Introduction to this Emerging Minds funded project by Lead Researcher, Dr Faith Martin, Coventry University:
Self-harm amongst children and young people is increasing. This requires intervention not only to reduce the distress associated with it, but also to reduce onward risk of suicidal behaviour. Services beyond the NHS are needed.
Relationship with parents, including poor parental support, and use of discipline and control, predict self-harm; however open communication, and validation are protective. Parents are then crucial to reducing prevalence of self-harm. Parents may respond to self-harm by reducing communication owing to worries about what to say, and by increasing controlling and monitoring. This may perpetuate self-harm. Parents describe needing information and parenting techniques.
Parents also require support for their own wellbeing. Sadness, guilt, shock, self-blame, anger, frustration, and isolation have all been reported. Self-management and social support are needed for parents.
Despite significant distress and potential relationship between parental response and young person’s self-harm, currently, there are no recommended standards of care for parents/caregivers of young people who self-harm. Intervention is needed with the intended outcomes to a) improve parents’ understanding of self-harm, b) provide parents with strategies to help support their child, and c) support parents’ own wellbeing. Subsequent research could examine the effect of this intervention on children’s self-harm.
Our intervention will be readily accessible, online, outside of the NHS, aiming to provide information on management of self-harm, interactions with their child, and to reduce parental psychological distress. Our study supports parents, enacting the narrative of integrated care. Subsequent work would explore the impact of better supported parents on the children’s mental health and self-harm. Additionally, parental knowledge predicts whether children receive treatment, a further potential outcome.
Findings will be shared with research participants and shared by our project partners with their service users. Lay summaries will be made available on a project website, with videos illustrating the findings (made with support of UWE media students). With support from UWE’s Communication team, we will press release key findings and seek exposure on local and national radio on key dates such as World Mental Health day. Dr Martin and Karen Lascelles will lead engagement using existing contacts and building new ones, with self-harm and children’s mental health academic networks, groups such as Bristol Health Partners, CCGS, STPS, and other non-statutory groups addressing young people’s mental health. Outputs include our intervention.
Significant progress will be made to address support for family members of young people with mental health problems, here specifically those who self-harm, through the creation of an intervention. The intervention will be accessible outside of the NHS, with broad reach. Subsequent work will be needed to create wider implementation, advertising the intervention through a range of existing agencies and channels to allow parents to find it. Recommendations for parents’ support will be provided, going beyond the needs addressed by the intervention, acknowledging and outlining what other support may be required. Further, we will collect data on the characteristics of the parents who take part, to ensure that we understand who the intervention may not be reaching, highlighting future projects to engage with diverse groups.
We aim to develop the research by applying for further funding to test the intervention, likely NIHR Research for Patient Benefit. The involvement of H4C as the technical partner adds sustainability. This Community Interest Company has been running successfully for around five years and already provides online interventions, at minimal cost in a sustainable fashion to other groups, such as Macmillan Cancer Support.
Following the project, Dr Faith Martin shared with us some of key messages which the research revealed.
We did a review of the existing published studies that look at the impact of self-harm in young people on their parents/carers. We also included interventions to support parents/carers. This has revealed the significant impact on parents/carers.
Lack of understanding about self-harm and knowledge about what to do to support their young person contribute to parents/carers distress. This is partly due to lack of confidence and fears of failing their child. This may be made worse by lack of professional support.
Practical needs to spend time looking after their child can contribute to lower self-care. Together, these aspects can combine to make parents/carers feel anxious, stressed, or depressed. This helps us to understand areas that an intervention needs to target.
Our co-design work to develop a digital intervention for parents/carers of young people who self-harm highlighted the need to include three broad elements 1) information about self-harm and why it happens, 2) exploration of parenting responses and ideas about supporting the young person, 3) support and techniques for parents/carers to manage their own wellbeing. Our study highlighted the challenges of recruiting parents/carers to a study that focuses on their outcomes.
It is important for parents/carers to feel able to address their own wellbeing, which they may not owing to concern for their child and a sense of guilt. Our results also showed that a flexible resource that parents/carers can access any part of at any time is preferred to a more structured approach.