Self-Harm and Attempted Suicide Response

Early intervention and prevention activities

As an educator, you have a role in engaging a student in a conversation about their mental health and wellbeing. This conversation requires you to exercise sensitivity and compassion.

Being aware of the limitations of your role is critically important – it is not the role of an educator to diagnose and determine the appropriate therapeutic intervention. It is your role to gather information that will inform what happens next and support those who are responsible for coordinating the student’s care.

It is important that you remind the young person of conditional confidentiality early in the conversation, particularly if you suspect they are about to make a disclosure regarding their mental health and wellbeing.

Educators can and should engage a young person in a conversation about their mental health and wellbeing, demonstrating genuine curiosity and interest in how they are doing or feeling. Any information you gather provides an indication as to their level of emotional distress and the subsequent actions required to offer appropriate supports and ensure safety. Intervening at the earliest point where changes have been identified offers the greatest potential for improving the mental health outcomes for young people.

SAFEMinds Tips to Inquire offers some questions that you might ask the young person to start a conversation about their mental health and wellbeing such as:

• 'Hey, are you okay?'
• 'You haven’t seemed like yourself lately, is there anything you would like to talk about?'
• 'Is there something I can help you with?'

Conditional confidentiality

When a student discloses their intent to self-harm or expresses their emotional distress through self-harm, school staff should carefully explain the limits to the student’s privacy and confidentiality. That is, that their personal and health information may be used or disclosed, even without their consent, in certain circumstances such as the following:

• to other school staff to enable school staff to appropriately manage the health, wellbeing and education of a child or group of children
• to external agencies or parents/carers if there is a serious risk to their health, safety or welfare
• to external agencies or parents/carers if there is a serious risk to another person’s health, safety or welfare
• to other school staff in order to be able to provide a suitable and safe workplace for all school staff (occupational health and safety obligations).

For more information, refer to: Privacy and Information Sharing Policy.

Educators might say one of the below phrases when explaining conditional confidentiality:

• 'Anything you tell me is confidential unless I’m worried about your safety or someone else’s safety. If I’m concerned, I’ll need to tell someone like the principal because your safety is the most important thing.'
• 'Our conversation is just between you and me unless I become so worried about your safety that I need to get someone else involved. If that happens, we will discuss what details are to be shared with the principal (or another member of staff) to keep you safe.'

The table below identifies key considerations for educators when engaging a young person in a conversation about their mental health and wellbeing. Seek professional support and guidance from your colleagues and avoid managing any concerns or difficulties on your own.

Supporting resource

SAFEMinds Safety Map provides a list of factors that can be used to determine the significance of the student’s emotional distress and the impact that is having on the student’s usual functioning. Recording data against each of the factors will provide you with a suggested course of action.

How to ask a student if they are self-harming

If an educator has concerns or evidence that a student is engaging in self-harm, it is essential to enquire about these thoughts and behaviours. It is also important to consider who is the most appropriate staff member to have this conversation with the student. For instance, if the student has existing relationships with any wellbeing staff in the school, this would be the most appropriate staff member to have this conversation.

Some signs that indicate a student may be engaging in self-harm include:

• inappropriate clothing for the season, such as long sleeves during high temperatures
• unexplained burns, cuts, scars or other markings on the skin
• unexplained markings on the non-dominant hand
• avoidance of events where participation requires less body coverage, such as swimming carnivals or physical education classes.

How to have the conversation

• Use open ended questions and non-judgemental language, verbal and body language to communicate your support and efforts to keep them safe
• Demonstrate your openness and care by using positive words and other non-verbal communication as you listen to the student’s concerns. Vulnerable students will often be concerned and hesitant to disclose their thoughts and feelings of self-harm to adults for fear that they will be judged or that their experience will be too hard to handle or shocking
• Know your personal limitations and ability to engage in this conversation

It is important that schools have a clearly defined process for escalation and support for staff in response to a self-harm incident involving a student. This includes identifying which staff within the leadership or wellbeing teams notify when an incident occurs and which staff will coordinate the response. Ensuring clarity regarding the roles and responsibilities of all staff will further support the early identification and improved mental health and wellbeing outcomes for students engaging in self-harm. It is recommended that all staff review and familiarise themselves with this process and required actions annually.

Understanding mental health along a continuum and its application within a school setting

The World Health Organisation (WHO) defines health as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’.

It is helpful to view mental health and mental ill-health as existing at opposite ends along a continuum of mental health (Be You). Our position along the continuum is influenced by social, emotional and environmental factors. Children, young people and adults alike constantly move along the continuum as we face challenges and situations in everyday life that test our capacity to cope and alter our mental health. Children and young people will typically sit at the end of the continuum of positive mental health and going okay. They can face adversity and have the resilience to cope with daily stressors. The promotion of help-seeking messages and awareness of the strategies that foster positive mental health is fundamental to early intervention and prevention of future mental health difficulties.

The process of recognising where students are positioned along the continuum of mental health and engaging them in a conversation to understand the factors that are contributing to their current mental health and wellbeing is consistent with the SAFEMinds early intervention approach of NIP it in the bud! (Notice, Inquire, Plan).

The Mental Health Continuum

Flourishing

If our mental health and wellbeing is flourishing we are:

• in a state of optimal functioning
• engaged with our environment
• connected to our community.

In a school setting this is a child who:

• is engaged in learning
• has good coping strategies
• is connected socially
• has the ability to problem-solve
• can maintain their energy and participation throughout the day.

Going okay

When our mental health and wellbeing is going okay we are:

• able to complete our daily activities such as work and study
• experiencing positive mental health with the absence of frequent or significant distress.

In a school setting this is a child who:

• maintains regular attendance
• approaches their learning with curiosity
• is socially connected
• experiences small observable changes in behaviour/emotions and/or social connection.

Going through a tough time

At the point in the continuum of emerging mental health concerns we are:

• experiencing difficulties maintaining daily activities
• experiencing noticeable changes in one of the domains of social, emotional and/or environment factors, evidenced by changes to behaviour, emotions and/or social connections.

In a school setting this is a student who:

• has come to the attention of an educator and/or a member of the wellbeing team
• is experiencing mild disruptions to their ability to engage in learning, behaviour, and social connections
• experiences periods of disruption and impact to their behaviour, emotions and/or social connections.

Severely impacting everyday activities

At the far end of the continuum where our mental health and wellbeing is severely impacting we are:

• experiencing thoughts and emotions that are distressing
• demonstrating behaviours out of the norm for that student
• experiencing persistent negative emotions
• requiring additional support to alleviate the distress experienced.

In a school setting this is a student who:

• may be unable to maintain regular attendance
• is socially disengaged
• is not engaged in learning
• has identifiable emotional distress.

The role of educators and school communities in supporting the mental health of students

Schools play an important role in providing an education environment that is inclusive and positive and can foster the skills and capabilities required to support the mental health and wellbeing of all students.

Research indicates that whole-of-school approaches to building a positive and inclusive culture of mental health and wellbeing facilitates optimal wellbeing outcomes for students. A whole-of-school approach is one that involves all members of the school community, from school leaders to staff, students and parents, each with an active role to play in building and embedding a positive culture of mental health and wellbeing.

For more information about whole-of-school approaches and departmental tools and resources available refer to the Mental health and wellbeing toolkit.