Protecting young people at risk of self-harm

Suicide and self-harm are complex and rarely initiated by one factor. Causes and motivations differ from young person to young person, and risk increases over time. However, children and young people who die by suicide tend to have endured one or more of these circumstances:

• Adverse childhood experiences (for example, some kind of abuse).
• Stress (for example caused by academic and/or relationship difficulties).

Life experiences (for example, depression, bereavement, isolation or loneliness).

In 2017 my Fellowship took me to Ireland and the USA to see schools and community-based projects using mindfulness and dialectical behaviour therapy (DBT). This is an evidence-based intervention for children and young people who present with self-harm and suicidal behaviours. On my return I set up Dialectical Behaviour Therapy (DBT) Skills Training Groups in schools in Denbighshire, my local area. These help young people to build meaningful relationships within their school, community and family, and help to counter the problem that many young people feel they cannot ask for help. The range of skills that young people can learn from DBT modules include managing emotions, navigating crisis situations and learning to respond differently (rather than simply reacting) to the urge to self-harm and to suicidal thoughts.

If I had to choose an easily accessible way for young people to look after their mental health at this time, it would be to learn ways to calm yourself when you are feeling overwhelmed emotionally. There are many things that can upset us to the point that we feel emotionally overwhelmed or even out of control. When we feel this way, the emotional part of our brain (the limbic system) becomes dominant and the rational part becomes less active. Calming our emotions through self-soothing is an important life-long transferable skill that everyone can benefit from learning.

When we perform any of the activities below, our brain will produce serotonin, a biochemical that brings a sense of calm. There are three diverse elements that can make an activity more soothing:

1. Familiarity: Activities that are linked with pleasant memories will be helpful in soothing your feelings. For example, walking on the beach and taking in the sights, smells and sounds may be comforting in that it reminds us of childhood holidays.
2. Multi-sensory: Our emotional brain reacts when activities are multi-sensory, involving more than one of our senses - sound, sight, taste, touch, smell and movement. For example, playing with calming lavender-scented playdough: it’s soft and malleable and squeezing it in your hands is very pleasurable. You can pull it apart and it will squish through your fingers and roll it back together to form a perfect ball.
3. Repetitive motion: Research has shown that repetitive motion, such as chopping wood, cycling or dancing (these examples could be multi-sensory too) can generate serotonin in our brain. We are naturally inclined towards repetitive motion, like squeezing a stress ball, skipping rope or swimming when we are anxious or agitated.

In June I received a recent award from the Churchill Fellowship’s Covid-19 Action Fund, to extend my work in schools. Schools are important settings for reaching young people who are at risk. The award will enable therapists to be trained in how to transition our established face to face DBT format of therapy and group meetings into digital online formats.

Developing the online project will benefit more young people than the face to face programme could reach, and accessibility will be significantly increased. Attending a group for some young people, which includes walking through the door into a room full of other young people that they may not know, would be the last place they could feel safe.

I see this work as part of trying to meet young people 'where they are' and, where possible, in a way that works for them. This is the central change that enables young people who are at risk and are too embarrassed, feel stigmatised or lack confidence to work in a conventional face to face group in order to access DBT. Meanwhile the content of our skills modules provides participants with mindfulness skills, emotion regulation, distress tolerance and interpersonal effectiveness skills. This will prove beneficial across a spectrum of challenges that children and young people encounter in their lives.