As a psychiatric social worker I see both youth and adult clients in an acute in-patient psychiatric hospital. It's clear that not all individuals who are depressed engage in self-harm and not all of those who engage in self-harm are clinically depressed.
In assessing youth, or adults, I gather information related to use of substances as these have a huge impact on the psycho-emotional functioning of individuals. Alcohol abuse, in particular, is often highly correlated to Major Depressive disorder, as well as an increased risk of suicide.
Another important area to assess is social relationships. I've found with women, young and older alike,a break up with a partner is often an impetus for depressive symptoms and self-harm episodes. With both younger and older clients (most often female) there also may be emerging, or previously unrecognized, features of Borderline personality disorder.
Assessing feelings of hopelessness, meaning in life and future orientation (defined life goals and focus beyond their current situation) are crucial in understanding what suicide risk someone may pose to themselves. I've found that most people are quite open about these things when asked.
In working with clients who self-injure, I ask the particular client what purpose the self-harm activity serves for them. For many it reduces and releases the unbearable, and often overwhelming, feelings and emotional tension they are experiencing as a result of external triggers and internal conditions.
From a scientific standpoint, when individuals inflict physical pain to themselves, they get a release of endorphins. This stimulus-response chain is dangerous and this is one of the reasons people become chronic self-harmers. They aren't learning healthier, more adaptive strategies for coping with their feelings and self-harm becomes their habituated behavioural response to stress and overwhelming feelings that are triggered by things that occur in their world.
The specific interventions recommended will depend on the co-morbidity of other mental health and physical issues, family history of mental illness, what kind of natural and professional supports are available in the community. Most often, a combination of psychiatric medications, such as anti-depressants anti-anxiety, are recommended to be combined with individual cognitive behavioural therapy (CBT). For those with Borderline features, Dialectical Behavioural Therapy (DBT) delivered in a group, or individual format has been scientifically validated as effective treatment. Some health regions will offer these services at no-cost to clients.
******************************************
When self injury turns suicidal for teens
Futurity, October 5, 2012. U. MISSOURI (US) — A survey of more than 60,000 Minnesota teens showed that about 4,000 reported injuring themselves and nearly half of those attempted suicide.
Researchers who analyzed the survey have identified factors that will help parents, medical professionals, and educators recognize teens at risk for self injury and suicide.“For many young people, suicide represents an escape from unbearable situations—problems that seem impossible to solve or negative emotions that feel overwhelming,” says Lindsay Taliaferro, an assistant professor of health sciences at the University of Missouri.
“Adults can help these teens dissect their problems, help them develop healthful coping strategies, and facilitate access to mental health care so their problems don’t seem insurmountable.”
Taliaferro analyzed data from the 2007 Minnesota Student Survey to pinpoint factors associated with self injury.
“Of the teens who engaged in non-suicidal self injury, hopelessness was a prominent factor that differentiated those who attempted suicide from those who did not have a history of suicide attempts,” says Taliaferro, who reported findings in the journal Academic Pediatrics.
Parents, teachers, and medical professionals sometimes avoid talking to teens about self harm because they aren’t sure how to help, Taliaferro notes.
“Adults don’t need to solve all the teens’ problems, but they should let the teens know they have safe persons they can talk to,” Taliaferro adds. “Sometimes just talking about their feelings allows young people to articulate what they’re going through and to feel understood, which can provide comfort.”
Taliaferro recommends that parents strengthen connections with their teens and help foster connections between their children and other positive adult influences.
“One of the most important protective factors against teens engaging in self injury was parent connectedness, and, for females, connections with other prosocial adults also were associated with reduced likelihood of engaging in self injury,” Taliaferro says. “Parents are extremely valuable influences in their children’s lives.”
Although parents play influential roles in teens’ lives, Taliaferro says mental health professionals are the best resources for troubled teens.
Medical professionals, such as primary care physicians, can also serve crucial roles by identifying teens who self injure and referring them to community support systems and mental health specialists before their behaviors escalate, Taliaferro says.
Researchers at the University of Wisconsin-Eau Claire, the University of Minnesota, and Penn State contribute to the study.
Source: University of Missouri
***************************************
For more information and resources for intervention, here is a previous post from Advocacy BC:
No comments:
Post a Comment