NON-SUICIDAL SELF-INJURY
(NSSI)
A Resource for Teachers
Defining non-suicidal self-injury (NSSI)
• Deliberate self-inflicted injury to one’s own body tissues
without conscious intent to die
• Not considered a socially approved practice within one’s
culture
• Excludes ear piercing, tattooing, circumcision, or cultural
healing rituals
Prevalence rates
• 15% to 20% of middle and high school students engage in
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NSSIB
Prevalence rates are much higher in clinical samples of
adolescents (between 12-65%)
Typical age of onset occurs during middle school, roughly
between the ages of 12 to 15 years
In adolescent samples, females are more likely to report
having self-injured but by late adolescence, young males
and females report similar rates
The most commonly found risk factors for NSSI is having
difficulties with regulating emotions
Common forms of NSSI
• scraping or scratching
• interfering with a
skin
• cutting skin
• self-hitting or banging
(to break or bruise)
• burning
• pinching
healing wound
• self-biting
• picking or ripping skin
NSSI vs. Suicidal Behaviour
Non-suicidal self-injury
Suicidal behaviour
Intent
To get immediate relief
from negative emotions
To die in order to
permanently escape
emotional pain
Repetition
More frequent
Less frequent
Lethality
Often involves less lethal
methods but with a
potential for lethality
Tends to involve more lethal
methods
Psychological Often used to relieve
consequences psychological pain
Often aggravates
psychological pain
Gender
Occurs more often in women
but men are more likely to
die by suicide
May or may not occur
often in women,
depending on sample
Why do people engage in NSSI?
• To reduce negative emotions and thoughts
• NSSI involves the body’s natural pain killers. This can result in the
release of pleasant feelings
• To stop themselves from acting on suicidal thoughts and
urges
• To punish one-self
• To reconnect with one-self and others
NSSI is complex and is often the result of many
converging factors. The explanations are equally
complex.
How can School Personnel help at the
time of disclosure?
Do:
• Respond in a calm and caring manner.
• Don't be afraid to state, "I've noticed injuries that appear to be
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self-inflicted, I care about why you might be doing that" or, "it
appears you have hurt yourself, do you want to talk about it?”
Understand that this is the student’s way of coping with pain.
Have a non-judgemental compassion for the student’s
experience.
Offer to be a caring adult for the student while they are seeking
mental health support.
Acknowledge their feelings; offer to listen, be available.
Encourage participation in extracurricular activities and
outreach in the community (e.g. volunteering with animals,
nursing homes, tutoring or mentoring).
Discover the student’s strengths.
How can School Personnel help at the
time of disclosure?
Don’t
• Be overly reactive as this could alienate the student and damage the
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developing alliance.
Show excessive interest in the NSSI behavior.
Permit the student to relive the experiences of NSSI in detail, as this
can be triggering.
Try to stop the behaviour with threats or ultimatums.
Discourage self‐injury; threaten hospitalization, use punishment or
negative consequences.
Act shocked, overreact, say or do anything to cause guilt or shame.
Publicly humiliate the student .
Talk about the student’s NSSI in front of class or peers.
Agree to hold NSSI behaviour confidential.
Make deals or promises you can’t keep in an effort to stop NSSI.
School response protocol
Wounds are severe or lifethreatening or the student
is attempting suicide
Wounds are not lifethreatening
• Provide first aid and assess
• Report all concerns related NSSI
lethality of injury
• Send someone to call 911 and to
communicate with the principal or
designate.
• Listen empathically and carefully to
the student’s message.
• The principal or designate will call
the parent(s) or guardian(s).
to the school principal or
designate.
• A suicide risk review will be
conducted by an ASIST trained
staff
• The ASIST trained staff and
principal or designate, will identify
the level of NSSI risk
Should the student be identified as potentially suicidal, DSB
Ontario North East Youth Suicide Prevention, Intervention and
Response Protocols are followed.
Staff suspects
NSSI
Student shows
signs and
symptoms of NSSI
School staff
becomes aware
of student NSSI
Self-disclosure
of NSSI
Contact the
Principal or
Designate
DSB Ontario
North East
Protocol
Flowchart
ASIST trained staff
conducts suicide
review and consults
with the principal or
designate
NSSI - Low Risk
NSSI - Moderate of High Risk
* Any associated risk of suicide
* Self-injury is superficial
* Severity of self-injury is high
* No co-occurring mental health
* Co-occuring mental health issues
or related conditions
health problems.
* Encourage student to call
parent(s)/guardian(s)
* If child is under the age of 12, call
parent(s)/guardian(s)
* Refer student to Mental Health
Team and/or external services
* Follow up 2 weeks later
If the student is
suicidal, follow
suicide protocols
Provide first aid and
assess lethality
* Not suicidal
issues or only mild mental
Peer
disclosure of
NSSI
* Call parent(s)/guardian(s)
* Encourage parent(s)/guardian(s) to
call their family physician, NEOFACS
Intake for Mobile Crisis Response
1-866-229-5437 or another
emergency mental health facility
* Follow up 2 weeks later
(see:
http://docushare.dsb
1.edu.on.ca/docush
are/dsweb/Get/Doc
ument78908/DSB1%20IN
TERVENING%20WI
TH%20SIB%20%20Protocols%20%20Draft(1).pdf).
Confidentiality
Be cautious about telling the student that you won’t tell
anyone about their self-injury. There could be
• a risk of suicide
• a health risk
• a self-injuring group of peers, and/or
As per our protocol, staff shall report all concerns related to
potential self-harm to the school principal, vice-principal or
designate:
http://docushare.dsb1.edu.on.ca/docushare/dsweb/Get/Document78908/DSB1%20INTERVENING%20WITH%20SIB%20%20Protocols%20-%20Draft(1).pdf.
Circles of vulnerability for
contagion of NSSI
Geographical
proximity
Social
proximity
Psychological
proximity
Contagion in Schools
Schools
• Trends have been suggested whereby multiple students
who self-injure, communicate frequently about NSSI, and
trigger the behaviour in each other.
• Youth may self-injure in front of each other, share the
same tools, implement or take turns injuring the body
parts of others in the group.
• Some adolescents will pick up self-injuring behaviour from
siblings or peer group leaders.
Managing contagion in the school
When discussing NSSI with students, the following guidelines
will help in preventing contagion:
1. Do not allow students to share detailed information regarding
NSSI, reveal their scars, or share NSSI related images or
stories.
2. Do not use school-wide assemblies, newsletters, school
newspapers to address an “outbreak” of NSSI.
3. Do not present media that glamorize NSSI [as part of
classroom curriculum].
4. When educating youth about NSSI, discuss the behavior in
its broader context; that is, as a maladaptive coping strategy
among several others (such as substance abuse, or risktaking).
5. Emphasize the need for students who are engaging in the
behavior to seek support.
THANK YOU!
• We hope that you found this a useful introduction to
NSSI.
• For more information, please refer to pp. 121 – 125 of
Supporting Minds: An Educator’s Guide to Promoting
Students’ Mental Health and Well-being:
http://www.edu.gov.on.ca/eng/document/reports/Suppo
rtingMinds.pdf
Should you have questions,
your Mental Health Leader is available
to provide ongoing support and
leadership to your team.