Educators and Self-Injury

The missing manual for understanding
and aiding students who self-injure.

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Educator Response

Educators of all types are in a unique position to help kids. Many students may not have all of their basic needs recognized and met within their home environments. Do not assume that parents or caregivers are noticing and taking care of your students’ needs.

Don’t ignore it- trust your gut

There are two principles to keep in mind when encountering a student whom you know or suspect is self-injuring. Number one: Do not ignore anything suspicious. If your gut instinct tells you that something is going wrong with a particular student, follow up on it. It is natural to tell yourself that it is not what it appears to be, to accept flimsy explanations, and to hope that someone else is helping the student. The fact is that you may be the only one who has noticed and you may be the first one to provide a listening ear and valuable linkages to support and intervention.

Extend an attitude of calm understanding

The second principle to keep in mind is to do your very best to present an understanding and sympathetic attitude. It may seem incomprehensible to you that this behavior is useful to the student, but it does serve a purpose for those who practice it. While unhealthy, it is very different from suicide- suicide is a choice to end one’s life, whereas self-injury is a coping mechanism to continue living. Calmly listen to the student and let the student define their behavior in terms of whether or not it was a suicide attempt. Take appropriate action based on the information gleaned in your discussion with the student.

Any educator who encounters NSSI should keep the two above principles in mind. Other important principles include:

Be a link between the student, onsite mental health staff, and offsite mental health professionals

School sites may need to exercise flexibility in allowing a self-injuring student to access the school counselor or school psychologist by means of a simple signal or short statement of request.  Many students will feel uncomfortable if they are required to give a lengthy explanation for why they need to leave a classroom or other school activity. Onsite and offsite mental health professionals* should work together whenever possible to make plans** for the student to follow at school when they are feeling dysregulated and may possibly self-injure.

*With a Release of Information signed by the parent.

**Documented in a 504 or incorporated into an IEP

NSSI cannot be effectively treated solely within the school environment.

NSSI is a problem that is most effectively addressed at a clinical level, by a professional with NSSI expertise. School staff may provide a sympathetic ear, may develop a plan for students when the urge to self-injure occurs within the school day, and may offer other services through the school psychologist or school counselor, but the school alone cannot provide adequate intervention or the long-term therapy required to remediate this complicated phenomenon. Even with expert intervention and loving family support, NSSI may persist for many years. However, there are cases where the school may become the only place for intervention. When this occurs, the school psychologist or school counselor should consider utilizing the following resources:

Teachers and other educators should routinely refer self-injuring students to the school nurse, and the school psychologist or school counselor for further assessment.

Teachers and other non-mental health educational staff can play a key role in the well-being of students who self-injure by identifying and listening to these students as they are able. However, they should never try to handle the situation on their own. Students should be referred to the school nurse and either a school counselor or school psychologist to assess the situation and make referrals to outside resources. Assessment includes determining risk-level status by considering the risk of suicide, physical injury, and the presence of other co-occurring risk factors (such as mental health disorders).

Mental Health staff at school sites must develop a list of outside referrals.

It is outside the scope of this website to suggest professionals in areas throughout the United States and beyond. Mental health staff at school sites should have a list of information about counselors and therapists in the area who feel comfortable addressing self-injury in children and adolescents.

Schools should develop a specific protocol for dealing with cases of self-injury.

Important concepts for school counselors and school psychologists

It is beyond the expertise of most school counselors and school psychologists to provide adequate intervention for self-injury solely within the educational setting. Cases of self-injury should routinely be viewed similarly to cases of expressed suicidal ideation or intent in the following three ways: 1) In almost all cases you need to inform the parent, 2) The student and their family should be referred to professional help, and 3) Follow up: create reminders for yourself to follow up with the family and find out if the student is getting help.

It is also important to remember that the student should be told the limits of confidentiality at the outset of any counseling sessions. The student must understand the counselor or school psychologist’s responsibility to break confidentiality when there is a potential of “harm to self.”

While a student who self-injures should not be treated solely within the school environment whenever practicable, the following skill sets would be appropriate for school counselors and school psychologists to address when they work with self-injuring students:

  • Coping skills
  • Identifying and appropriately expressing emotions
  • Self-acceptance
  • Self-Compassion
  • Mindfulness
  • Hope-building

It is also important to remember that because of the contagion factor, self-injuring students should not be seen in homogeneous groups. They may be included in a group addressing a relevant skill such as those listed above, but should not be aggregated into a single group of self-injurers.

Richard Lieberman, school psychologist and consultant for Los Angeles County, provides the following information regarding contagion in a pamphlet developed for his district:

  • Each student should be assessed and triaged individually. If the activity involves a group “rite of togetherness,” the peer group should be identified and each student interviewed separately.
  • When numerous students within a peer group are referred, assessment of every student will often identify an “alpha” student whose behaviors have set the others off. The “alpha” student should be assessed for more serious emotional disturbance. While most students participating in a group event will be assessed at low-risk, identifying moderate and high-risk students and targeting them for follow-up is critical
  • Respond individually, but try to identify friends who engage in SI.
  • School mental health professionals should refrain from running specific groups that focus on cutting rather than focusing on themes of empowerment, exercise/tension relief, and grief resolution.
  • Health educators should reconsider the classroom presentation of certain books, popular movies, and music videos that glamorize such behaviors and instead seek appropriate messages in the work of popular artists.
  • Monitor the internet chat and websites.
  • SI should not be discussed in detail in school newspapers or other student venues. This can serve as a “trigger” for individuals who SI.
  • Those who SI should be discouraged from revealing their scars because of issues of contagion. This should be discussed, explained, and enforced.
  • Educators must refrain from school-wide communications in the form of general assemblies or intercom announcements that address self-injury.
  • In general, a designated person should be clear with the student that although the fact of SI can be shared, the details of what is done and how, should not be shared as it can be detrimental to the well-being of the student’s friends.

*Adapted from: Lieberman, R., Toste, J.R., & Heath, N.L. (2008). Prevention and intervention in the schools. In M.K. Nixon & N. Heath (Eds.), Self injury in youth: The essential guide to assessment and intervention. New York, NY: Routledge.

For school psychologists or school counselors looking for more extensive self-injury resources, you will find an in-depth manual and accompanying student workbook at selfinjury.com.

Additionally, Richard Lieberman with Suicide Prevention Services in the Los Angeles Unified School District has collaborated on creating the following resources: