Why it is important to understand and respond effectively to self-injury
Self-injury is identified as being prevalent in the general population, with Australian research finding 8.1% lifetime prevalence in the general population (Martin et al, 2008; 6). A much higher prevalence is found in the population of young people seeking assistance for youth AOD services, with 41% of young people in youth AOD treatment in Victoria reporting having ever deliberately injuring themselves (YSAS, 2013).
It has also been found that incidents of self-injury peak during the years 18 – 24 (Martin et al, 2008; 6), which is in the range of ages seen by youth AOD services.
In the absence of other ways of coping with distress, self-injury can be a self-management in the same way that substance use can be. In this sense self -injury and substance use are behaviors that can share common determinants.
It has been identified that staff working closely with clients who self-injure experience emotional strain and stress. By increasing knowledge and skills in working with clients with self-injuring behaviour, it can improve staff well-being and outcomes for clients (Cameron et al, 2012).
Considerations for different practice contexts
Good clinical governance requires that youth AOD service should have policies and procedures to guide staff in how to understand and respond to self-injury. Self-injury is an issue that is relevant in any youth AOD work practice modality or service type.
Clinical settings provide a safe and contained space for young people to disclose self-injury and work through any associated issues.
Practitioners can develop an understanding of the function self-injury serves and the meaning it has in the lives of each young person. From this point there is an opportunity to enable each client (and where appropriate those involved in their care) to develop strategies to either self-injure more safely and/or to find constructive alternatives and make changes.
It is unlikely that young people will self-injure on-site. Immediate action might be required where young people discuss plans to self injure or are assessed to be at risk. Practitioners might also encounter young people immediately after they have self-injured.
Outreach has similar opportunities and constraints in relation to understanding and responding to self -injury as in clinical settings. Outreach practitioners have the added advantage of spending time with the young person in a variety of natural contexts meaning that risk conditions for self-injury can be assessed and more practical harm reduction strategies developed.
Day programs are safe but (not entirely private) spaces that young people can access as the need arises. This means young people might choose to attend to find relief from distress. Attendance and participation can be a coping strategy as an alternative to self-injury but there is also potential for young people to self-injure on site. The advantage is that practitioners can spend time with the young person and come to understand particular stressors that lead to self-injury. Both strengths and limitations can be recognised and strategies to handle overwhelming emotions can be developed and practiced. Young people might immediately require support and first aid after self-injuring.
Residential service settings, in most cases are AOD free environments where young people are housed continuously over 24 hour periods that can extend for weeks and for months in the case of residential rehabilitation and therapeutic communities. Self-injury may emerge as a way of coping without access to substances, particularly where they have been used as a way of managing distress.
Where a young person is withdrawing from substances (either residential or outpatient), the symptoms may exacerbate intolerable feelings, such as anxiety, increasing the risk of self-injury. Residential services should be proactive in raising the issue of self-injury (and other issues and behaviors) prior to intake. Where self-injury is an issue, management plans can be established.
Practitioners in residential services do have the advantage of directly observing the contextual stressors that may trigger self-injury and, with a young person, develop a range of alternative strategies that can be practiced under guidance. Practitioners should be aware that:
- Being in a service setting for 24 hours may limit access to some positive means of managing distress such as participation in favorite activities
- New stressors or challenging situations such as the constant presence of other young people and the rules and regulations of the residential service can also increase the likelihood of self-injury
It is essential that practitioners prepare young people to be as safe as possible and to pursue their self-injury related post a residential stay.