School nurses stand on the frontlines of a growing mental health crisis among adolescents: self-harm. Far from being a cry for attention, self-injury is often a coping mechanism—an attempt to manage overwhelming emotional pain through physical means. By getting equipped with the knowledge and tools to address self-harm effectively, school nurses and other school health professionals can create non-threatening school environments and offer appropriate care and support, helping to decrease stigma and make a significant impact on the mental health and well-being of their students.
Defining Self-Harm
Self-harm, also referred to simply as “cutting” or, more generally, as non-suicidal self-injury, or NSSI, is defined as the act of deliberately causing harm to oneself, typically without suicidal intent, in order to reduce psychological distress. It can manifest in various ways, including cutting, scratching, burning, hitting, or head-banging. While not usually an attempt at suicide, self-harm is a clear indication of a troubled student and can be a risk factor for future suicide attempts if underlying emotional needs are left untreated.
Understanding the Impact
Over the past 15 years, data has revealed a notable rise in non-suicidal self-injury (NSSI) among adolescents, with around 17% indicating that they have attempted self-harm at least once. These behaviors typically occur around 13, reaching their highest prevalence by approximately 16 years old. Although many adolescents experience self-harm as an isolated or rare occurrence, those who engage in more frequent episodes face significant long-term risks, including an increased risk of suicidal ideation and attempts.
Identifying Students at Risk
Identifying early signs of self-harm is crucial for providing timely support and intervention. School nurses are uniquely positioned to leverage their exceptional assessment skills to notice subtle yet critical indicators. They are often the first to observe physical signs such as unexplained cuts, bruises, or burns during routine health screenings or when addressing minor injuries. These physical indicators, along with behavioral changes like mood swings, social withdrawal, or wearing inappropriate clothing (such as long sleeves in warm weather) to conceal injuries, can signal a student in distress. With their clinical expertise and ability to build trust, school nurses are well-equipped to recognize these warning signs and facilitate early intervention.
Establishing School Supports
The establishment of comprehensive school-wide supports equips all students and staff with the necessary knowledge and skills to recognize warning signs, provide assistance to individuals in need, and understand the available resources to turn to for further care. In collaboration with school administrators, counselors, and other appropriate staff, school nurses can work to advocate for and implement a clear protocol for addressing self-harm. Additionally, incorporating mental health awareness campaigns and programs into the school curriculum can help cultivate an open, empathetic, and supportive school environment where students feel safe seeking help and empowered to support each other.
