• Health

Suicide and self-harm

Suicide is a serious concern in Namibia, but schools are often ill-equipped to deal with suicidal learners, as well as with those struggling with poor mental health or thoughts of suicide or self-harm. When learners are struggling with depression and suicidal thoughts, changes in their behaviour can usually be detected, which facilitates early intervention.

The National Safe Schools Framework (NSSF) is a dimension of the Integrated School Health Programme. The programme focuses on promoting the health, safety and well-being of learners and other school stakeholders in Namibia, and was developed to provide practical guidance to schools and stakeholders on how to systematically improve the standards of school safety and to develop a culture of care in any school. One of the key areas of focus is suicide and self-harm amongst learners in schools.

Common signs of distress are detailed below.

Assessing learners at risk of suicide and self-harm

The mnemonic device ‘IS PATH WARM’ helps to assess risk. Each letter corresponds to a behaviour frequently experienced or reported within the few months prior to suicide or self-harm.

Ideation:

Does the learner speak about suicide, threaten to kill him/herself or express a wish to be dead?

Substance Abuse: Is the learner using, or increasing the use of, alcohol and/or drugs?

Purposelessness: Does the learner feel like there is no point to life, or that they have no purpose for being here or have no reason to live?

Anger: Does the learner have problems with uncontrollable anger? Is s/he lashing out?

Trapped: Does the learner feel trapped, seeing no way out of his/her current circumstances or state of mind?

Hopelessness: Does the learner have an excessively pessimistic view of themselves, others and the future?

Withdrawal: Does the learner voice a desire to withdraw from family, friends and society? Has he/she already begun withdrawing from school and/or social activities?

Anxiety: Does the learner feel anxious, agitated or unable to sleep, or express a desire to sleep all the time? Either can suggest increased risk of suicide or self-harm.

Recklessness: Is the learner acting recklessly or engaging in risky activities that are out of character, without considering potential consequences?

Mood Change: Does the learner struggle with dramatic mood changes?

Self-harm

Self-harm is any behaviour where the intention is to deliberately cause self-harm. Self-harm can be triggered by particular stresses and resolves fairly quickly, or it may be part of a longer-term pattern of behaviour that is associated with more serious emotional/mental health difficulty. Learners who self-harm often have the same risks factors as learners who are at risk of suicide. Self-harming may also escalate to the point of suicidal thoughts or attempts.

Examples of self-harming behaviour:

Cutting

Taking an overdose of tablets

Swallowing hazardous materials or substances

Burning (either physically or chemically)

Over/under-medicating (e.g. misuse of paracetamol or prescription medication)

Punching / hitting / bruising

Hair pulling / skin picking / head banging

High-risk behaviour, such as running in front of cars

Episodes of alcohol/drug abuse

Over/under-eating, which can at times be an act of deliberate self-harm.

There may be a change in the young person’s behaviour which is associated with self-harm or serious emotional difficulties:

Changes in eating/sleeping habits

Regular cuts and bruises, or a large number of scars

Learner has paraphernalia associated with cutting or burning, such as razor blades, lighters or chemicals

Attempts to hide the signs of self-harm, such as wearing long-sleeved clothes even in hot weather

Increased isolation from friends/family

Changes in activity and mood (e.g. more or less irritable or aggressive than usual)

Lowering of academic grades

Talking about self-harming or committing suicide

Abusing drugs or alcohol

Having an unfeasible excuse for injuries

Becoming socially withdrawn

Expressing feelings of failure, uselessness or loss of hope

What can schools do to address self-harm?

Implement the activities to build positive and collaborative practices (section 4 of this document), since the best prevention method is having a supportive environment in the school which is focused on building self-esteem and encouraging healthy peer relationships.

Educate school staff on self-harm, the causes and the warning signs.

Address emotional wellbeing, promoting coping strategies as part of the Life Skills curriculum.

Have crisis telephone numbers available and easily accessible.

It is important that all attempts of suicide or deliberate self-harm are taken seriously.

Assess for suicidal risk by asking the learner what they hoped would happen as a result of their self-harm and how they feel now.

Encourage the learner to speak to someone whom they trust, who listens properly and does

not judge.

Help the learner to identify solutions to issues that might be causing them stress.

Offer information about support agencies.

If you assess that the learner is at risk, refer them for medical or psychosocial help.