Self-Harm Policy

(Last reviewed 27/05/2025)

Relevant Legislation & Guidance
Standards and Regulations
Fostering Services National Minimum Standards (England) 2011:

1. Standard 2 – Understanding your role as a foster carer
2. Standard 3 – Understanding health and safety, and health care
3. Standard 5 – Understanding the development of children and young people
4. Standard 6 – Promoting health and wellbeing
5. Training, Support and Development Standards for Foster Care

Introduction

The agency is committed to always protecting and promoting every child’s or young person’s safety, wellbeing and best interests. All staff members and carers must promptly report any incident or concern about a child’s or young person’s welfare.

This policy sets out information and practice expectations for supporting children and young people who harm themselves or talk about suicide.

Any child or young person who shares distressing thoughts or shows risk to themselves or others must be taken seriously, and appropriate help and support must be provided without delay.

Aim of Policy

The policy aims to:

1. Offer a clear framework for managing self-harm and suicide risk.
2. Share guidance on reducing the risk of injury or death and on safeguarding the safety and wellbeing of children and young people.
3. Lessen uncertainty and stress for carers, SSWs and Team Managers when they support children and young people who self-harm or express suicidal thoughts.
4. Set out the reporting requirements.

Definition of self-harm

Self-harm means a child or young person deliberately hurts or injures their own body. It is unfortunately common and is one of the main reasons young people contact Childline. Self-harm is often used as a way to cope. A person hurts their body to manage emotional pain or to replace numbness with physical sensation.

People may self-harm to escape an unbearable situation or emotional pain, to relieve tension, to express anger, to generate guilt, or to seek comfort and care from others.

Within the group of children and young people who are looked after, some are especially vulnerable to risks linked to self-harm. These include those who:

1. Talk about self-harm, including thoughts of suicide.
2. Have carried out self-harm.
3. Engage in self-injury such as cutting or blood-letting.
4. Share suicidal thoughts.
5. Have attempted suicide.
6. Tie or attempt to tie ligatures.

Many children and young people who become looked after may have lived through significant trauma and are often highly vulnerable. They may have multiple and complex needs, and significant behavioural and emotional difficulties, which can lead them to take high-risk actions.

Threats of self-harm and actual self-harm cover a wide range of actions, from talking about harm to showing self-harming behaviour to suicide. Even when the intent to die is low, self-harm signals deep distress and must be taken seriously. Some people who do not plan to die may do so because they misjudge the seriousness of their chosen method or do not receive help in time.

Self-harm is usually hidden and can take many forms: biting, scratching, cutting, overdosing on medication, swallowing toxic substances, or taking risks in dangerous places such as roads. It can also appear through disordered eating patterns such as anorexia or bulimia.

The reasons why children and young people in care self-harm are often complex and varied but generally relate to a mix of factors that can include:

1. Past and ongoing trauma.
2. Significant and continuing stress.
3. Limited emotional or behavioural coping skills.
4. Limited self-care skills.
5. Emerging or diagnosed mental health or psychological conditions.
6. Limited supportive networks.
7. Few alternative coping strategies.

A common trigger is trauma linked to abuse or loss, such as the death of someone important or parental separation. Pre-existing mental health difficulties can intensify these problems and increase the risk of self-harm.

However drastic it may seem, self-harm can be an attempt to express feelings that words cannot capture. It can temporarily reduce extreme stress or feelings of disconnection. This relief is linked to the release of endorphins—natural brain chemicals that lift mood and numb pain. Over time, some young people can become both physically and emotionally reliant on the endorphin release and thus on self-harm.

Self-harm involves both the act (or threat) of self-injury and, crucially, an awareness of motive. Understanding motive distinguishes self-harm from other adolescent risk-taking or experimental behaviours.

Although self-harm and attempted suicide do not always involve a desire to die, there is a strong link between self-harm, attempted suicide and death by suicide. Self-harm is always a sign that something serious is happening for the child or young person. Every incident of self-harm must be taken seriously and met with support.

Warning signs that a child may be self-harming

The following behaviours may suggest that a child is self-harming:

1. Changes in eating or sleeping patterns (for example, appearing very tired if not sleeping well).
2. Greater isolation from friends or family and social withdrawal.
3. Noticeable changes in activity or mood, such as becoming more aggressive or more inward-looking than usual.
4. A decline in academic performance.
5. Talking or joking about self-harm or suicide.
6. Risk-taking behaviour (such as substance use or unprotected sex).
7. Expressing feelings of failure, worthlessness or hopelessness.
8. Changes in clothing, such as loss of pride in appearance, reluctance to roll up sleeves in front of others, or wearing long sleeves even in hot weather.
9. Increased aggression or bullying.
10. Obvious cuts, scratches or burns that do not appear accidental.
11. Frequent claims of accidents leading to injury.
12. Regularly bandaged limbs.
13. Reluctance to take part in physical activity that requires changing clothes.
14. Refusing to remove a jumper or frequently pulling sleeves down over wrists and hands.
15. Giving away possessions.

Suicide

Suicidal behaviour refers to any deliberate action that could be life-threatening, such as taking an overdose. It can also include repeated risky behaviour that could lead to death.

Suicidal thoughts mean that someone is thinking about ending their own life. This is different from a young person’s normal exploration of life’s meaning. Further discussion will usually clarify whether someone is thinking about suicide.

Suicide is the act of deliberately ending one’s own life. A person can also die unintentionally following a serious episode of self-harm.

Warning signs that a child may be at risk of suicide

When a child or young person may be at risk of suicide, it is essential to consider both the seriousness and immediacy of that risk. Depression, hopelessness and persistent suicidal thoughts are known indicators. Always take seriously any statement about wanting to die, as many young people who die by suicide have previously shared their intention with a professional.

Working with Children and Young People with Learning Disabilities

Young people with any level of learning difficulty or disability can show the same self-harm behaviours as other young people and should receive the same supportive approach.

Carers should learn about the child’s learning needs and the best ways to communicate with them. Children with Autism, Asperger syndrome or significant learning difficulties may need adapted communication methods to discuss these issues. Therapeutic interventions must be adapted to their needs, and referrals should be made to CAMHS. Advice can also be sought from the LASW.

Some young people are at higher risk of self-injury and self-harm, including those with severe learning disabilities, limited or no verbal communication (including children with Autism and Asperger syndrome), acquired brain injury, mental health conditions—particularly if diagnosed late—certain rare genetic conditions, and sensory impairment. Children in these groups who start self-injuring should be referred to specialist CAMHS promptly, as longer-standing behaviours are harder to change. Young people with severe or profound learning disability are less likely to use traditional self-harm methods. Instead, their emotional distress may show as immediate self-injury such as head-banging, eye-poking or hand-biting. Assessment and intervention are complex and require input from specialist CAMHS staff.

Levels of risk can be categorised as follows:

Low Risk

1. Brief thoughts with no plan.
2. No active plan to harm self or others.
3. No history of self-harm.
4. No changes in behaviour.
5. Able to think about future plans (days, weeks or months ahead).
6. Situation is painful but manageable and has a clear context (for example, exam-related stress).

Medium Risk

1. Frequent suicidal thoughts—some brief.
2. No clear plan or immediate intent.
3. Current or past self-harm and thoughts of self-harm.
4. Previous suicide attempts.
5. Increased drug or alcohol use.
6. Known mental health issues with services involved.
7. Safeguarding concerns that prevent safety planning.

High Risk

1. Current self-harm that endangers the child’s or young person’s health or wellbeing.
2. Talking about or showing a strong interest in suicide or death, or identifying with others who have died by suicide.
3. Comments suggesting ambivalence about the future or that problems will soon end.
4. Frequent and persistent suicidal thoughts that are hard to dismiss.
5. A specific plan to take their own life.
6. Access to means to end their life (for example, stockpiling medication).
7. Significant drug or alcohol misuse.
8. Belief that situations cause unbearable pain or distress.
9. Previous, especially recent, suicide attempts.
10. Evidence of current or recent mental illness.
11. Few protective factors, such as social isolation or strained relationships with parents or carers.
12. Limited support systems when distressed.

Important things to remember – Do’s and Don’ts for Carers SSWs and TMs
Do:

1. Treat every indication of suicide or self-harm as important.
2. Listen with empathy, avoid judgment and speak thoughtfully.
3. Ask clear, direct questions early to understand the level of risk.
4. Explore other challenges such as bullying, substance use, bereavement, relationship pressures, abuse and identity or sexuality concerns.
5. Where relevant, check how and when parent(s) will be informed.
6. Encourage safe contact with friends, family and trusted adults.
7. Ensure immediate support is in place and arrange medical care when needed.
8. Seek guidance from specialist services.
9. Record concerns and actions in line with the agency’s procedures.
10. Make timely referrals.
11. Take part in creating Risk Assessments and Safer Caring Plans.
12. Carry out agreed actions with the carer, LASW and SSW to reduce risk.
13. Identify protective factors and offer ongoing support and monitoring.
14. Act promptly if concerns about suicide risk increase.

Don’t:

1. Promise absolute confidentiality (see below).
2. Make assumptions or react before considering every risk factor.
3. Dismiss what the young person shares.
4. Assume a young person who has threatened self-harm before will not do so again.
5. Remove the young person’s sense of control.
6. Label self-harm or suicidal thoughts as “attention-seeking.”
7. Show visible shock or anxiety.

Reporting, recording and confidentiality
Open communication is essential: a child or young person needs to feel able to share their feelings without fear of judgment. If there is a risk of serious harm, they should feel safe to approach their carer in the moment of risk and, for older children, to seek medical help themselves when necessary.

Although everyone has a right to confidentiality, including those under 16, sharing information is justified when it clearly serves the child’s or young person’s best interests.

Explain confidentiality processes to the child or young person. All professionals and foster carers are accountable.

If information is shared, a child or young person can expect to be:

1. Told that their information is being shared, with whom and why.
2. Kept up to date.
3. Offered suitable support. Carers and SSWs must record all discussions or actions about self-harm or suicidal intent with the LA in line with policy.

If self-harm poses a risk to health or wellbeing, or if suicide is being considered, always talk with the child or young person and share information with the SSW and the child’s social worker.

When responding to self-harm, the immediate safety of the child or young person is the first priority. Carers, LASWs, SSWs and professionals such as CAMHS must also help the young person build skills and strategies to understand motives and follow LA procedures. Work together with the young person to examine risks and teach sustainable ways to reduce or stop the behaviour. Positive, trusting relationships among the carer, SSW, LASW, CAMHS and the young person are vital so the young person can review and recognise the value of agreed strategies.

Self-harming actions can be distressing for everyone involved. Carers, their families and SSWs will receive support to reflect on the impact of such incidents.

If carers are supporting a child who is actively self-harming or suicidal, they must, with the LASW, create a plan that helps them manage the emotional effects on themselves and other children and young people.

The carer must complete an Incident Report. The SSW must speak to the Team Manager, complete a Risk Assessment and update the SCP. The SCP must reflect any change in vulnerability or risk and detail support strategies; a separate risk assessment must cover the support and action plan. The SSW or their TM must be contacted.

An Incident Report must be completed within 24 hours and the Registered Manager informed as soon as possible. Any serious self-harm or dangerous behaviour, including suicide, must be reported to Ofsted within 24 hours.

Self-Harm Risk Assessment

Supporting guidance tools for assessing self-harm and risk management

Protective Factors	Risk Factors
Family Factors	Family Factors
Child	Child
1. Experiences high self-esteem

2. Uses effective problem-solving skills
3. Shows an easy temperament
4. Gives and receives love
5. Formed secure early attachments
6. Enjoys a good sense of humour
7. Loves learning
8. Is female
9. Communicates well
10. Holds beliefs beyond self
11. Has close friends | 1. Experiences low self-esteem
12. Has limited problem-solving skills
13. Shows a difficult temperament
14. Struggles to give or receive love
15. Experienced insecure early attachments
16. Tends to view things literally
17. Fears failure
18. Has a genetic vulnerability
19. Is male
20. Has limited communication skills
21. Thinks in a self-centred way
22. Feels rejected or isolated by peers |
    | Parents | Parents |
    | 1. Hold positive self-esteem
23. Share a warm adult relationship
24. Report high marital satisfaction
25. Communicate well
26. Enjoy a good sense of humour
27. Demonstrate unconditional love
28. Set developmentally appropriate goals for the child
29. Give accurate feedback
30. Use firm yet loving boundaries
31. Believe in and practise a “higher purpose” | 1. Hold low self-esteem
32. Experience violence or unresolved conflict
33. Report low marital satisfaction
34. Use high criticism and low warmth
35. Offer conditional love
36. Set goals that are too high or too low
37. Engage in physical, emotional or sexual abuse
38. Neglect the child’s basic needs
39. Provide inconsistent or inaccurate feedback
40. Use drugs or alcohol
41. Experience mental health difficulties |
    | Environmental Factors | Environmental Factors |
    | School | School |
    | 1. Maintains a caring ethos
42. Treats students as individuals
43. Fosters warm relationships between staff and children
44. Builds close links with parents and social care
45. Delivers strong PSHE
46. Implements clear behaviour, anti-bullying and pastoral policies
47. Accurately assesses special needs and provides appropriate support | 1. Places very low or very high demands on children
48. Treats the student body as one unit
49. Keeps distance between staff and children
50. Shows absent or conflict-filled staff relationships
51. Places low emphasis on PSHE
52. Uses unclear or inconsistent behaviour, bullying and pastoral policies
53. Ignores or rejects special needs |

Intrinsic – Self-Harm – Risk Indicators

Risk Indication	Protective Factors	Low Risk	Med Risk	High Risk
Eating	No current difficulties	Misses meals or comfort eats	Noticeable weight change	Severe weight loss or food refusal
Self-Poisoning	No current difficulties	Talks about self-poisoning	Plans self-poisoning	Ingests poison
Alcohol/Drug Use (including solvents)	No current difficulties	Use within cultural norms	Regular use	Uncontrolled use
Self-Cutting	No current difficulties	Scratches or picks skin	Breaks skin, causes sores or superficial cuts	Requires suturing
Burning	No current difficulties	Thinks about burning	Causes superficial burns	Causes deep burns
Sexual Activity	No current difficulties	Not sexually active within peer norms	Under-age sexual activity outside peer norms	Exploitative, coercive or abusive relationship(s)
Suicide Attempt	No current difficulties	Fleeting thought, states no action	Wanted to die but no plan	Plan, letter, isolating self

Extrinsic – Self-Harm – Risk Indicators

Risk Indication	Protective Factors	Low Risk	Med Risk	High Risk
Mental Health	Self-aware and able to discuss feelings	Signs of emotional distress	Distress affects life (e.g., missing lessons)	Emotional state affects many life areas
Bullying	No bullying	Feels some bullying is present	Becomes isolated	Avoids school
Family/Carer	Supportive and involved	Some support	Ambivalent	Abusive
Depression	Mood within typical adolescent range	Appears sad, low appetite, sleep disrupted	Tired, reduced concentration, poor self-care	Disengages, isolated
Peer Group	Supportive friendships	Changing peer group, some risk-taking	Peers engaged in anti-social activities/hostile	Peers in dangerous activities/open hostility
Family History	Supportive and involved	Some mental health history	Recent or current self-harm in family	Suicide in a close family member

If you note one or more High-Risk indicators, or two or more Medium-Risk indicators, plus a risk factor in Section 2, raise the concern with the Team Manager and the local authority social worker.

Flow Chart of Low, Medium and High Risk Action. This will always start with an information-gathering conversation.

Flow Chart of Low, Medium and High Risk Action.  This will always start with an information gathering conversation.

 

Resources

Consideration needs to be given to the provision of appropriate training and information to carers and SSWs involved in working with children and young people most at risk of self-harm and suicide.

https://camhs.elft.nhs.uk/Conditions/Self-harm-and-suicidal-thoughts

Young Minds:

Young Minds is the UK’s leading charity committed to improving the emotional wellbeing and mental health of children and young people.

https://youngminds.org.uk/find-help/for-parents/parents-guide-to-support-a-z/parents-guide-to-support-self-harm

https://youngminds.org.uk/find-help/feelings-and-symptoms/suicidal-feelings

NHS

https://www.nhs.uk/conditions/self-harm

Mental Health Organisation Myth Busting Self Harm.

This foundation is the UK’s for ‘everyone’s mental health’.   They influence policymakers and advocate for change

https://www.mentalhealth.org.uk/publications/truth-about-self-harm

Harmless Charity

Harmless is a user led organisation that provides a range of services about self-harm and suicide, including prevention, support, info and training. This is based in Nottingham but the information and resources is very useful.

http://www.harmless.org.uk/

NSPCC

This website is excellent for links to other resources, such as taking about difficult topics, books, etc.

https://www.nspcc.org

https://www.nspcc.org.uk/preventing-abuse/keeping-children-safe/mental-health-suicidal-thoughts-children

https://www.nspcc.org.uk/preventing-abuse/keeping-children-safe/self-harm

Bereaved by Suicide

People who have experienced suicide in the family have a higher risk of suicide themselves, so it is important to be aware of this if you are working with children and young people who have been bereaved by suicide. ‘Help is at Hand’ is a useful resource produced by the Department of Health for people bereaved by suicide and other sudden, traumatic death. It also provides information for healthcare and other professionals who come into contact with bereaved people.

https://www.nhs.uk/Livewell/Suicide/Documents/Help%20is%20at%20Hand.pdf

Coping with Self-harm: A Guide for Parents and Carers

Developed by researchers at the University of Oxford.  This guide was developed from talking to parents and carers of young people and is aimed at helping parents, carers, other family members and friends cope when a young person is self-harming. It includes information on the nature and causes of self-harm, how to support a young person when facing this problem and what help is available.

http://www.healthtalk.org/files/upload/Self%20harm%20parents%20guide.pdf