 In this series, I answer your questions about self-harm. I'll be adding to this series over time, so if you have a question, please leave it in a comment below or email it to me at pookieatinourhands.com. I really think it's important that we talk more about self-harm and everywhere I go, people have tons and tons of questions for me. So get asking and I'll get answering and I'd really love your input on these questions too, so do comment, please. Today's question comes from Adventures in Well-Being, Kerala's whore over on Twitter. And she asks, how do you best support a group of young people engaging in self-harm? Now, there's two different kind of tenets to my answer here. One is if it's a group of young people who are self-harming together and it's kind of part of their group identity and the other is about how we support groups of young people and we've brought them together because the thing they have in common is that they self-harm. So a kind of support group if you like. So taking the first one, this is something we used to see more of and actually I'm hearing less about it now, but where you'd have a group of young people and they would self-harm together and that would literally be part of their group identity. We often found that this was something that was happening in our kids who identified as kind of emo or goth or that sort of thing and that the actual harming activity was a part of what they did together as a group. Now here, we needed to understand a bit about why this behavior was going on and why it was so important for these young people to be harming together, but the key thing was about trying to look at this group and say, can we kind of help you re-identify yourselves as a group? Is there something else that you can do together that helps you have that sense of belonging, helps you have this sense of something that you're doing together with which you identify that isn't actually going to do you harm? So it's quite common for young people to come together and to engage in different behaviors. It might be listening to a certain kind of music. It might be engaging in self-harm. It might be alcohol or drugs or there's all different things that we might do together as a group and some of those things are fine and some of them are actively harmful and when it's harmful then we need to help those young people to think about different behaviors that might meet the needs. So here the need is one of belonging and I'm harming because I'm in a group and we all do it and that's kind of part of what we do. It's part of our identity. So instead we'd say, well, what else is important to you? And there are lots of different approaches here. The key thing is to open yourself up to listening to this group, to understanding what makes them tick and thinking about how else can we get this sense of belonging? So you might have a group of young people where actually they really into a certain type of music. So you might think about, well, can we support you to put on an event that really draws on that love of that music? It might be that there's a particular sport that they'd all like to try out together. Or there's all sorts of different things that you can do but the thing here is that as humans, one of the things that we strive to do is to belong and sometimes the self-harming behavior is purely that. It's kind of a way of belonging to this group. So we need to think really carefully about how can we meet that need another way. In these instances, most of the young people who are engaging in self-harm, they won't be getting the kind of, they won't be having an emotional need met in the same way that majority of young people that we think of self-harming are. So we don't need to think about replacing the harming behavior in the same way. It's about finding that sense of belonging. However, any time that a group of young people will have all engaged in self-harm, it's perfectly possible that for one or two of them, actually this did meet a deeper emotional need. And it's possible that that self-harming behavior might continue because they might have tried it once and they found actually it made them feel better in some way. So we need to make sure that we keep open lines of communication with the members of that group so that if they do need additional support and more sort of traditional help with their self-harm, that we can help with that. Now the other kind of group I was talking about was the group where you've brought them together because these are young people who are currently engaging in self-harming behaviors or they're at risk of self-harm. And bringing them together can be really powerful as long as we do it carefully. So a really fantastic example of this is the Mind and Body project from Add Action. And this is a project which screens young people in school settings and it draws out those who are currently engaging in low level self-harm or who are at risk of developing those behaviors. These young people are then brought together and they work through some group therapies like a group therapeutic input. So it starts off with individual interviews and ends with individual interviews, but in the middle there's a series of sessions where they are taught largely practical skills based on dialectical behavior therapy, which is a very, very practical approach to doing things like understanding and responding to difficult emotions. And the kids in these groups, they become a really important source of support to each other, but they're also developing these skills together. So they will learn things like distress, tolerance. They'll learn things like mindfulness. They'll do practical things like creating a self-soothe box for themselves. They'll learn breathing strategies, all sorts of different things that can help them in those difficult moments to try and help them either stop self-harming or to help them not ever go down that route because instead they've got loads of other different ways to solve the problem rather than turning to harmful activities. So when you're working with a group in this sense, you've brought them together because they are self-harming or at risk of self-harm. There's a couple of things we need to be really careful of. One is being careful that these young people can exit the group at an appropriate time. So we need to think about beginnings and endings here. We want to make sure that these young people potentially are an ongoing source of support for each other, but they're actually to belong in this group, to be part of this, you don't have to be currently self-harming. They can be a real issue that young people can come across online forums or real-life groups where in order to be part of that group, you having dysfunctional harming or drug use or alcohol misuse or eating disordered behavior. And if that behavior stops, you no longer are part of that group. And so you have to exit and you've lost this really good source of support and you've lost your sense of belonging. That's a real issue. So we need to think about how do we enable exits to happen at a healthy time for the individuals or do we have a finite number of sessions? The other thing that we need to be careful of is that when we bring a group of young people together, that they're not causing harm to each other. So sometimes when young people are very explicit about methods of self-harm or they might talk about ways of hiding self-harm and that kind of thing, this can provide a bit of a how-to guide for other people in the group. So we need to be really clear from the offset about what our ground rules are about what's in and what's out in terms of discussion here. This is also important because it stops the young people having to take on too much emotional baggage from the other people in the group because again, they'll really want to support each other but it's really important that they know what their role is, where that role ends and at what point problems should be escalated to an appropriate adult. So I would really encourage you to have a look at the Mind and Body project. There's some really great practice going on there. This is a project that's been going on for several years and I've been hugely privileged to be a big part of that project right from the start and they're learning all the time. So when I did my last training session with the Mind and Body team, they had recently brought on board essentially a family link worker and we're really recognizing now the importance of educating and supporting families around their child who is engaging in self-harm behavior as well and that was a new thing and was having a huge impact. So they're learning all the time but yeah, learn from them, have a look at the best practice there and if you're someone who commissions services then it is a commissionable service too which has been proven to be highly impactful. Hope it was helpful. Thank you, bye.