 I'm Rick Bradley and I'm the Operations Manager for Mind and Body. I'm Carl Robinson and I'm the Senior Supervising Clinician. I'm Tom Dabbano and I'm the Family Worker for the Kent Mind and Body team. And I'm Sophie Beer, a team leader for Mind and Body. OK, so the first one we've got is if we stop a young person self-harming using one method, they'll move on to another. So I think from the discussions that we've had in general what we find is that the reasons why somebody might self-harm it's really important just to look at their specific motivations. And it may be that if they're wanting to try and get a feeling of control then they could potentially look at a different method or a different distraction or another exercise that would be less risky. It doesn't necessarily mean that they would move on to maybe from cutting to a different type of self-harm. So probably the main thing for us to take away from today is that it's really important to look at the motivations behind what they're doing and to be really clear and speaking with the young person about why they're making those behaviours, making those choices with the view to putting support in place that will be less risky further down the line. No decisions about me without me should this always apply in cases of self-harm. I think self-harm is really a behaviour that young people do when they feel they don't control much in their lives but one thing they can control is their body and what they do to their body. So I think if you were to take decisions about them around their self-harm without notifying them it would really feel like they were out of control of that situation and that decisions were being made before them. So I think as much as you can you should really consult with young people and I think they'll be the experts about what will work for them, what's in their best interests. I think it's essential to get the young people on board in order for them to actually commit to it and you're far more likely to get a positive response by involving them within that whole process. Give them a sense of ownership over their action plans and what works for them. The more severe the injury, the more distressed the young person is. I think in our discussion week we recognised that every individual situation should be looked at on its own merit and actually it's about recognising again the method, the reason behind the motivation of that and what the young person is trying to achieve from self-harming and actually it's about recognising that rather than necessarily looking at the severity of the particular injury. We also spoke about one individual young person could be at one time possibly going self-harming and later on down that journey no longer be self-harming but they may still be under a great deal of distress so it's about not dismissing that or making assumptions about it as well. If a young person is self-harming our aim is to work towards a time when they're no longer harming themselves and I think the important thing around this is to work with the young person for them to set their own goals what they want to achieve and to help them really in supporting them to hopefully reduce the harm, reduce any risks but predominantly it's about them setting their goals and us supporting them to do so. I think one of the other things that came up on that was about making sure that you're not going to force them towards something they don't want to do but to certainly look at motivations and possible benefits of changing behaviours if they might be problematic. It's quite similar to this one I think which is some young people don't want to stop self-harming and they should have a right to choose and I guess that's quite a regular theme of discussions is that if that young person isn't at a stage where they are ready to make a decision we can't be pushing them into anything that is not in their mindset at that stage but I suppose there is also a, we have an opportunity when we're working with young people that we need to try and take advantage of to actually try and engage with them to explore what the possible risk factors might be of some of their behaviours and to look at what the possible benefits might be again of them making changes and if we can appropriately involve other people in that as well whether that's their parents, carers, other friends maybe or school staff so that young people get a package of support around so even if they're not ready at that particular time when they are ready and when they feel they've got the right motivation they can access support in a more, probably in a manner that's likely to be a bit more successful. If a young person can't explain why they're self-harming there's not a lot we can do to help them so we spoke today about how the mind and body programme uses a lot of cognitive behaviour approaches and one of the resources that you guys use is the Hot Cross Bond tool so I think that's a really good tool to help young people think about their thoughts, feelings and how that translates into behaviour just because somebody can't explain why they're self-harming it may just be, you need to break it down a bit maybe they haven't got the emotional literacy to be able to explain why it is they're reacting in such a way so I think there's a lot we can do to help them a lot of psycho-educational work as well around understanding what self-harming behaviour is and why people self-harm. I think that's something that comes out a lot from the work is just if young people are helped to understand why they do what they do it can be a really powerful thing because generally I think their experience might be that they're told off quite a lot and even they don't know their motivation sometimes or what they're doing so yeah I think that's really important and a really valuable role I think for parents and carers to be able to support that process of helping that individual to understand where they're coming from and the more they understand that the stronger that relationship and support can be I've got reducing access to means is an important means of reducing risk and harm so I think again it's about recognising that actually sometimes by removing different items that somebody might use to self-harm actually doesn't necessarily reduce the risk and harm it can actually increase it to a certain degree so we have to be mindful of the reasons why that young person may be self-harming and to actually look at the right support around that and then looking at alternative means that they can use and until those are in place and functioning well then we need to be mindful of not necessarily trying to remove some of those things but there may be situations where it's really important to look at that so again recognising each individual situation is really important and also recognising that the WHO sort of advises of sort of removing implements and items that might be used within that but again we have to be mindful of recognising the possible consequences to that and sometimes that self-harming behaviour can be the difference between reducing thoughts or feeling of sort of suicide and actually by removing implements then actually that can increase that sort of suicidal sort of thoughts and perhaps intention as well I think with that one that was one of the cool ones to I guess where we were talking about making sure that the young person is involved in those decisions so to explain that this is the rationale behind it but what we don't want to do is leave them without any mechanism that they can maybe keep themselves on that equilibrium so that it's not a process where you do those things without their involvement but if a young person's self-harm is superficial, controlled and their wounds are well managed there is no urgency for them to stop and I think the important thing with this one is if you're working with a young person they may perceive that their behaviours are not a great risk however I think the important thing for us to focus on with them is looking at why they are taking part in certain behaviours looking at what they're gaining from it and then we can explore with them alternative safer strategies to help them manage those emotions and sort of safer behaviours over time and work with them to set an action plan My last one If a child has been harm-free for six months and they slip up, it's back to square one we would be very much against that sort of being the case I mean for some young people it will be that they might take a big step back in terms of their recovery but actually for a lot of people a slip up can just be a bit of a blip on the side of change they wouldn't have to retrace their steps and go right back to the beginning again Certainly with young people I've worked with previously having a slip up can be a real motivator not to go back to where they were it can be a bit of a moment of realisation actually they've done it once but they really didn't want to do it again after that so again I think what we want to try and do is look at what the trigger was for maybe that change again reviewing things like their motivation and where they want to be and give them an opportunity to reflect on how to try and stop those things from happening again and what can be put in place to support This is quite a controversial one Risk-taking behaviour isn't something we should be overly worried about so I think the pure nature of adolescence is that young people take risks but there's obviously healthy risk-taking behaviour and risk behaviour that can be detrimental to well-being Young people's love for things like places like amusement parks and bare ground rides and stuff when you get a bit old you're a bit like oh I'm going on that it looks a bit rickety but young people are all about taking risks so on the one hand we want them to go out and experiment with risk but on the other hand in the roles that we take in our work we are quite mindful of harmful risk behaviour and I think it's really good to have conversations amongst ourselves within kind of team meetings, supervision sessions peer supervision to kind of speak about risk and where we feel it's kind of harmful I think we will have different thresholds for different risks I think again it's where it's really helpful for young people themselves to realise that they're basically designed to be risk-takers once they know that I think it helps them to sort of maybe manage some of those risks in a little bit with some of the right strategies but it just helps to explain why they are so impulsive I think sometimes we have to be mediators so I imagine Tom York often sat with parents and they are really kind of anxious about the risk and the young person is minimising it and I think sometimes we can use our experience to kind of mediate between them and say actually mum's got a point when you go on top of tour buildings later at night that is risky and something that could happen to you so it's kind of like having to mediate and I think it was also about looking at it from different perspectives from parents and carers to young people and helping both parties to actually understand the differences from where each are coming from and having that conversation because I think we look at all these subjects it's all about the way that we communicate with each other and for young people that are struggling with around self-harm it's about how they actually communicate that information and for parents and carers I think it's about that process of understanding where their child is coming from and having a clear idea and the best way to do that is to have those conversations and that can be the really kind of key starting point I think one thing that I've taken away from today around risk behaviours and sort of more general behaviours when we were discussing what behaviours would be sort of a red flag for us I find it really useful to think about it in the sense of could a young person go a day without taking part in that behaviour and also are certain behaviours like eating behaviours over-exercising things like that is it ruling a young person's life is it the young person in control of that behaviour or is it that behaviour control in a young person when we're assessing should it be a red flag as such and should we be concerned about it I think that's quite useful At the moment if we want a young person to stop self-harming we should always I guess there's lots of things that we can do and the kind of most important thing I guess key thing is to involve them in the process letting them be part of that sort of process and letting them feel in control of that as well because it's about them being able to sort of make those changes and sustain those changes by the support and again it's about looking at different alternative methods that they can use and also again the support around them so recognising the wider family friends, relatives that they've got there that they can actually be there to be supportive and to be encouraging them in the right way and then my final one very much follows on from that as well is if we want a young person to stop self-harming what shouldn't we do so the flip side to everything you just said really that if we want to support a young person and we want them to feel comfortable in disclosing and opening up to us then we shouldn't be judgmental we shouldn't be imposing our own emotions onto them and it's important really for them to feel like you said that they've got control and I say in the action plan for themselves anyone else any big nos and don'ties I think maybe the only thing when we were having group discussion was about being mindful of the work that we do being in groups of not having conversations which are too open which might be triggering in terms of specific behaviours for other young people I think it's really it's key that we can have very open discussions with young people but that would be more in a one-to-one environment rather than having those discussions where it could be problematic for others in that group but it goes back to Tom's point which everybody was in agreement that the young person and their choices need to be sentry to that process