Self-harm prevention: VUB professor reaches out to Flemish youth
With as many as one in 10 young people in Flanders engaging in self-harm, psychotherapist Imke Baetens has launched a project to find the most effective treatment methods
Difficult first steps
For the joint project between VUB and the University of Leuven, psychotherapist Imke Baetens (pictured left) has trained 45 therapists across Flanders in the treatment of non-suicidal self-injury (NSSI): the direct, intentional injury of body tissue, like cutting, burning and head-banging.
The next step is to find adolescents between 12 and 21 who self-harm and are willing to take part in outpatient therapy. The biggest problem is getting the message to the people who need to hear it.
“It’s a topic with a lot of secrecy,” Baetens admits. “When parents first find out their child is self-harming, they are of course distressed, but their child says they won’t do it again, and the parents believe them. We get a lot of parents who call, but getting their children to the therapist is a difficult step.”
To spread the message, she has contacted family doctors and pupil support agencies and is leading workshops and lectures in schools across Flanders.
The study offers up to 300 adolescents eight to 10 sessions of specialist treatment: half of them see behavioural therapists on their own, with parents invited for one session; the other half involves purely family therapy, with all family members invited to every session. Baetens will be closely studying their outcomes.
A 12-year-old is obviously very different from a 21-year-old, so the therapy has to be personalised and age-appropriate. “The important issue for me is to find out what works for whom,” says Baetens. “To see if there are types of self-injurers who benefit more from family treatment or behavioural therapy, and why.”
Adolescents who self-injure sometimes go into chat rooms and motivate each other to cut deeper or more seriously
Sessions are partly reimbursed by health insurance, and, thanks to support from service clubs and other groups, there are free places for 30 young people who are unable to pay.
In non-clinical samples, there’s no gender difference in the incidence of NSSI. Young adult females do it as often as males, but among young men it’s often more secretive, and it takes a different form: head-banging, for example, or punching a wall.
It’s also less likely to be perceived as NSSI by society. “When a guy hits a wall, he’s aggressive, he’s just being a guy,” says Baetens. “There are societal issues involved, as well as the personal issues.”
Are some people just more predisposed to self-harming than others? “There is some new research in which we can see that people who self-harm react differently to pain,” Baetens says. She previously carried out a study in which she monitored blood pressure, heart rate and breathing, and found clear physiological differences between adolescents who engage in NSSI and those who don’t.
Most specifically, she found, they differ in socially stressful situations. “A colleague in Germany did a social exclusion game in which they simulated bullying, resulting in significant physiological arousal,” she says. “And I did a discussion session with young people and their parents, asking them to discuss a difficult topic for 10 minutes. Those who engaged in NSSI were much more worked up by the discussion than others. Their stress systems were overwhelmed.”
Baetens has just helped a group of Flemish students to set up a support website, Verwonderd. In the coming months they hope to hold information nights for young people and arrange support groups for parents as well as a guided chat room.
“There are times when adolescents who self-injure go into a chat room, and it becomes destructive. They can motivate each other to cut deeper or more seriously,” she warns. “There needs to be a professional mental health worker watching over the conversation and trying to keep it supportive and not destructive.”
Mental health provision locally needs a lot of improvement, Baetens adds, and the biggest problem is the time it takes before someone can see a specialist. “We have waiting lists of sometimes a year. Imagine you’re feeling depressed or suicidal, and you have to wait a year. There’s a huge role for pupil support agencies in schools, but now, especially with the introduction of inclusive education under the M decree, they’re just overwhelmed.”
What should you do?
If someone thinks a child or friend is self-harming, how can they best support them? Baetens: “Stay open and talk to them, tell them you’re worried and that you want to help them find professional help. Don’t judge, don’t dramatise, don’t ask them to stop. I get a lot of emails from people who have said to their boyfriend or girlfriend, ‘If you don’t stop I’ll break up with you.’ But that just doesn’t work.”
Photo © VUB 2016 – Saskia Vanderstichele