Crisis, Self-Harm and Suicide

Crisis

Experiencing a mental health/ emotional crisis means feeling unable to cope with overwhelming or upsetting thoughts and feelings. Crisis is different for everyone. There may be different triggers and different ways in which people experience crisis- there is no right or wrong way to think or feel when in crisis. Not everyone who engages in self-harm behaviour is in crisis and not everyone who engages in self-harm is suicidal. Not everyone who experiences suicidal thoughts or urges engages in self-harm and they may not appear to be in crisis.

Situations that might trigger or contribute towards experiencing a mental health or emotional crisis for children and young people:

• Relationship difficulties or conflict and arguments with friends, family or partners.
• Bulling/ teasing/ harassment (verbal, physical, emotional, financial, sexual); direct or indirect.
• Abuse (verbal, physical, emotional, financial, sexual, neglect); direct or indirect
  Being in or worrying about being in trouble.
• Having multiple demands/ having too many things to process, manage or do
  Being a carer and or having increased responsibilities.
• Stressful or traumatic life events which can be sudden, unexpected or expected such as accidents, injury or illness, bereavement, family breakdown or change in living circumstances.
• Physical health illness or pain (to self or other)
• Change or transition (e.g., school)
• Perceived or real failure/ not meeting expectations or hopes
• Build up of difficulties or long term
• Extreme fatigue
• Drug and alcohol misuse

Self-Harm

Self-harm involves the act of doing something to cause harm or omitting to do something which in turn may cause harm (such as not taking prescribed medications).

There are many forms of self-harm.

There are many reasons why a young person may engage in self-harm and each individual episode of self-harm may have a different trigger or reason. The most important thing to know about self-harm is that it is purposeful and meaningful; it serves a need or function.

Self-harm can be a very secretive behaviour as if often associated with feelings such as guilt and shame which can make it hard for someone to share how they are feeling and what they are doing. Here are some signs to look out for;

• Unexplained cuts, bruises or cigarette burns on the body. These marks could be anywhere on someone’s body.
• Unexplained blood stains on tissues, sheets or clothing.
• Keeping themselves fully covered at all times, even in hot weather.
• Self-loathing and low self-esteem; blaming themselves, thinking they’re not good enough or expressing a wish to punish themselves ; making statements of worthlessness or hopelessness.
• Becoming very withdrawn and not speaking to others.
• Unusual weight loss or weight gain, or changes in eating habits. A young person may try to hide this by wearing loose clothing or being secretive about eating.
• Evidence of vomiting in toilets, wash basins, showers or baths (drains may become blocked).

Suicide

Suicide is the act of intentionally and purposefully ending one’s life.
A lot of young people may experience thoughts about wanting to harm themselves or end their life, particularly when in crisis or they experience a distressing life event.

It can be difficult to notice if a young person is experiencing thoughts and urges or even making plans to end their life, particularly as suicidal thoughts and urges can occur suddenly, unexpectedly and impulsively, especially among adolescents.

Some signs include but are not limited to;

• Withdrawing from friends, family, responsibilities, commitments and previously enjoyed activities.
• Low mood and or irritability which is uncharacteristic.
• Uncharacteristically reckless behaviour.
• Disinterest in maintaining personal hygiene or appearance.
• Poor diet changes, rapid weight changes.
• Appearing distracted or agitated.
• Poor sleep.
• Alcohol or drug misuse.
• Expressing or appearing hopeless; failing to see a future or appearing to give up or be disinterested in their hopes, dreams, goals or ambitions.
• Believing they are a burden to others.
• Saying they feel worthless or alone.
• Talking about death or wanting to die

Steps to take if a young person is in crisis or makes a disclosure of self-harm or suicidal intent:

• Protect time and space to listen to them without interruption; think about the setting you are in.
• Listen calmly, without judgement or rushing to solutions (unless it is an emergency and requires immediate intervention).
• Validate the emotion, not necessarily the behaviour.
• Provide information about where or how to access appropriate support.
• Encourage young people to make safe, informed decisions.
• Don’t make promises you can’t keep

Making a crisis and coping plan with a young person:

Every young person could benefit from having their own person crisis and coping plan, whether they are known to experience episodes of crisis or not. A crisis and coping plan can be completed by anyone but should always be done with a young person.

A crisis and coping plan should consider the following;

• What it looks like when the young person is well, coping and functioning at their usual level.
• What early warning signs begin to show when a young person is struggling.
• What signs indicate when a young person is in crisis.
• What some of the triggers or contributing factors might be for a crisis.
• An action plan of what to do when the early warning signs are showing.
• An action plan of what to do when in crisis

For a copy of a coping and crisis plan you can use with a young person click on the download below.

To watch a video of someone completing this coping and crisis plan with a young person click here: https://youtu.be/Ls8i391_aCc