While self-help is no substitute for professional support, digital tools can enable young people to channel overwhelming emotions into something less harmful.
The Samaritans define self-harm as ‘any deliberate act of self-poisoning or self-injury without suicidal intent’, and a worrying number of young people are doing it. Hospitalisations of nine to 12-year-olds because of self-injury has doubled in the last six years, while doctors are reportedly seeing self-harm in children as young as ten.
Estimates show that around a quarter of 14-year-olds self-harm. But these figures are just that — estimates. The true number is, unfortunately, much higher. Statistics rely on people coming forward, yet so many people will never seek help. This isn’t much of a surprise, since self-harm is still often treated as taboo; something to be ashamed of.
While it would be reductive to suggest that Covid-19 has caused a spike in self-harm cases, lockdown and a lack of access to NHS support have caused many people to relapse. Myself included.
Relapses are terrifying because it can feel as if all of that time in recovery has been wiped away like a smudge on the lens. But it hasn’t. Urges can be overwhelming, and sometimes we have a wobble and give in. That’s OK.
Only through addressing the root causes of self-harm, ideally through therapy, can we truly move away from these urges, but there are ways to manage and control them in the meantime. As, the harsh reality is, self-harm treatment is severely lacking. Frankly, it doesn’t surprise me that hospitalizations are rising. If your injuries aren't ‘serious enough’ to be admitted to A&E or the psychiatrist ward, you’ll likely be offered a route to self-help (in other words, you’re on your own). This doesn’t mean that talking to your therapist or GP about self-harm is pointless, but you may come up against frustrating barriers.
These stark failures of the mental healthcare system provide gaps for private digital technologies to fill. One such solution is a free app called Calm Harm.
When you open the Calm Halm app, you are greeted with a message: ‘The urge to self-harm is like a wave… Once you surf the wave the urge will fade.’ You click ‘Ride the Wave’ and are directed to a bunch of techniques taken from Dialectical behaviour therapy (DBT), split into categories of Distract, Comfort, Express Yourself, Release and Breath. The lists are pretty substantial. You can choose to Think of a country for every letter of the alphabet or write what’s upsetting you on a piece of paper and tear it up until the urge goes away.
I caught up with the founder of Calm Harm, Clinical Psychologist Dr Nihara Krause, to find out more.
Sian: When, and why, did you develop Calm Harm?
Nihara: I specialise in working with self-harm, so ten years ago I started Stem4, a charity that supports positive mental health in teenagers.
Initially, our aim as a charity was to go into secondary schools and colleges and identify issues in healthcare. We found that it was tough for young people to access help, partly because health resources are stretched, but also that the acceptance criteria is for those who are very severe. For people who might have self-harm issues that don’t meet those criteria, or you want to get help right now, rather than having to wait to go see someone, there seemed to be a gap in the market. I worked with young people, asking them what they think might be helpful. And they were 100% sure that they wanted a digital tool, something that they could trust. That’s why the app is password protected.
And what does the app do?
The app uses a form of treatment called DBT, or dialectic behaviour therapy. It is a form of cognitive behaviour therapy, and not many people are trained in terms of delivering it. You can access it primarily in the NHS through group work. It’s all about trying to learn to manage and regulate strong emotions, which lie at the heart of self-harm.
The app itself looks at the main reasons why people might employ self-harm behaviours. For example, do they use it to express something? Or to comfort themselves against something that feels very difficult for them to tolerate? The categories focus on these different core triggers, to provide young people with tools to meet those underlying factors.
The app invites you to ‘ride the wave’. What is the significance of this?
I use the wave analogy because if we can somehow surf the urge to do something, then we can get a bit more of a handle on it. It’s a really simple process of just waiting, starting to build a process of observation, and then deciding on whether you want to continue to do something more positive, rather than something that might give you a quick fix but may leave you feeling worse than when you started.
How has it been received so far?
Initially, we created it as a charity so we fundraised to put together a very simple prototype. I then applied to be part of a digital innovation lab with the NHS. I wanted to make sure that we could meet the clinical criteria so that the NHS would recommend it. I was thrilled that I was able to get accepted into the first NHS digital cohort.
Since we founded it, we’ve had about a million and a half downloads across the world.
That’s pretty impressive. How do you know what techniques are useful for young people who are self-harming?
We listen to user feedback, so it’s very much co-developed. We provide young people with the option to hide things that might be triggering for that individual. We listen to people who write in saying ‘OK this might be recommended but it doesn’t help.”
So, for example, guidelines advise that you put ice on the area that you want to harm yourself. Yet we had a lot of young people write and say that wasn’t helpful, that it was triggering. So we took it out.
Is this just about distraction techniques then?
We also encourage self-reflection, because often, when you’re younger, you want a quick fix. The app doesn’t aim to be a treatment in any way, because I think that would be minimising the meaning of self-harm to young people. But it sort of says, well, if you are doing what you are doing because you are low in your mood, you might want to contact these people. So we signpost on to what might help.
I have a booklet on how to talk to a friend, parents, or a GP. Because even though we tell people to go see a GP, it’s overwhelming to have that conversation. So we have some tips on things you can do, some things you could write. We’re hoping we can give young people some tips on how to talk about it and if it doesn’t work, how they can go forward and try again.
That’s great. What’s next for the app?
We try and update every quarter. Here, we look at what times of the year or what events might trigger off downloads. For example, when the A-level results came out we had an absolute flurry of downloads. In response, we are producing resources that we send to universities around dealing with exams.
We also discovered that people who weren’t self-harming were using it to manage anxiety, so I decided to develop our second app, which is called Clear Fear. We’ve also got an app for parents, carers and friends, called Combine Minds. There’s a section on how to talk to somebody who might be self-harming and help support them and how to listen.
We have now gone back and we’re looking at our data. Primarily, it was downloaded by parents and carers and about 51% of them said they had a young person either in treatment, or who had a diagnosis. But over the pandemic, we’ve had a lot more friends download it.
On this, how can you help a friend who is self-harming?
Friends are often the first to be told so it’s a really stressful position to be in, I think.
I would say, be available and don’t just squeeze in a discussion. Make time for it. But don’t ask them directly if they are doing anything, because often people will just say no. It’s more about being open and saying, Oh, I noticed that maybe you didn’t join as much, or you’re looking a bit down, how are you? Be prepared to ask a few times, kindly.
Absolutely do not say ‘just try and stop’ because if a person could stop, they would stop. It’s all about encouraging them to try and get some support. And that can’t be just from a friend, because a friend should be there as a friend, rather than becoming a substitute therapist. You could offer to go with them to the doctor or to talk to them on their behalf. Particularly if a person is depressed and they’re self-harming, then it’s really important to make sure they get a proper assessment of care.
This being said, services have been stretched at the moment, which is dangerous because you don’t want young people to be disappointed, thinking ‘I got to a point of asking for help. And now there’s nothing’
Going to a GP isn’t the only option. There are loads of organisations that offer help, such as the text message service Shout. Digital might not work for everyone, but it’s worth exploring those options.
Text Shout 85258.
Call the Samaritans on 116 123.
Call The Mix helpline on 0808 808 4994.
Call C.A.L.L. on 0800 132 737 (Wales only).