Most adolescents who self harm do so in response to interpersonal crises and can be discharged for treatment as outpatients. Inpatient psychiatric treatment is usually reserved for those who have severe depressive or psychotic disorder, present an ongoing risk of suicide, or are in the middle of major psychosocial difficulties, such as disclosure of sexual abuse.
Self poisoning is the second most common method (after self cutting) for deliberate self harm by adolescents
A crisis intervention model is often most appropriate. Compliance, however, can be a problem because the self harm may have had a positive effect by providing temporary relief from a difficult situation. Also the take-up of treatment depends largely on parental background and attitudes, which may include denial and negative views about psychological help. A home based treatment programme may overcome some of these problems.
Problem solving therapy is often used with adolescents and has the advantage of being direct and easily understood. Using problem solving techniques and rehearsing coping strategies can help the adolescent when he or she is confronted with future crises.
The problem solving approach can also be extended to involve the whole family. Family interventions are structured, usually last five or six sessions, and can be home based. Essential elements include the improvement of specific cognitive and social skills to promote the sharing of feelings, emotional control, and negotiation between family members. Role play can be a useful additional technique. It is wise to anticipate crises by making provision for appointments at short notice or giving telephone numbers for emergencies. Adolescents who self harm can also be treated in groups.
If depression is present, cognitive behaviour therapy is an effective treatment in adolescents. The selective serotonin reuptake inhibitor fluoxetine (Prozac) is effective in this age group. However, in view of the risk of further self harm by overdose, it is wise to limit supplies of this drug and get other family members to handle it, at least initially.
If school problems, particularly bullying, are prominent, liaison with the school is important. Further help may be provided by a school counsellor. In the case of learning difficulties, an assessment by an educational psychologist may be helpful in devising suitable educational options. When the self harm occurs alongside substance and alcohol misuse or violence, specific treatments for these conditions may be indicated. For older adolescents, referral to a self help agency or walk-in counselling service may be appropriate—and more readily accepted.
Important issues in assessment of adolescents who have self harmed
Assessment of families of young people who seriously self harm
Treatment options for adolescent self harm
Basics of problem solving therapy