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Opera North - The Little Greats

Harmless: Nottingham's Self-Harm and Suicide Prevention Organisation

9 October 17 interview: Lucy Manning
illustrations: Ben Lord

In honour of World Mental Health Day, we spoke to the force of nature that is Caroline Harroe. Caroline is the CEO of Harmless, an organisation that goes above and beyond to help those in our city who are experiencing distress, and are battling with self-harm. They’re celebrating their tenth birthday this month, and looking forward to moving into their own, dedicated premises. What better time to sit down for a cuppa?

Tell me about Harmless...
Harmless is a CIC [community interest company] and we’ve been in operation since October 2007. We were originally established to respond to the needs of people that self-harm, as well as their friends, family and professionals, to be able to give people that had not traditionally had access to support services somewhere to go. We’d seen the massive lack of provision through first-hand experience, and we used our experience to say, “Hey, it can get better.” The whole service is built on embodying hope, and using our own, lived experience to communicate hope to others.

Thousands of people have moved through our service over the last ten years, and what we offer has progressed, too. We provide direct access support, so people can self-refer and agencies can refer people as well. People can just walk into one of our open sessions and say they need some help, plus we have an online support portal, and we provide short-term, long-term and group psychotherapy.

We have a team of project workers who help people manage their day-to-day lives; everything from finance management to self-management work if therapy isn’t right for them. Sometimes people just need to feel contained by a supportive team, and that can be enough. We want to make people feel supported, so we do what they want us to do.

We go wherever people need us to be; we’ve met people in the back of pubs, we play crazy golf. It’s really important that people know they can have a cuppa and get to know us first; they don’t have to commit to a six-week, intense psychotherapy programme.

Why do people self-harm?
If you’re having a really bad day and then you stub your toe, you forget about your bad day because you’re thinking about your toe. Afterwards, it all comes back but, in that instant, the pain interrupts thoughts and emotions. Self-harm does that, too. If you’re uncomfortable with how you feel, doing something to change that is a normal, human desire. We’re used to the answer of people self-harming to cope, but actually, if you look at it in less of a box, we all do stuff to our bodies to change how we feel, like doing exercise when we’re angry.

People have states that they’re particularly challenged by, and they might harm differently, or more, depending on the states they’re uncomfortable with. It’s not a one-size fits all. We know that people usually start self-harming in one way, and then self-harm in different ways for different states. Unless you resolve the distress that’s driving it, people usually become more risky and their thoughts and intentions of suicide worsen. We’re not sure if that’s because they self-harm, or whether it’s because their distress becomes more hopeless.

Is part of the treatment you offer giving people an alternative method of interrupting those feelings?
That’s some people’s approach. Our approach is: “Those feelings are not gonna go away, so let’s help you tolerate them.” You can’t always fix the source of someone’s pain, but you can change their relationship to it, and if you learn to tolerate it, people usually have less of a need to grab at something to cope.

Do you think that your user-led approach, and staff’s experience with self-harm and mental health, has enabled you to respond to service users more effectively?
It’s a blessing and a curse. While we have experience in our team, which is really important, that isn’t representative of our users, so we have to constantly revisit what works from a consultation point of view. We don’t do an assessment at the first point of contact, so people can come in and just have a chat. That seems to make a difference because we have really high levels of retention and really solid rates of recovery that are not traditionally found within services. I think that’s because we stick with people for as long as they need us, as opposed to a six-week block.

So you’re removing the fear of accessing a service...
That’s vital. But we also have to validate the fear of accessing services; I’ve had some dire experiences with them. When a large proportion of clients come to us and the first six months consist of working on the distress they’ve experienced through accessing services, that’s not acceptable. That shouldn’t be anybody’s story. They shouldn't be saying “I have all these issues, I hurt myself and I often think about dying, but the biggest problem in my life at the moment is the service that I’ve experienced from providers.”

Why is there such a problem, do you think?
There’s still limited provision. For instance, there’s more of a pathway for younger people. If you’re over eighteen and you self-harm, you’re in distress or feel suicidal, and you have a diagnosis of depression and/or anxiety, you’re considered to be under primary care and there’s a way to get help.

If you start ticking the “risk” box, you can’t access those services anymore, but you’re not yet able to access secondary services. There’s this huge, gaping chasm, and there are commissioners who are looking at how to bridge that gap, but it’s been known about for over ten years. It’s a bit like pinball: not risky enough for one place, but too risky for somewhere else.

There seems to be a preconception that self-harm is a young person’s issue. Would you say that’s correct?
The data shows that there’s a high rate of self-harm in children and young people populations, but we haven’t undertaken the same level of research across adult populations. That’s not the same thing as saying “This is a children and young person’s problem.” We do know that the average age of onset is thirteen or fourteen, and there are reports, such as the paper in The Lancet, that show self-harm declines over a person’s age span. However, until we were funded by Children in Need and Comic Relief for Young People’s Work, our largest cohort of people were around 35, so I don’t think this is just a young person’s issue, and I think it’s a really dangerous message to give out.

It hugely stigmatises people if the large-scale public understanding is that self-harm belongs to children and young people. If you’re an adult, not only do you have issues of poor provision to overcome, you also have to tackle this pervading stigma that you’re on your own because “adults don’t do this.” Adults do do this.

We also know there’s a relationship between self-harm and suicide; even though they’re different, people who self-harm are at a higher risk of suicide. The rate of suicide is three to one, male to female. There are lots of issues surrounding male mental health, but we don’t talk about these issues further down the spectrum; we don’t talk about males that might self-harm, and if we don’t talk about that, then it’s hardly any wonder that we’ve such high ratios of male suicide. We need to do better.

I was an ambassador for self-harm and suicide across the Foyer network, which is for homeless young people in education. I went into a number of venues to conduct training, and I’d ask “Is a girl cutting herself self-harm?” People always say yes. If I asked, “A guy walks out of an exam and punches a wall, is that self-harm?” Everyone would say no. Well, it is.

We know that males and females engage in different types of behaviour, so maybe we just need to ask different questions. We’ve got to start talking in accessible terminology to have a better understanding of these things. It’s not just a teenage girl in her bedroom, cutting. Self-harm can be any act of harm that you undertake in an act of distress.

What about drinking and drug use?
Under traditional diagnosis and terminology, most working definitions of self-harm don’t include those, or eating disorders, or risk-taking behaviour. However, we see self-harm sitting on a spectrum. There’s the traditional definition of self-harm, which would be any act of harm with or without intent to die, and then you would see other things that sit closely alongside it.

At one point, I was at one end of that spectrum, and I’d like to think that now I’m at the opposite end of that spectrum. But we’re all free to move along it depending on what happens to us. I think that makes people feel vulnerable, so it’s easy to say “They’re the self-harmers over there.” People think of self-harm in a pigeon hole, and they say “Well, I haven’t done that.” But if I ask, “Who’s driven recklessly because of distress?” then people start to see the barriers between them and somebody falling into the traditional definition of self-harm closing. Part of the stigma is that people don’t want that gap to close. We don’t want to think of ourselves as unhealthy.

It’s part of a bigger conversation about the spectrum of mental health...
Yeah. It’s not an “us and them” thing; self-harm is a manifestation of something else, it’s not the problem. It’s a communication to yourself and an expression of distress, or a manner of coping that exists when there’s something else wrong, and if the “something else” wasn’t there, it’s unlikely that the self-harm would be. Our success in this field is helping people with whatever motivates their distress.

Would you say self-harm is a symptom of poor mental health?
I would say self-harm is a symptom of other things; whether that’s mental health difficulties or pervasive life problems. The problem with this field and providing services to people that self-harm is that there is very often not a diagnosable accompanying mental health condition. There’s distress, and if left long enough it will become something bigger, but in the first instance, it’s not a mental health condition. We have services for mental health conditions, but people that self-harm may not have one. We don’t have enough early-intervention work.

It’s like you have to get worse to get help.
Absolutely. If your self-harm is more severe, you get help faster. And then society says “You’re attention seeking and manipulative because your self-harm is worse.” But society also tells people that we’ll pay more attention if a behaviour is more severe. Go figure.

It must be frustrating trying to work against a system and a structure that seems to be stacked against you...
I’m going grey really fast. When we set up the service, it was based on wanting to make a difference, but to do that we have to be really strategic. We’ll always be there for our clients, but our mission has to be greater because they still have to go back into a world that might judge or fear them. It’s our job to challenge that as well.

I’m the CEO of Harmless and The Tomorrow Project, I’m a qualified CBT [cognitive behavioural therapy] Psychotherapist, I’m married with three children, and I can’t get life insurance, mortgage insurance or travel insurance, because I self-harmed as a teenager. The level of stigma that’s pervasively embedded in our society needs challenging, because there are people with far less of a voice than me that are gonna come up against barriers, by virtue of the fact that they’ve asked for help when they were thirteen. Nobody knows, and service providers aren’t aware that that’s the implication of the service they provide from the minute it’s on your notes.

We tend to think of people making judgments like “You’re a nutter” as stigma, but actually, it’s so entwined in the systems that support our lives that we have to tackle stigma on a much greater scale. And it pisses me off.

It can also work the other way, in that people might not access help services because they know it’s going to impact them later on in life.
And that’s dangerous. While there’s a time and a place for statutory provision, it needs to do things differently; we need to work together collaboratively, and listen to what our service users want.

We did a consultation with a community sample asking them where they would go if they were in high levels of distress or were contemplating suicide. 96% of males said they wouldn’t go through an NHS door. So provide them some place different; we’ve seen people in skate parks and pubs. Our male ratios go up in those places. So do it. It’s not rocket science.

You’ve spoken of having lived experience of self-harm, do you think there needs to be more people like yourself working towards creating a better understanding of what it takes to help people recover?
Yes. The Time to Change campaign has made big gains nationally, and it’s done that by getting positive role models to speak out. Mental health stigma has moved on significantly in the last five years because of it. I think it’s really important for people in distress to be told by people that know there is another side. Otherwise, what’s the point? There was a time when I didn’t see the next ten minutes let alone the next ten weeks, but we have to be willing to stand up and say “Hey, life can get better.”

What kind of impact do you think social media sites have had on the conversation, and people’s mental health in general?
Social media is a blessing and a curse. It’s naive to say it’s all bad because it’s not; social media promotes contact that is helpful, and it promotes stigma challenging conversation. But it can also do the opposite. If you’re being bullied, that bully enters your world wherever you are. There’s no space for people who are suffering.

And there’s a direct recourse to people who are vulnerable. We know that it’s not helpful for groups of people who self-harm or are feeling suicidal to congregate with each other, and social media enables that. In the first instance, what we know is that those connections promote a sense of feeling like you belong or that you’re understood, but they don’t promote recovery, because in order to access those groups and connections, you need to still have the problem that brought you together. We also know that people are easily triggered, or their behaviour is escalated, by their exposure to others. So, “I self-harm because I hate myself, but they hurt themselves more than I do, so I need to hurt myself more to prove that I hate myself as much as I say I do.”

It’s an ugly world, but if we harness and keep up with it, then we can do some good. Service providers need to get up to date; a large cohort of services are provided by people who haven’t grown up with social media, who don’t understand the cultural difference social media presents to young people today. We need to be developing sound, technological advances to take our services to people where they will use them, and we need more early-intervention services. We need to get our hands dirty.

So, you’ve hit the ten-year mark, congratulations!
We’re 50-60% self-funded through business and fundraising activities, so it’s a big deal that we’ve made it here. Over the last five years, especially in our local area, we’ve seen services close on a daily basis. We’ve cut it fine a few times this year, but we’ve just secured lottery funding which means our services are extending. And we’re moving to a dedicated building, just off of Forest Fields, that will provide all of our suicide-prevention activities under one roof. People will be able to come to us and know that they are greeted at the door by someone that understands them.

Are there any achievements from the past ten years that you’re particularly proud of?
Last year, in November, I won one of the ten Outstanding Young People awards for the UK – for business, enterprise and entrepreneurship – and I’ve just been selected as one of the top twenty internationals. So that will potentially take our work onto an international platform. And we’ve been shortlisted in two Positive Practices in Mental Health award categories: recovery and co-production, so service-user representation. That sums up what we’re about; we involve people in their own care, and then we help them to get better.

If anyone reading this is struggling with self-harm, or knows anyone who they think might be, what can they do?
We provide support to people that are at risk of self-harm and suicide. That means we’re not just interested in people that are actively harming themselves, we want to stop it before it happens. People can have a dialogue with us at any point, and they can do that however they feel comfortable. Come to one of our drop-in sessions, call us, email us, Facebook message or tweet us. We won’t exclude people. We will do our damnedest to help you achieve a quality of life where you can say, “I feel alright to carry on.”

If you, or someone you know, is struggling with their mental health, you can get in touch with Harmless on social media, via their website or by giving them a call. If you feel you are unable to keep yourself or someone you know safe, call 999, or head to your local A&E department.

Harmless, 1 Beech Avenue, NG7 7LJ.  0115 934 9445

Harmless website

@HarmlessUK

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