There are many pressures involved when fostering children. In many ways these are relative – a forgotten lunchbox for school, for example, isn’t serious – perhaps just irritating. Then there are the more serious concerns, staying out late beyond an agreed return time. Individually, these can set the nerves ‘jangling’ – taken cumulatively, it is not surprising that the best foster carers have to be able to fall back on a core of inner resilience. But there is one particular issue that can be extremely difficult for the most experienced foster carer to deal with. And particularly nerve-wracking it can be – self-harming behaviour.
Self-harming is when a child or young person decides to deliberately hurt or injure themselves. And it is far from rare, being one of the most common concerns young people contact ChildLine over. The behaviour is usually concealed and can take many different forms: biting, scratching, cutting, overdosing on medication or swallowing toxic materials. It may also take the form of risky behaviours in hazardous places such as roads. Self-harming may also manifest itself in disordered eating behaviours such as anorexia and bulimia.
Concentrating on why children self-harm reveals two main reasons. The usual trigger is often trauma brought about by abuse or loss. This could include the death of a family member, or someone close: divorce or separation can also be triggers. If a child or young person already has mental health issues, then this can compound all the associated problems resulting in self harming.
Self-harming, however seemingly drastic, can be a form of expression where words cannot convey the hurt, pain or emotional confusion. Paradoxically, it can relieve hyperstress symptoms and address feelings of emotional disassociation. This is brought by a distinct physiological effect: self harming releases endorphins into the body. These are a class of naturally occurring chemicals produced by the brain. They have the effect of acting to lift mood, as well working as a pain killer. A vicious circle is created as young people can become both physically and mentally addicted to endorphins and consequently become addicted to self-harming.
When fostering children, you as the foster care will be responsible for recording any and all incidents of self-harming. The young person’s supervising social worker should be kept informed of every episode. It can be difficult to accept, but the outward signs of harm such as cutting; although worrying, are the outward expressions of inner turbulence. The advice of CAHMS (Child and Adolescent Mental Health Services) should be sought (referral via your GP). Communication is important: a child or young person should feel able to communicate their feelings without fear of being judged. If there is a risk of significant harm, the young person should feel they can approach their carer if at the point of risk, and be able administer basic first aid, or be able – in the case of older children – to make their way to a doctor or hospital for attention. There are some other measures that can be taken: coping strategies can include having a red elastic band on the wrist, or using a toothbrush to scrape the arm. This has the effect of releasing endorphins, but minimising physical damage.
Always remember self-harming is a coping strategy to deal with entrenched pain and distress. The kind of upset that a young person may simply not be able to articulate for the present. This means when fostering children who are experiencing such pain, lines of communication must always be open. The time may come when a young person may be able to put into words what their distress is all about. Sometimes the degree of trauma to which they have been exposed has been so great that before they can use words, it may be easier to express their feelings through writing, drawing, painting, movement and dance – or a combination of such activities. It is important to work closely with the supervising social worker so the opportunity for communication is always there. You should never threaten, be dismissive, ignore the behaviour or assign blame. The role of the foster carer is to monitor and be present to provide reassurance and acceptance. It is common for a young person to feel a sense of shame for they may be in a confused state. This means a foster carer should not judge. The goal is to provide the opportunity for a young person to feel they can safely begin to unburden themselves of experiences that have been so traumatising they are not immediately able to put them into words.
Perhaps the biggest myth of all is that self-harming is concerned with attention seeking. The point has already been made that it can revolve around the setting up of a cycle of physical addiction that can be hard to break. Because the activity of self-harming can be shocking and disturbing for the carer, an assumption is all too often made that such an activity will result in a suicide attempt. It has to be stated that this is extremely rare: again the involvement of mental health professionals should be in place where there is any pattern of self-harming. Some of the other less than helpful myths in existence is that a young person is enjoying the pain inflicted, it is a passing phase or that there is no desire in them to get better explaining why they are so often reluctant to seek help.
Beware: there are some websites and forums that actively promote self-harming as a positive thing to do. Some of the best sites for general information include:
And the good news at the end of this rainbow…we provide all our carers with FREE membership of FosterTalk: this means any member of a household may phone FosterTalk’s 24 hour Counselling Helpline. Speak to a qualified counsellor on our special helpline: 0844 800 3880. Mobile users can ring Freephone 0344 800 3880. All calls made are entirely confidential. The duration and frequency of calls is unlimited.