Concerns about Self-Harm

Considerations when Supporting Youth

• Find a private spot to have a conversation with the youth.
• Stay calm – this is your superpower. 
• Through conversation, explore and determine how severe self-harm behaviors have been in the past and are in the present. Exploring risk of severity includes identifying if the youth has a current plan for self-harm, intent to act on the plan, and resources to implement the plan. 
• Generally, a youth who has a plan, intent, and resources would be considered high risk and should receive immediate intervention.
• If you are concerned about immediate risk for self-harm, you may need to call 9-1-1, go to your local emergency department, or contact Mobile Crisis (608)
  784-4357. 
• This scenario may include a youth who is actively engaging in self-harm behaviors or has an immediate plan to engage in self-harm behaviors as well as access to means. 
• If there is concern about immediate risk, do not leave the youth alone and if possible remove access to harmful items.
• If you are NOT concerned about immediate risk, it may be appropriate for you to continue a conversation with the youth about their experience of self-harm. 
• During this conversation, it would be important to monitor your own emotions and be mindful of any thoughts/biases you may have related to self-harm behaviors.

• Self-harm behaviors are typically utilized by youth who are attempting to cope with distress but may not have other more effective means of coping at the time.
• It may be helpful to explore with the youth what the self-harm behavior provides for them as well as what stressors they may be attempting to cope with.
• It may be appropriate to develop a safety plan with the youth. Safety planning may include:
• Determining supports the youth have in place, identifying when they would need to reach out to the supports, and expanding supports as needed (such as contacting a school counselor for additional support or safety planning).
• Exploring who is aware of the self-harm behavior and who should be notified about this behavior.
• Removing access to sharp or dangerous items when possible and as appropriate
• Collaborating with caregivers, parents, or guardians.
• Provide reassurance to the youth by letting them know you are there for them and your priority is keeping them safe. 
• Make sure the youth is supervised at all times, check in with them about how they are feeling, and finally, implement the agreed upon safety plan.

Connect with Supports

• There are several different ways to seek counseling or treatment. This includes a private therapist, a school counselor, mental health center services, and/or substance abuse treatment. Private therapists can be a licensed clinical social worker (LCSW), a licensed professional counselor (LPC), or a psychologist. This is usually covered by insurance and may occur weekly or every other week depending on treatment needs. Therapy is individualized and collaborative. A therapist may offer more frequent sessions if needed or may recommend a higher level of care as needed.
• Youth may also be able to receive counseling at school. This may be in the form of a school counselor who is accessible to all youth. The school counselor can give you more information about services available in the school.
• The School District of La Crosse also has a Student Family Assistance Program which offers short-term solution-focused interventions to support student mental health. If you are interested in this program, reach out to your school counselor. 
• Youth in crisis may need more intensive support than outpatient therapy or school counseling. 

Resources

• Resources may involve supports indicated above or other levels of informal support which may be identified on the youth’s safety plan. 
• If there is concern of imminent risk and safety planning is not appropriate, you may need to explore additional levels of support.
• If possible, it is most effective to approach this decision involving additional levels of support and intervention from a team-based approach. 
• When you are able, involve school counselors, parents/caregivers, or other adults in this process while still respecting the youth’s privacy and confidentiality.

• Action steps if youth indicates they have a plan to engage in self-harm:

• If there is immediate, imminent risk call 9-1-1 or take the youth to the local Emergency Department.
• Work collaboratively with the youth to identify who else should/could be notified (parents, guardians, caregivers, support individuals) and establish a short-term safety plan.
• If the youth is seeking treatment or immediate mental health support, has a plan and intent to self-harm, take them to the local Emergency Department.
• If the youth is NOT open to engaging in treatment or safety planning but you have safety concerns, contact 608-784-HELP (608-784-4357) if you are in La Crosse County and request a mental health assessment from the Mobile Crisis team.
• The crisis responder will complete their assessment and make recommendations for crisis stabilization. The hope is to serve youth in the least restrictive environment that will support their mental health needs. 

Utilizing the Emergency Department

• Depending on the situation and action steps from above, you may identify that it is important to take the youth to the local emergency department for an assessment
• Take the youth to the Emergency Department if you feel it is safe for you to transport them.
• If it is not safe to transport, you may need to access emergency services such as law enforcement or use of an ambulance. 
• If there is a concern of overdose, contact 9-1-1 immediately.
• A parent/guardian must be present through the intake/admission process while at the emergency department. 
• Youth can be evaluated in the Emergency Department for mental health concerns and possible placement in the hospital. They can arrive with parents, or with the support of law enforcement and/or other professionals. 
• Youth must go through the process of medical screening, which can take several hours. They will be evaluated by a physician and mental health professional, often a social worker, while in the emergency department.
• If it is determined that hospitalization is appropriate, the social worker will work to facilitate this placement.
• If the youth is agreeable and parents/guardians are agreeable, they will work with the social worker to begin the hospitalization and inpatient treatment.
• If the youth and/or parents/guardians are not agreeable, the youth would need to be evaluated by a crisis responder through La Crosse County to determine appropriateness for involuntary hospitalization. 
• In the case of involuntary hospitalization, law enforcement typically works collaboratively with the crisis responder and hospital staff.
• After the involuntary hold is initiated, law enforcement and the crisis responder do not stay through the process of finding a placement. The hospital social worker works to coordinate treatment and care. 
• If the youth does not need a hospital placement, Emergency Department staff will explore other options with the family. This may include shelter care, partial hospitalization, a safety plan, and information for follow up services.
• Under some circumstances, parents may decide against the recommendation to hospitalize their child. This is a parent’s right, and other community-based options are available. It is important to know that not following this recommendation may result in a report to Child Protective Services from the mental health or medical provider.

• At our local inpatient adolescent unit, the age limit for hospitalization is 13 years old. Youth who are younger and need hospitalization are transferred to another hospital outside of our community to receive treatment and support.

Call 9-1-1

• Call 9-1-1 if you are concerned about serious harm and need medical assistance or support from law enforcement or emergency services in getting youth to Emergency Department.
• When calling 9-1-1, be ready to give the dispatcher your name, phone number, current location/address, date of birth, people involved, a description of the situation, and what kind of help you need. It may be helpful to inform the dispatcher of the youth’s mental health concerns so that the responding law enforcement officer is aware.
• There are several possible responses by law enforcement. Law enforcement may provide support to stabilize, transport youth to the Emergency Department for evaluation, and/or place a youth in detention.
• Once law enforcement arrives, the outcome is up to their discretion. However, in our community law enforcement typically works collaboratively with Mobile Crisis in order to ensure appropriate assessment and support.

What Else Can I Do?

If you would like assistance getting help for yourself or you would like to refer your child, student or friend for professional services, reach out to your school student services offices for additional support and information.

Community Resource

Great Rivers 211

Great Rivers 2-1-1 offers free, confidential community information and referrals 24 hours/day. Dial 2-1-1 or (800) 362-8255 to talk to an information and referral specialist.