Steven Walker is Head of Child and Adolescent Mental Health at Anglia Ruskin University, UK. He is a registered social worker and psychotherapist and has worked in social care for over 30 years, specialising in child protection and child and adolescent mental health.

In this frank interview, Steven discusses the growing problem of self-harm amongst young people; how stereotypes and the current cuts in social care spending are affecting professionals’ ability to tackle this problem; and how his new book, Responding to Self-Harm in Children and Adolescents: A Professional’s Guide to Identification, Intervention and Support, can help.

You have written many popular books relating to child and adolescent mental health, including The Social Worker’s Guide to Child and Adolescent Mental Health. Where you find inspiration and motivation to write?

My own teenage years were not always happy times and I have dedicated most of my professional life to helping and supporting young people with emotional or mental health difficulties. Fortunately, I enjoy research and writing so I can share my ideas, knowledge and skills with staff who want to make a positive difference to the well-being of young people, who are so often misunderstood and demonised by adult society. There is still considerable prejudice against young people and so little help and support that I don’t find it difficult to get motivated or inspired to carry on doing what I do. Young people are our future, adults have created the world in which they witness huge inequality and injustice, so we owe it to them to provide whatever support they need to cope.

Can you tell us a bit about your background, and how this new book came about?

I’ve worked and taught in child and adolescent mental health for about 20 years. I came across mental health problems in young people in my first social work job in Tower Hamlets in 1985. It’s in every aspect of social work in one form or another but it gets labelled as youth crime, school problems, anti-social behaviour and binge drinking. I was inspired by The Maudsley Hospital Children’s Department where I was placed as a student social worker during my training. Young Minds is another source of inspiration –  they do a lot with precious little resources to champion young people’s mental health.

I feel that the problem of self-harm and suicide are still difficult areas in which to work, and very stigmatising for young people and their families who are affected. I hope the book is accessible to a range of people who will find crucial advice on how to identify, assess, manage, treat and support the recovery of young people who are sufffering. Probably the most important thing readers will hopefully take away from the book is a sense of optimism, demystification of self-harm and suicide, and practical guidance.

It is often claimed that there is a shortage of training for health and social care workers in relation to self-harm. Do you agree and, if so, why do you think this is?

Lack of in-depth training is one issue that prevents staff from being able to understand, manage and support a young person who self-harms or exhibits suicidal behaviour. The two issues are not the same and this is partly why there is confusion among professional staff, and why families are reluctant to involve health and social care services. Recent cuts to Child and Adolescent Mental Health Services (CAMHS) services in terms of staff and range of support will make this situation worse. There is no national training for staff who are likely to come across a young person who self-harms, such as teachers, social workers and those working in Youth Services or places which are accessible to young people seeking help outside statutory Health and Social Care systems. Young people’s mental health and emotional well-being has never been a priority for any government, but currently training budget cuts are reducing even further the chances for staff to improve knowledge and skills in this area.

It is reported that self-harm is a growing problem in children and young people. Why this might be?

The problem with self-harm and suicidal behaviour is that it is easily hidden, carries considerable stigma and is misunderstood by many professional staff. Evidence suggests that it is increasing as a generation of young people are exposed to a harsh economic and social climate, competition for higher education and skills training, and increases in poverty, unemployment and parents under considerable stress. Young people find ways of coping in these circumstances and self-harm is a strategy many are using to cope with feelings of anger, despair and hopelessness.

Are there certain social profiles of children and young people who are most at risk of self-harm?

There is no typical profile of a young person who self-harms; each individual person has a unique history of development, resilience, family dynamics, vulnerability and socio-economic factors which together can – with a significant trigger such as a bereavement, parental divorce, or sexual abuse – create the conditions for self-harm to begin.

What are the most common misunderstandings between young people who self-harm and the professionals who work with them?

Nurses who encounter self-harm in emergency units can sometimes respond in a way that comes across as punitive, unsympathetic and judgmental. This is very unhelpful to a young person in crisis. It’s because they see self-harm or suicide attempts as self-inflicted injury, whereas their training is mostly about disease, biology and surgery. They are not properly trained or supported by managers in this area and they are always overstretched, so when someone with self-injury requires help they feel angry. This attitude harms the young person, hinders their recovery and prevents the young person seeking support to stop self-harming in future because they fear such punitive/ignorant attitudes. These attitudes are not restricted to Nurses but felt by others working in Health, Social Care, Criminal Justice, and Education contexts. Any person encountering a self-harming young person needs to show concern, care, and compassion and this book will help them start by understanding the problem and what actually helps.

You are Lecturer in Child and Adolescent Mental Health at Anglia Ruskin University. Can you tell us about your role, and the course that you run? What are you working on now?

I designed, developed and delivered one of the very few CAMHS training courses for multi-disciplinary students in the UK from Health, Social Work and Education contexts, whose employers recognised the need for specialist training in this area. The course won a prestigious National Training Accolade in 2004 for ‘most innovative multi-disciplinary training’ and was approved as a post-qualifying award by the General Social Care Council. The innovation was the multi-professional nature of the student intake. We recruited Psychologists, Psychiatrists, GP’s, Social Workers, School Nurses, Health Visitors, Teaching Assistants, Housing Department staff, Youth Workers, CAMHS and Youth Offending Team staff.

Government cuts have dealt a blow to the course, which is no longer viable due to low numbers of students sponsored by their employers. I’ve just completed a major research project on Cyber-Bullying which is another major threat to young people’s mental health and is more harmful than ‘traditional’ bullying. I’m currently working on a research bid to examine the problem of young people who run away from residential care and their mental health needs. And I have just been commissioned to edit a book on the Mental Health system and how it fails those who are suffering.

Copyright © Jessica Kingsley Publishers 2012.

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