What to do next?
After identifying that a student has self-injured, teachers and other school staff should refer students who self-injure to the school nurse or first aid officer to treat the student’s wounds and to assess whether the student has serious or life-threatening wounds requiring referral to a hospital emergency department. Some medical professionals may have negative reactions and responses towards students who self-injure. Therefore, a school staff member should accompany the student to the hospital emergency department and stay with them until their parent or guardian has arrived.
However, if the student does not require treatment by the school nurse, first aid officer, or hospital emergency department, then teachers and other school staff should follow their school’s policy for responding to students who self-injure, which my involve referring students who self-injure to the school counsellor (if available) or the school principal.
Although students who self-injure can be reluctant to seek professional help for the behaviour, it is essential that students who self-injure are assessed and treated by a trained mental health professional. When speaking to the student about your intentions to refer them to the school counsellor, teachers and other school staff should listen to the students concerns about seeking professional help, and reassure the student that the school counsellor is best equipped to help them. Students who self-injure should be referred to the school counsellor even if this means breaking the students confidence.
The school counsellor can then meet with the student to conduct a thorough risk assessment to assess the severity and intent of the behaviour (i.e., with or without suicidal intent), and determine the next most appropriate course of action. Although students who self-injure are often not suicidal, it is important for the school counsellor to assess the student’s risk of suicide by asking about previous suicide attempts, current suicidal thoughts or plans, and history of family or peer suicide.
The risk assessment should also assess the severity of the physical injuries, frequency of self-injury, methods of self-injuring, escalation of self-injury over time, wound care strategies, triggers for self-injury, and mental state following self-injury, and also establish if there is any evidence of co-occurring mental health problems, such as substance abuse, anxiety, depression, eating disorders, and a history of trauma or abuse.
Once the risk assessment has been conducted, the school counsellor should determine the next most appropriate course of action, which in most cases may involve meeting with the student’s parents and discussing options for referring the student to an external mental health professional with experience working with adolescents who self-injure.
However, it can be difficult to know when and how parents of students who self-injure should be informed about their child’s self-injury. For this reason, the procedure for contacting parents of students who self-injure should be clearly outlined in the school’s policy for responding to students who self-injure so that teachers and other school staff are on the same page when contacting parents of students who self-injure.
However, regardless of when schools decide to contact parents of students who self-injure, the school counsellor should advise the student in advance of their intentions to contact their parents, and the student should be invited to be present when the call is made to their parents so they are aware of what is discussed. The school counsellor should then meet with the student and their parents to discuss the referral process to an external mental health professional.
When deciding whether or not to contact parents of students who self-injure the school counsellor should consider respective state and territory laws, respective state and territory governing education department policies, relevant codes of ethics and ethical guidelines, and the school’s policy for responding to students who self-injure.