Understanding Mental Health
High Risk Behaviours
What is Non-Suicidal Self-Injury?
Non-suicidal self-injury (NSSI) is the deliberate and direct destruction of one’s body tissue, without suicidal intent and for reasons not socially or culturally sanctioned. The definition does not include tattooing and piercing (which are socially sanctioned), or substance abuse and eating disorders (which result in indirect harm). The most common age of onset for NSSI is early adolescence, and 14 to 20% of adolescents in school report engaging in NSSI at least once in their lifetime.
Why do students self-injure?
There are many reasons why students self-injure, but the most commonly reported function is as a means of coping with difficult, often overwhelming negative feelings (e.g., anxiety, stress, sadness, numbness). Other, less common functions include communicating feelings, self-punishment, and avoiding suicidal thoughts and urges.
How do I know if a student is self-injuring?
NSSI is typically a very secretive behaviour, and it is not unusual for adolescents to have difficulty talking about their injuries with others. It is not uncommon for no one to know about their NSSI. However, signs that a student is engaging in NSSI may include:
Unexplained cuts, burns, or bruises on the arms, legs, or stomach
The possession of razors, or other sharp objects
Continually wearing bulky, long-sleeved clothing regardless of the weather.
What should I do if I know a student is injuring themselves?
When first learning about a student’s self-injury, you may feel frightened, uncomfortable, shocked, or horrified by NSSI; these are normal reactions. However, it is important to monitor your reactions, as you may be the first person the student has spoken to about their injury. They are likely scared and nervous. Communicate calmly and respectfully, and let the student know that there are people who care for them and that they are not alone. Listen to the student, and try to understand what they are experiencing. Use non-judgemental language, and do not over react. Do not panic, and do not respond with shock or revulsion. Trying to threaten or coerce the student likely will not be effective, and may harm their trust in you. Do not ask about the details of the injuries, and do not allow the student to describe the behaviour, as this may trigger the desire to engage in the behaviour again. Do not talk about the student’s NSSI in front of other students, but do not promise the student that you will not tell anyone else, as you may be required to break confidentiality based on school protocol.
For a more complete list of Dos and Don’ts, refer to http://sioutreach.org/learn/school-professionals#firstresponse
How is NSSI related to suicide?
NSSI and suicide are separate behaviours, and students that engage in NSSI may not have any suicidal thoughts. However, students who injure themselves may be at greater risk of suicide, and the school’s mental health professional should perform a suicide risk assessment in order to determine whether it is necessary to refer to emergency mental health services.
How do I help my student stop self-injuring?
We must always remember that students can stop injuring themselves. However, students who have used these methods for coping with their difficulties for a long time may find it very difficult to change their behaviour, and may be ambivalent about modifying their coping mechanisms. It is important for us to provide useful resources, and encourage students to find appropriate support from professionals who have experience helping adolescents who self-injure.
Some tips and resources can be found at the following link: http://sioutreach.org/help-and-recovery. Although these do not substitute for the advice of a mental health professional, they may help students begin to cope more effectively. For a more comprehensive fact sheet for school professionals, including references and resources, refer to http://sioutreach.org/learn/school-professionals, or http://sioutreach.org
For a list of books and empirical articles that may be useful, refer to http://sioutreach.org/resources/school-professionals
Other information on NSSI can be found at the following links: