MANAGEMENT OF SELF HARM IN NORTH TYNESIDE SCHOOLS PROJECT SANDRA TELFORD & CLARE COLLINGS
Background • North Tyneside CAMHS Partnership works together to provide a range of services and resources to support children, young people and their families who are at risk of developing or are experiencing mental health problems. • The TAMHS pathfinder programme raised awareness and staff confidence in identifying and supporting children and young peoples emotional wellbeing and increased awareness of how and when to seek more specialist support. • Opportunities created to strengthen links between CAMHS and schools (mainstream and special schools) • Local lessons learned from a local North Tyneside High school
Stage 1 Establishing the evidence base National policy and research :- DOH Nice Guidance : Deliberate Self Harm ( 2004) The Truth Hurts ( 2006 ) North Bristol /NHS/ Barnardo’s Self Harm: Information and Suggestions for School Staff (2011) Sussex PMHW toolkit Deliberate Self Harm and Suicide :Safeguarding Children and Young People. North East Regional Inter-agency Procedures Project 2005 Hidden Pain? Self Injury and People With Learning Disabilities (2009)
Stage 1 Establishing the evidence base Websites :- www.youngminds.org.uk selfharm.org.uk selfharm.net nspcc.co.uk www.mind.org.uk
Stage 2 Consideration of current local procedures North Tyneside A & E procedures CQC comments on management of self harm: ‘children and young people attending A & E at North Tyneside General Hospital are safeguarded well. A flagging system is in place to highlight children who have a child protection plan in place or other additional services such as CAMHS. A comprehensive assessment is carried out on all children that meets fully with national Institute for Clinical Excellence Guidance and ensures that children are kept safe by assessing them for non accidental injury and communicating effectively with other professionals involved in their care.’ Regional Deliberate Self Harm and Suicide: Safeguarding children and young people (NE England Regional Inter-Agency Procedures). Lack of a specific North Tyneside Local Education Authority or LSCB safeguarding procedure on self harm
Key messages from policy and research Clearer roles for schools The use of supportive screening and assessment tools care pathways between CAMHS,LD services and schools Appropriate training for Tier 1 staff Agreeing a clear school policy Issues of consent , confidentiality and safeguarding to be considered in managing deliberate self harm. Information to be available for children, young people and parents on deliberate self harm. Self injury in people with Learning Disability is far more similar to self-harm in people without Learning Disability than is different to it. Need equitable service provision.
Stage 3 Establishing the Stakeholders The aim was to ensure a multi agency strategic collaboration and ownership of the project. Key stakeholders :- Lead emotional Well Being advisor LEA Lead school Public Health Nurse Lead Primary Mental Health Worker and team Principle Education Psychologist Lead Family support worker Community Learning Disability Team Lead Safeguarding Nurse for Northumbria Healthcare Trust
Stage 4 Undertaking an audit of need Initial focus on 4 Middle, 11 High and 5 Special schools. Questionnaire devised for baseline measurements of : • current policy/procedures/recording tools for assessing and managing self harm. • how schools identify self harm • working definitions of self harm • processes involved in informing parents and advice given • contact with other professionals • requirements for a standardised policy/procedure and training package
Findings • No standardised process/guide • Poor systems of any form of data collection • Very fragmented system across schools What they wanted: • Standardised systems across North Tyneside schools • Training in identifying and managing Self Harm
Step 5 • Secured funding from DoH £19,000 to develop a guide, procedure and training programme • Developed a guide for the management of self harm for North Tyneside schools • Commissioned Young Minds to support us in developing and facilitate a training programme for North Tyneside Schools staff • Consultation and development of resources with young people
Young Peoples Voices
School Staff views and quotes “ This is exactly what we needed . Self harm really worries us and we don’t know what to do when we come across it . This Training has given me the Knowledge to know what I need to do and who to contact “ “The resources are great . This Guide will make me feel much more supported and able to know what to do when come across a young person who is self harming” “We need more of this kind of approach to support school staff in managing self harm” “This is a great project “
Current position • Project group continues to meet up • Local authority website • Short listed for Northumbria Healthcare NHS Trust award 2014 • Short listed for the Nursing Times award 2014 in two categories
Future Plans • Plans to write up a publication for the Young Minds Journal • Training to become available twice yearly for the North Tyneside Children's Workforce • Evaluation of the project • Apply for further funding to develop resources • Working with young people in schools
Strengths and Challenges • Multi agency working • Multi agency strategic agreement • Time frames • Communication systems • Young Peoples involvement • Focus groups • PMHW led and coordinated • Cost effectiveness • Clearer stepped approach to the management of self harm • Equitable provision for all children regardless of their cognitive level of ability • Early intervention and mental health promotion
DISCUSSION What is your role as Primary Mental Health Worker within self harm?
Questions • How are children, young people, parents and carers supported around self harm? • Do you offer self harm training? • How frequently is training offered and to who? • Who are your key partner agencies addressing self harm? • Whose role is it to manage crisis/urgent self harm incidents?
References Camelot and Mental Health Foundation (2006) Truth Hurts – Report of the National Inquiry into Self-harm among Young People. London. Mental Health Foundation. Cello and Young Minds (2013 ) Talking Taboos Talking Self-Harm. www.yongmidns.org.uk. DOH (2004) Nice guidance CG16 : The short-term physical and psychological management and secondary prevention of self harm in primary and secondary care. NICE. www.nice.org.uk. DOH (2014) Closing the gap: priorities for essential change in mental health. DOH. www.gov.uk/dh. Emmerson,E. and Hatton,C. (2007) The Mental Health of Children and Adolescents with Learning Disabilities in Britain. Lancaster University. Heslop,P. and Lovell,A. (2013) Understanding and Working with People with Learning Disabilities Who Self injure. London. Jessica Kinsley Heslop, P. and Macaulay, F. (2009) Hidden Pain? Self Injury and People With Learning Disabilities. Bristol:Bristol Crisis Service for Women. HM Government (2011) No health without mental health: Across-Government Mental Health Outcomes Strategy for People of All Ages. www.dh.go.uk/mentalhealthstrategy.
References Royal College of Psychiatrists (2010) Self-harm, suicide and risk: helping people who self-harm. Final report of a working group. College Report CR158. London. Sussex Partnership NHS Foundation Trust : Sussex PMHW toolkit. Sussex Partnership NHS Foundation Trust. Welsh Assembly Government (2008-2013) Talk to Me: A national action plan to reduce suicide and self harm in Wales. Welsh Assembly Government. www.wales.nhs.k/documents.talktomee North Bristol/NHS/ Barnardo’s (2011) Self Harm: Information and Suggestions for school staff. North East Regional Inter-agency Procedures Project (2005) Deliberate Self Harm and Suicide: Safeguarding Children and Young People. NSPCC (2009) Child protection research briefing- Young people who self-harm: Implications for public health practitioners. NSPCC.
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