or emergency services appropriately

Module 1 of 3

Understanding self-harm

Self-harm is usually a way of managing unbearable feelings — turning emotional pain into something visible and controllable, punishing oneself, or breaking through numbness. Rates among looked-after children are several times the general population.

Dismissing it as attention-seeking guarantees the child will hide it, which increases risk. Removing every possible means is neither achievable nor therapeutic; reducing access to the highest-risk means while addressing the underlying distress is.

Module 2 of 3

Responding in the moment

Stay calm and matter-of-fact. Provide first aid without comment on the injury itself, thank the child for letting you know, and be honest that you have to record it and tell your manager. Shock, disgust or anger on your face will end the disclosure.

Afterwards, explore what was happening before, and build alternatives with the child — grounding techniques, cold water, intense exercise, writing, a phone call. Alternatives only work when the child chooses them, so never impose a list.

Module 3 of 3

Suicide risk and escalation

Ask directly: are you thinking about ending your life? Asking does not plant the idea; it is one of the most protective things you can do. Explore whether they have a plan, the means, and a timescale — these raise the risk substantially.

Any immediate risk means staying with the child, removing means and calling 999 or attending A&E. Non-immediate concerns are escalated to the manager, GP and CAMHS the same day, with the placing authority notified and a safety plan reviewed.