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Brent Morgan - Gonna Be Okay (Lyric Video)

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Podcast: Supporting Children & Young People who Self-Harm in Lockdown - Emerging Minds

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The Emerging Minds Network is pleased to share recordings from our joint webinar with The Mental Elf on 12 May 2020 The aim of the webinar is to share what research tells us about self-harm and youth mental health and to explore the potential practical implications for children, young people and their families right now during the COVID-19 lockdown.

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Local guidance for working with Children and Young People at risk of self-harm

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Social media can be both a positive support and a negative influence. Platforms where young people can be bullied, feel pressured into an identity they think their peers want them to hold or be exposed to harmful content, which could lead to self harm and suicide.

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Molly Russell's Father Wants Social Media Companies To Take Responsibility For Harmful Content | GMB

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Results

An overview of participant demographics is presented in Table 1, showing that the data represents the views of a diversity of genders, ethnicities and age groups. We were also able to recruit both young people admitted informally and those on a section, alongside staff who were qualified nurses and those who were non-registered nursing assistants. Our carer group included both mothers and step-fathers. The analysis process resulted in the development of six key themes: Therapeutic relationships are the treatment, Cultivating connection, Knowledge is power, Being human, The dance, and It's tough for all of us in here. Fig 1 outlines the sub-theme structure and Fig 2 depicts the conceptual relationship between themes. The results section is structured at the thematic level, with detail from the sub-themes woven into the analytic narrative. Quotes are provided alongside ID number and participant grouping.

Theme one-Therapeutic Relationships are the Treatment: ' cos at the end of the day it's the relationship between the patient and nurse that really matters' (20, YP).

Therapeutic relationships are the main aspect of inpatient mental health care for young people and their families; they are not just the facilitators of other forms of care, they constitute the essence of the therapeutic milieu. However, they are not fully equivalent to other treatment; they are collaboratively built (not 'done to' or 'given to'), they require skilful development and maintenance, face unique barriers, and can have far-reaching impact on mental health and life experiences:

The function of therapeutic relationships is unique and commensurate with the needs of young people requiring hospital admission; 'people that are here usually really struggle with relationships and I don't think they know what a healthy relationship is' (19, Staff). All groups recognised the value and potential function of relationships and their variety and both their fragility and durability is also apparent, ' I feel like a lot of the times if you've built that connection it's not really gonna go ... it sort of creates a sense of normality' (12, YP).

Therapeutic relationships have to be maintained. They require personal qualities, understanding, team work and emotional support to sustain them, because ' starting something is different from managing' (9, Staff). The investment of time is key, conferring value and recognising worth, otherwise the opportunity can be missed:

When staff members are available, this confers value and care, it ' sends a message that you care enough to follow through, and if you're consistent, after a while I think they're gonna trust you, and that's when they'll start to talk to you a bit more, and you start to get the relationship' (19, Staff). This highlights the importance of reliability and consistency in YP feeling valued and cared for; essential for a trusting relationship. Participants felt managing the development of relationships cannot be based on a manual or protocol; ' I feel like if you're not prepared to treat people on an individual basis, based on kind of who they are, and sort of have a blanket rule, it will not work' (1, YP). Staff elaborated this, suggesting it requires skilful use of self; responsive and flexible interactions that are dynamic and unique to each pairing and patience, ' you don't know what they have gone through so don't force relationship' (9, Staff). Despite threats to this relationship, staff persist with developing it:

Even once initial trust built, the work is not done; therapeutic relationships face ruptures; there are times when young people might push relationships away and 'put a wall up against everybody' (2, Staff). Staff find themselves stuck with how to manage this while protecting the relationship-balancing the need to persist yet not intrude and eventually findings themselves exhausted and frustrated, which in turn can affect relationships and outcomes:

Judgements or perceived judgements can also pose a barrier to engagement, as young people fear that their behaviour might elicit bad feeling from staff, which in turn can damage trust. All groups recognised that this could happen after a single incident or moment; signifying fragility of the alliance and the need for dynamic, responsive and long term work in order to maintain relationships. Despite such relational challenges, participants felt there is always the potential to establish a therapeutic alliance, it just requires time and active effort by staff to foster a personal connection.

The alliance with staff is more than a task, it is a connection that can facilitate young people to be the best version of themselves; ' To then becoming more of the person that they want to be and sort of working things out themselves, moving forward and focusing on things and then deciding their own interests' (2, Staff). When the relationships do not work, it is not just a loss of these potential benefits, it can be fundamentally detrimental to hope; ' you're just like ah I'm back here, it's just the same old thing, why do I have to be here sort of thing' (20, YP). Effective relationships, in all their complexity and challenge, bring a deep emotional bond that can be lifesaving, giving ' you one more like reason to live and it would give it a bit more time so you think she's right, because she is going to be here for me, maybe she's telling the truth, maybe she will be' (17, YP).

Theme two-Cultivating connection: 'I think a relationship is about kind of having a connection' (4, Staff).

A mutual connection is part of the foundations of a therapeutic relationship, with important qualities and requisite ingredients. Although all parties input into this, staff have a crucial role to play in how they behave and approach work with young people and families:

Whilst staff have a crucial role in building this sense of connection, all parties are required to input; there is mutuality in its creation. This must be underpinned by shared respect and trust; ' there should be, that length of respect to anybody, as you know respect the next person as how you want to be respected' (14, Staff). If this is not present, it poses a considerable barrier to treatment outcomes; ' if you don't have mutual respect, then you don't get the trust, if you don't have the trust, then the therapy is pointless' (1, YP). Mutual trust facilitates connection via the revealing of inner experiences:

Carers further reiterate the importance and yet difficulty of trust across all parties; highlighting its fragility, with failings impeding relationship building and increasing the likelihood of ruptures, necessitating genuine honesty and transparency from all involved:

These more abstract relational ingredients that contribute to the connection are facilitated by activities that promote common interests, shared experience, casual and sometimes humorous conversation. Alongside staff members having the personal qualities to aid connection, they must also be given opportunity for this to occur, ' if you watch a movie with someone you have shared common interests, you make history together, something to discuss with' (9, Staff). Participants generally preferred such interaction to be more casual, as a more personal connection reduced young people's anxiety and encouraged more open and honest communication:

Whilst this casual context, and the wider cultivating of connection, was viewed as a joint endeavour, staff were highlighted as having a key role in fostering this, via actions, broad approaches and availability; ' You find something that they are interested in ... you sit down, you chat ... you find out how they like their tea, you take it to them, you smile, you just sort of find a way ... spending time in the communal areas, it's the little things' (5, Staff). This suggests early cultivating connection does not necessarily require formal discussion or structured sessions, but rather a relatively normalised situation whereby two people invest time in being present with one another, and express an interest in what each has to say. The nature of young people's difficulties may pose an initial barrier to this connection, although staff participants state this can be overcome by minimising the interaction further; ' I just want to be here, I want to see, I just want us to be together, no talk, nothing. So we both sit, nothing, and it works' (9, Staff). Such a technique mitigates the need for verbal communication, and associated anxiety, whilst allowing the clinician to demonstrate they care about the young person's welfare, want any interaction to be on the shared terms, and are available if needed. These positive features were valued across participant groups; ' he's not intrusive or anything like that; he just lets you flow you know what I mean and listens and guides a bit and he's very good' (7, Carer). Moreover, insight was gained as to why actions of normality were so well received:

Young people and carers value staff taking the initiative in building the connection:

Part of the staff role is also to be approachable, so that people can feel comfortable to raise concerns or initiate conversation if they feel able to; ' I thought if they're just approachable, I'd never come in and think I need to talk about that and I'm scared to say it, I do feel like if something is bothering me, they'll listen to me and you know it's not hard to say' (21, Carer). Being approachable is essential to cultivate a two-way connection, whereby all parties feel they have opportunity to contribute. This is augmented by all involved genuinely demonstrating interest in what is said, which is lacking when the young person is not acknowledged or given space to express; ' when it's not in-depth they're [staff] just like try and get out of it as quick as they can like oh yeah yeah I get it and all that, you know like skirt away, move on as quick as possible like they're not interested, you can tell when they do that' (23, YP). This can lead to considerable relationship ruptures; dissipating any feelings of being cared for, valued or listened to, and inhibit any benefits from a positive connection.

Theme three-Knowledge is power: ' you might say well that's [communication] overkill but actually this is our child, so nothing is overkill' (22, Carer).

Knowledge, understanding and information are important in the development of relationships. Recognising and sharing knowledge amongst staff, young people and families does more than communicate understanding; it recognises roles, reflecting and conferring mutual power and thus engendering meaningful collaboration. Where this does not work well, relationships can become strained. Participants agreed that it is important for all parties to develop an understanding of mental health generally; whether through personal and professional experiences or formal training:

I think having a good theoretical knowledge is always useful as well, for what might be going on for someone, cos you can kind of, I know you shouldn't second guess what's going on for them, but it does help to frame it and think about. (19, Staff)

Their experience with patients, and I guess the training they've done, as well as other factors, like their childhood and stuff like that, affects everyone ... they've learnt a broad range and then they cater to the one they're best with. (20, YP)

Such increased understanding can be applied to young people's care, as well as demonstrating that, at least on a theoretical level, staff understand the psychological difficulty young people are experiencing. This provides a foundation upon which to develop more person-specific knowledge. Gaining insight to people's unique story and the nature of inpatient care is deemed important across participant groups, in order to build a trusting and supportive relationship:

I think if you come onto the ward, you've got to spend quite a bit of time observing, getting to know that person, see how they are, have a look at them, watch them, understand what they do when they're not trying to show you what they do. (22, Carer)

Just learning by effect and cause like what that individual, what triggers them to be anxious, because they need to know that to work with them... they need to understand that and make an individual plan because not everyone is the same. (10, YP)

Whilst this individualised approach to knowledge generation can support person-centred treatment, staff members need to carefully balance their professional knowledge with that they can garner in the context of the unique relationship with each young person. There is a risk of invalidating young people's experiences and relationship rupture, especially if a dichotomy exists between the young person's and clinician's treatment strategy. This may be augmented if the young person does not fully understand, or is unable to communicate, their mental health difficulties and needs. In addition, staff's understanding of young people must also consider them and their family in their cultural context; ' there's an Asian girl on this ward, who understood about festivals, it's been nice, they understand' (18, Carer). If there is a lack of cultural understanding or acknowledgement by staff, it is likely to lead to a disconnect in the relationship, as the young person or carer feels devalued:

Moreover, knowledge is not static and needs to be shared and held in relationships as well as within clinicians, requiring a willingness for all parties to engage with one another to expand their mutual understanding. This creates a culture whereby professionals can share knowledge to provide support. However, carers experience blocks to this knowledge transfer:

Proactively using effective communication to distribute information is crucial and where this does not happen effectively, it can impact on relationships, experiences of the admission, and treatment outcomes. When knowledge is not shared in a transparent and accessible way, individuals are likely to feel disempowered; ' more transparency [is needed] instead of all these hidden laws, because they like to say that there's a lot going on behind closed doors' (20, YP). Transparency, coupled with being proactive is essential to ensure that family members feel valued and involved:

Carers also have considerable knowledge to share with staff, and if this is not appropriately acknowledged, it can be invalidating; likely placing a considerable strain on the relationship:

It is necessary for staff to build positive relationships with carers in order to value and share this knowledge, which in turn will further foster a positive relationship, so as to inform their individualised treatment strategy; 'just communicating it in a way that's positive and making sure that she understands and that she still feels safe and that the trust's still there' (3, Staff).

Theme four-Being Human: 'human support; they are listening to my breathing and I am listening to yours, and that is it' (9, Staff).

Alongside their roles in the system (staff, young person, carer), all parties bring their human selves to the relationship. It is crucial that individuals are treated as such, with their unique qualities, perceptions and needs. This is difficult for all and can have specific consequences for staff who face additional emotional challenges as a result of this authentic vulnerability, balancing this humanness with their nursing role, moving along the spectrum between the two as required:

Participants all recognised that young people are more than patients or even 'young people'; they are human beings with individual differences and needs. They bring with them prior experiences, expectations and qualities that need to be recognised and worked with in order to develop effective relationships; 'every child is different and every family is different, there's no handbook, it's the same with having kids, none of them are the same' (3, Staff). When this individuality is not recognised, it is experienced as painfully dismissive and rejecting, 'I'm just another number that just needs to get shipped out of here' (6, YP). Perhaps surprisingly, the inpatient environment can also be a space where young people are able to connect with their identity; 'to sort of just be themselves which they never really had an opportunity to do' (2, Staff). This may be due to the creation of a safe emotional space that encourages open communication, whereby mental health difficulties are destigmatised and young people no longer need to 'hide' this part of their self; allowing a freedom to fully be, and develop, themselves. In relation to this, young people and carers recognise that they have specific needs that others might not share and that might affect the relationship:

I'm one of these people I get attached to things and people way too easy, and I know it's not the case with everybody but I do. (17, YP)

[Son] is not a child that would go up to someone and say he needs help, he needs prompting all the time ... I have felt that some staff have just left him. (24, Carer)

Family members and carers are also human beings with individual differences and emotional needs; it is important these are recognised and supported in order to foster therapeutic relationships:

This encapsulates the emotional hardship parents can experience, providing clear evidence for the need for staff to provide support; especially considering the parent or carer is often the primary supportive figure to the young person, and thus an important protective factor. Young people too acknowledge that their parents are people in themselves who might need support from staff and welcome that; ' I'm grateful that the staff here have actually, they're giving support to her [mother] as well' (6, YP), emphasising the triumvirate nature of the relationship. In response, staff have to carefully assess and react to individual family member's needs, being attuned to their preferences. Participants felt such individual differences could be challenging, exacerbated by the different roles that members of the same family might occupy:

Such variation across and within families increases the potential for communication difficulties and associated distress, emphasising the need to ensure opportunities are provided to explore different family members' needs and perceptions. As healthcare professionals, it is staff who are best placed to not only facilitate this, but genuinely acknowledge and appropriately respond to such considerations.

Staff members are people too and have to bring their authentic 'human selves' to work in order to cultivate therapeutic relationships. They also face a unique challenge in having to balance this with occupying nursing roles and professionalism, balancing both dynamically; ' they can have a really good time with you, but they know that you're here for business and they know that you keep them safe' (3, Staff). This requires fluidly shifting between positions, depending on the circumstances:

However, staff member's humanness comes with vulnerability; an exposing of the self that fosters the relationship and can also, crucially, support young people to sit with their own vulnerability:

Acknowledging and projecting this humanness can model a more realistic sense of self to the young people, potentially lessening the disproportionate expectations they place on themselves, and the. Although, being human can be at odds with 'doing the job', when the job involves so many tasks:

Consequently, staff members have to step away from this professional role sometimes, which can reap benefits for the relationship; ' I would say they would need to be able to switch off from nurse mode at times' (12, YP). Talking to a 'human being' as opposed to a 'nurse' not only promotes better engagement and communication, but also develop the young person's sense of self:

If a young person is able to make this distinction, it is likely to have a profound effect on their perception of themselves, their future following discharge, their treatment and their recovery. As such, modelling, promoting and developing humanness is essential for positive recovery outcomes. Demonstrating vulnerability and expressing emotions is a way to show this; actions that young people highly valued. Aside from the therapeutic benefits such compassionate actions can have, they also allow staff to be seen as flawed, available and distinctly human:

However, staff cannot simply, 'be human' and bring their inner selves, they also have to balance this with professionalism, with an ability to bring distance from their inner world. Balancing this sense of human, open connection and formal nursing responsibilities was suggested by participants to be managed through the application of boundaried professional care:

This exemplifies how a staff member can effectively balance their personal humanness in cultivating a positive relationship, with the necessary authority to implement professional boundaries and provide containment. However, moving along this human-professional spectrum brings costs as well as benefits, as staff can experience impacts on their emotions, sense of self, exacerbated by the inpatient environment and acuity of young people's mental health presentations. These impacts can affect nursing staff in a way that may impede their ability to move towards the human end of the spectrum and apply their positive personality characteristics, '[staff] would be really stressed, and there is only so much you can be yourself when you're tired' (1, YP). Such outcomes inevitably lead to disengagement from the relationship, hindering potential benefits, and possibly exacerbating the emotional distress young people experience. Consequently, staff have to be able to let difficult emotions wash over them:

Here, the staff member describes how when boiling an egg in its shell if you remove it from the water, the surface dries immediately. Therefore, this idiom illustrates that staff need to let things wash over them quickly-be impervious to emotional distress. Another version might be 'like water off a duck's back'. In reality, this cannot always be possible, while also being vulnerable and human and open. Coping by cutting off is a short-term solution but comes with costs-the vulnerability, connection and care that young people and families value so much; ' I think it is something people struggle with... I think a lot of nurses manage by not letting themselves care too much, or be too involved' (19, Staff). This not only highlights the difficulty of balancing humanness and professionalism along a fluid spectrum, across countless interactions and circumstances, but also the potential danger of staff positioning themselves too firmly at the professional end in order to protect their own emotional wellbeing, when not offered any alternative support to manage this emotional pain.

Theme five-The Dance: ' you're almost just taking that hat off and putting another one on' (19, Staff).

Therapeutic relationships in inpatient CAMHS are like a dance. They involve multiple protagonists, with different positions, moving with fluidity across space and time. Young people, carers and staff have to occupy different positions and roles over the course of the admission, playing different parts and coming together or moving apart. Staff members have to be particularly flexible in order to facilitate this and, alongside the human-staff spectrum noted above, have to shift in other ways. Roles and positions come with responsibility and power and although we might seek equal collaboration among all groups, there needs to be flexibility in this over the course of the admission.

Being part of the relationship- having a position in that-helps people feel involved and yet is also taxing. Staff members seek to acknowledge young people and family members in a way that recognises their position and humanness. Carers value staff taking on some of their role for a while:

Whilst this brief 'respite' is well received, not just for carers emotional wellbeing, but to pause and review the system that may influence a young person's mental health, there is also a concern of staff taking on too much responsibility and negatively impacting young people's sense of agency:

This taking on of responsibility can exacerbate the emotional burden that staff experience. In addition, there's a fear that it could render young people overly reliant on others, at risk of becoming deskilled or disempowered and limiting the normative adolescent development towards independence. Staff members have to navigate these complexities, balancing the need for care and independence, for safety and empowerment. These concerns are not confined to staff and parents, but young people similarly want agency in the interactions and decision making, although this can contrast to the inpatient setting whereby 'y ou've got no control over what's happening. You can't change anything that's happening... No, you just have to sit there and let everything happen... [its] not nice cos' you wanna' be in control' (8, YP). Whilst this likely negatively impacts ownership over their recovery and prompts disengagement, participants equally stated they value staff that recognise their position and share power in the relationship; ' you're not pushed to do anything, you're encouraged ... there's no obligation or anything like that, it's very much on your terms' (1, YP). Empowering young people in this way helps them have confidence in their own abilities establishes a safe culture of growth, with a supportive structure, that allows young people to develop their skills at their own pace.

The triumvirate nature of the relationship requires particular recognition, responsiveness and flex, with a need for staff to occupy some of a parental position, without undermining their role; ' you're guarding them aren't you really... but it's not a triangle' (16, Carer). Such positioning can be challenging for parents, who as the party not based on the ward, may already feel the triangle is unequal and their position threatened. Young people were also aware of this; ' when I've had problems in the past she'll [mother] just say oh well they think they know what they're doing so you need to rely on them and I'm not sure if she feels like she's getting edged out, by their input' (6, YP). This places considerable onus on staff members to provide opportunities for involvement flexibly, which doesn't always happen:

This highlights how everyone is involved in the dance, but it is nursing staff who must proactively take the lead and apply professional skills to establish a therapeutic framework that can develop the skills of the other parties so that they may have a greater role.

During the course of an admission, there is a need for flexibility and movement between and roles, as needs arise and skills are developed. Staff have to be responsive to the movements of others and the emotional tone in the context; ' You could come in one day and it's a really nice sort of day, the young people are all getting on with their own things. But you could come in two days later and every patient is sort of struggling with different things' (2, Staff). Such fluctuation creates a sense that staff have to flex to the moment-to-moment needs of young people, which they too acknowledge:

This exemplifies how mental health difficulties, coupled with difficulties forming positive relational connections, can prevent young people from both eliciting and accepting support, despite having awareness that it will be beneficial. Considering this and the need for flexibility, staff must maintain a sense of continuity; keeping the rhythm of the dance even though the steps might change:

Working in this way not only responds to the variation of young people's care needs, but also continually reassures them support is available whenever they feel ready to accept it. However, staff acknowledge how this shifting and changing of roles can be difficult for young people and challenging for the relationship, despite its necessity:

The need for responsiveness can be particularly apparent when approaching discharge; when the relationships with the ward are ending, fostering autonomy and connections with community. Staff recognise the anxiety that this period brings for young people; ' once they start looking at discharge, they think well how am I gonna make it on the outside, who am I gonna have, am I gonna have these people, am I still gonna be friends with the peers that are on the ward with' (15, Staff). Also, young people see how their relational journeys have only just begun when they leave the ward:

Such concerns highlight the importance of staff developing the skills of other parties in 'the dance', so that it can continue without them post-discharge. This is especially true for carers, who play a vital role; ' you kind of got to be doing it together haven't you, because your gonna live with them, your gonna take them home aren't you' (16, Carer). If they are not equipped to manage this, it could bring future mental health deterioration and re-admission.

Theme six-It's tough for all of us in here: ' there's never too long without some sort of kerfuffle' (12, YP).

Inpatient CAMHS units-the systems in which these relationships exist-are challenging to be in for young people, family members and staff. This challenge is somewhat-though not fully-shared and mutually recognised. Managing these challenges necessitates both individual and systemic solutions.

Young people are often bored, there are arguments and disagreements; staff take time to manage this and this in turn can detract from building relationships, further impacting ward atmosphere:

Such difficult circumstances may lead to increased isolation and hinder positive connections, coupled with ward procedures that can take time away from focusing on the relationships; 'it's the relationship between the patient and nurse that really matter, not what's behind an office, cos you have a lot of paperwork to do, so maybe letting time to have a break from the paperwork, that could help build relationships' (20, YP). S taffing levels impact the basic provision of opportunities to cultivate connections and build relationships. These systemic concerns may create a sense that staff do not have time for young people, fostering feelings of invalidation and impacting trust and connection.

Some of these systemic challenges are mutually recognised by young people, staff and family members. Staff members recognise that inpatient environments are not welcoming; ' it could be the first time ever away from their mum and dad or their carers, their first maybe ever away from home, their brothers and sisters. And it's a place they've never been before, people they've never met and quite sometimes a loud noise environment' (2, Staff). Also that the nature of the admission can make it difficult for them to build up relationships; 'there is a pressure of time, because they're not going to be here forever, and if that's hard for us, then it's going to be super hard for them' (5, Staff).

Young people see the emotional toll that the environment takes on staff; ' Staff have been in tears because people aren't making their jobs very easy. I know some staff having to take days off because it's just too much working here' (12, YP), and, in turn, feel the impact themselves; ' when things are difficult on the ward it really sort of shows in the staff as much as they try and hide it ...we're not a stupid group of kids' (12, YP). Carers also see the strain; ' we understand that's not always [easy], you've got alarms going off, we're not daft you know, we know' (16, Carer). The emotional toll of the job can act as a barrier to staff members moving towards the 'human' end of the human-staff spectrum and thus hinder the benefits this can provide. This potential shortcoming is recognised by family members who value nursing staff and their skills in particular, yet acknowledge how the systems they are part of can impede the core of their professional remit and cast a shadow on their values:

Although many of the challenges of inpatient wards are shared, some staff members experience racism, and feel alone with this; ' Could be just racist, it boils down to that I would think and I mean a lot of agency staff come here, they are black, so there is always that stigma between you know agency staff so I dunno' (14, Staff). In addition, staff who identify as black or mixed race experience a disconnect from some young people and struggle to make sense of its origins:

These staff members draw on personal resources to help manage this particular challenge and work towards an alliance; 'my ethnicity plays along with trust like I felt even when I want to establish a relationship they draw back because of my ethnicity ... so to build that relationship takes extra like strength or extra input from me before the trust can be established' (9, Staff). However they need specific support from the system that is currently lacking:

Staff members rely heavily on one another for support, in the face of systemic challenges:

Whilst this can provide a robust support network that can allow good clinical practice to become further embedded within teams, if staff are under increased pressure and at higher risk of burnout, this may also become embedded. Similarly, when it's not accessible, wanted or effective from staff members, young people and carers have to seek support from their peers, in order to manage the system; ' sometimes we don't find it easy to talk to staff and find it easier to talk to each other, and I know we all have our own problems but honestly, sometimes talking to each other is what helps more than anything, cos we understand each other' (17, YP). This can help foster a sense of togetherness and understanding; 'I met one of the other patient's mums ... and I've since developed this friendship with her and that's been really helpful because you have somebody to talk to about the same experiences and how you've felt' (13, Carer). Finally, sometimes, sharing a laugh is the best medicine, for the predicament all find themselves in; ' I feel like humour is a lot of people's way of escaping that' (1, YP).

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Therapeutic relationships within child and adolescent mental health inpatient services: A qualitative exploration of the experiences of young people, family members and nursing staff

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Child and adolescent mental health services (CAMHS), especially inpatient units, have arguably never been more in demand and yet more in need of reform. Progress in psychotherapy and more broadly in mental health care is strongly predicted by the therapeutic relationship between professional and service user.

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Young people can be signposted to resources like this. Free online support for 11-19year olds experiencing self harm

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"Since starting alumina it's become the highlight of my week. It's such a safe, non judgemental place which has really helped me in my recovery."

Max

"If you're thinking about joining I'd say go for it, the team are lovely and everyone who does it is so welcoming and supportive"

Abi

Alumina is a free, online 7 week course for young people struggling with self-harm. Each course has up to 14 young people, all accessing the sessions from their own phones, tablets or laptops across the UK. The courses take place on different evenings of the week and are run by friendly, trained counsellors and volunteer youth workers. You don't need an adult to refer you or sign you up, and no-one will see or hear you during the sessions - you'll just join in via the chatbox. We want to help you to find your next steps towards recovery, wherever you are on your journey.

IS ALUMINA RIGHT FOR ME?

Are you...

10-17 years old?

Living in the UK?

Someone who self-harms or worries they might?

Looking for support but not wanting to do it face to face?

Wanting to move towards a life free from self-harm?

If so...

Alumina could be a helpful step forward. If you sign up we'll begin a conversation over email to work out if it might be a good fit - and you can ask us any questions you have. The only rule we have in Alumina is that we don't talk about suicide in the groups. If that's something you are struggling with thinking about we recommend getting in touch with our friends at Papyrus who are better equipped to support you.

"I thought it would be all serious and uncomfortable because of the self-harm talk but actually, the staff have made me laugh, we've been given a space that feels relevant to our ages and most importantly we can turn up in any mood and they'll be there for us." Runa

What's a session like?

"Clicking on the link for the first time was nerve wracking and intense with lots of thoughts going through my head. But within only a few minutes of the session I had a smile on my face and felt comfortable with the staff and the group."

Sasha

"Alumina was quite different to what I expected, I thought it would just be an intense 6 weeks and it would be over like other services. But it was nothing like that - instead I felt and still feel very supported by the staff. The group and staff are like a big family who's always there for me."

Samara

"Clicking that link for the very first time was terrifying. But I knew it could be life-changing. The first session I felt welcome, I no longer felt like an outsider. It's fun, believe me!! Most days I find myself looking forward to the next session because Alumina gives me a sign of hope."

Dan

Questions

We aren't a crisis service so if you're in need of immediate support please contact one of the following:

The Mix: Offering essential support for anyone aged 12-25. For their crisis messenger support service text THEMIX to 85258.
Childline: Support for anyone up to age 18. Call, chat online or email their crisis service.
Samaritans: Call 116123 anytime if you need to talk to someone.

We've changed the shape of our support for young people. This website introduces Alumina, our online support groups for young people struggling with self-harm. We've also recently launched beheadstrong.uk offering young people all kinds of information, stories and videos about looking after your mental and emotional wellbeing. You can find links to some of selfharm.co.uk's most popular articles below.

Yes we have! We have worked with 14-19 year olds for many years but we have always heard from people who are younger (or those who care about them) asking if we do anything for younger people. Then from September 2022 we reduced our age range to 11, and found how important it was to support this age range and that our Early Intervention project was great for this age range. Therefore, from October 2023 we will be aiming our work at young people in secondary school or college (or equivalent) and those transitioning to secondary school and our age range has reduced to 10-17 years old. If you're under 13 we will need to get permission from someone with parental responsibility for you, and we will email them to explain how Alumina works and make sure they are happy with you joining a group.

We aim to group similar aged young people into groups together, so 10-13-year-olds will be offered groups together and 13-17 year olds will be in other groups together. We are happy to work with anyone until the end of their full-time education, therefore we will work with 17- and 18-year-olds so long as they are three months or more away from finishing their education at the end of August.

Meet the team

Live Webinars

We have recently started to do live webinars on YouTube on issues related to self-harm and emotional wellbeing

Supporting Young People Who Self-harm

If you're a parent, professional or friend supporting a young person who's self-harming, we recommend taking an hour to watch this webinar with our Alumina Managers. They explore why people self-harm, why young people especially self-harm, why it becomes addictive, how to break the addiction cycle, and what young people wish the adults around them understood about self-harm.

"Alumina is a well thought through support service for young people; it is professional, caring and accessible to all. Signposting a young person to Alumina will help them begin their recovery journey."

DR. KATE MIDDLETON

Our Alumina advisory panel

More information about self-harm

We've moved some of our most popular articles about self-harm over to beheadstrong.uk, and you can use these links to find them:

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Free online Self-harm support for 10-17 year olds

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"Since starting alumina it's become the highlight of my week. It's such a safe, non judgemental place which has really helped me in my recovery." Max "If you're thinking about joining I'd say go for it, the team are lovely and everyone who does it is so welcoming and supportive" Abi Alumina is a free, online 7 week course for young people struggling with self-harm.

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Useful guide developed by researchers and clinicians from Oxford University