This week we will be reviewing an article from the American Psychological Associations’ Journal of International Perspectives in Psychology: Research, Practice, Consultation. This article, authored by Hasking, Bloom, Lewis, and Baetens is titled “Developing a Policy, and Professional Development for School Staff, to Address and Respond to Nonsuicidal Self-Injury in Schools.”. This article focuses on the necessity of developing professional training for school staff relative to addressing and responding to non-suicidal self-injury (NSSI) in a school setting. 


Why did they do it?

NSSI is defined as any nonfatal act that is self-inflicted and results in bodily injury, but is completed without the intention to die.  Prevalence rates of NSSI are substantial, with an estimated 6-31% of adolescents engaging in the behavior. While NSSI frequently co-occurs with multiple psychiatric conditions, it can also occur in the absence of diagnosed psychopathology and is associated with impairment independent of a mental health disorder

The authors highlight that school staff are often the first (and sometimes the only) individuals to whom children/adolescents disclose their NSSI. School staff are also in a unique position, given the high frequency at which they see the same children, of being able to notice changes in mood. Unfortunately, the literature suggests that school staff, more often than not, have little knowledge regarding NSSI and lack confidence in their ability to work with students who engage in NSSI. This can lead to inappropriate responses to student disclosures, as well as inadequate rates of referral, follow-up, and intervention. Thus, the authors of this study  are calling for clear policies and procedures to be implemented in school settings with the intention of increasing staff comfort/competence, and subsequently improving student outcomes. 


How did they do it?

The recommendations provided are drawn from international literature on NSSI prevalence, existing policies relative to how NSSI can be effectively addressed in schools, and the authors’ own personal experiences working in schools across three countries. Through these efforts, the authors of this article identified five key components to developing and implementing a policy to help address and respond to NSSI within a school system. These components are briefly summarized below.


What did they find?

First and foremost, ongoing professional development and training for school staff is critical for the implementation of a school-wide policy. The authors suggest having materials available for sharing and holding a small “new personnel orientation” at the start of each school year. Specific elements of such professional development should ideally include the nature and extent of NSSI, the association with suicidal thoughts and behaviors, reasons students engage in NSSI, appropriate response strategies, and awareness of the school response protocol. 

This brings us to the next major component, a protocol for appropriately referring students following disclosure of NSSI to a school staff member. The authors highlight the necessity of this protocol being separate and unique from a suicide/suicide prevention protocol, and that it should be comprehensive and updated yearly. 

Within this protocol, strategies for responding to NSSI as well as strategies for safely talking about NSSI with students should be discussed. How school staff respond to NSSI is, as the authors put it, “critical”, and responses should fall under the realm of what the authors call “respectful curiosity.” 

In addition, it is recommended that school staff conduct classroom sessions with students, focusing on improving healthy coping. This strategy is particularly useful in addressing the concern that talking about self-harm can increase risk of self-harm. 

Finally, the authors propose a strategy for engaging parents and caregivers. The authors suggest that when feasible, recruiting parents/caregivers for information sessions on healthy and unhealthy coping in parallel with the students’ sessions, can be helpful in addition to having NSSI resources specifically for parents/caregivers. 

For a more detailed description of the authors recommendations, we encourage you to go check out their article!


What does it all mean (our take)?

NSSI occurs more frequently than many people realize, particularly in our young population. The authors of this fantastic article are driving home a critical point - let’s try and better equip school staff to appropriately respond and react to NSSI disclosures. After all, school staff are often the individuals who students feel comfortable enough to discuss incidents of NSSI with. 

There is a general concept here of integrating mental health literacy into school systems - both for staff and for students. It is a concept that we feel is critically important and we applaud these authors for their input on how to bring it to fruition. It is through work such as this study that changes will happen. We are hopeful that school systems will eventually adopt this approach, not just with regard to addressing NSSI, but to addressing mental health more broadly. We suspect that by doing so, much of the stigma and other components associated with mental health will be reduced. 

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