I had the wonderful opportunity of introducing the Bible to a group of eighth grade girls. As a teacher, I plan my lessons to ask questions relative to today’s teenager to continue their involvement in class. After one of the video sessions in the T3 Teen Timeline by Mark Hart, we discussed what the Bible says regarding self-injury, which included tattoos, burning, and cutting. According to the video, the girls are called to help those in need. Little did I know the hidden issue of cutting in society would surface with such an active dialog. With shock and awe, I asked my class, to raise their hand if they knew someone that was cutting. In my class of sixteen, eleven girls raised their hands. My lesson plan was not ready for this redirection, but perhaps cutting’s impact on today’s youth is was something that needed to be addressed.
“Who knows someone who is a cutter?”
The hands rose slowly and with every one, the room got quieter. The girls were scared to admit what they see and hear. With a promise to help them, a twenty-minute conversation ensued. Disregarding a need to raise a hand, the questions began piggy-backing on one another. How can I help? What can I do? Where can I go? Will I get in trouble? Who do I tell? The girls were sharing things that left me speechless. I am not trained to offer mental health advice, but I could listen, take notes and get the answers they deserved. These girls did not know how to handle this in school, on the bus, in the neighborhood or at home. They did not know how to help and feared pain themselves. Until I could provide answers during the next week’s class, I requested any encounters be shared with their school counselor. I knew the school counselors are trained to handle this type of situation, and they can be an extra pair of eyes where a child spends seven hours of their day.
After class, I contacted the school counselor and the church youth director to share the journal of questions. I also shared in many situations the girls believed the parents do not know this is going on. If we could collectively save one life of self-injury, the request for help is worth it. Together, we can work to get this local epidemic under control.
Both contacts responded quickly with stories of how cutting effects today’s youth. Yet they were quick to point out neither the school nor the church is equipped to handle these cases. Any form of self-injury is a sign of bigger issues, many of which are deep rooted that require the help of medical personnel. When an incident is noted, assistance brochures are given to the reporters. While the assistance and handouts are helpful, it does not address what we can do as a community to create awareness, when we need to call for medical support and what health insurance benefits apply.
Recognizing why and how people cut helps direct what assistance to provide. Here are some symptoms a self-injuring youth:
- Scars, such as from burns or cuts
- Fresh cuts, scratches, bruises or other wounds
- Broken bones
- Keeping sharp objects on hand
- Wearing long sleeves or long pants, even in hot weather
- Claiming to have frequent accidents or mishaps
- Spending a great deal of time alone
- Pervasive difficulties in interpersonal relationships
- Persistent questions about personal identity, such as “Who am I?” “What am I doing here?”
- Behavioral and emotional instability, impulsivity and unpredictability
- Statements of helplessness, hopelessness or worthlessness
Once a symptom is identified, it is important to seek assistance from medical personnel, counselor or a trusted adult as soon as possible. While in therapy, communication in a friendship can be scary for fear of losing a friendship. Providing support through conversations and actions could prevent losing a life. Here are hints to help a friend:
- Talk about it. You’ve asked about the cuts and scratches — and maybe your friend changed the subject. Try again. Let your friend know that you won’t judge and that you want to help if you can. If your friend still won’t talk about it, just let him or her know the offer stands and you are open to talking anytime. Sometimes it helps to let a friend know that you care. Still, even though you do your best, your friend might not want to talk.
- Tell someone. If your friend asks you to keep the cutting a secret, say that you aren’t sure you can because you care. Tell your friend that he or she deserves to feel better. Then tell an adult in a position to help, like your parents, a school psychologist or counselor, or a teacher or coach your friend is close to. Getting treatment may help your friend overcome the problem. Your friend may be mad at you at first. But studies show that 90% of those who self-injure are able to stop within a year of beginning treatment.
- Help your friend find resources. Try to help your friend find someone to talk to and a place to get treatment. There are also some good books and online support groups for teens who self-injure. Be careful, though: Although some websites offer useful suggestions about how to resist the urge to cut, the stories or pictures some people send in may actually trigger the urge to cut in those who read or see them. And some sites promote a sense of sisterhood or solidarity that might interfere with someone getting help. There’s nothing cool about cutting — beware of people or websites that suggest there is!
- Help your friend find alternatives to cutting. Some people find that the urge to self-injure passes if they squeeze an ice cube in their hand really hard, draw with a red marker on the body part they feel like cutting, take a walk with a friend (you!), rip up old newspapers, stroke their cat or dog, play loud music and dance, or find another distraction or outlet for their feelings. These strategies don’t take the place of getting professional counseling, but they can help in the short run.
- Acknowledge your friend’s pain. Let friends who cut know that you get what they’re going through by saying things like, “Your feelings must just overwhelm you sometimes. You’ve been through a lot — no wonder you hurt. I want to help you find a way to cope that won’t hurt you anymore.” Try to avoid statements that send the message you don’t take your friend’s pain seriously (such as “But you’ve got such a great life” or “Things aren’t that bad,” which can feel dismissive to a person who cuts).
- Be a good role model. Everyone experiences painful emotions like hurt, anger, loss, disappointment, guilt, or sadness. These emotions are part of being human. Coping with strong emotions — instead of dwelling on them and continuing to feel bad — involves a few key skills, like knowing how to calm yourself down when you’re upset, putting feelings into words, and working out solutions to everyday problems. If you can be the kind of person who can do this, your friend will learn from you.
It is important as a true friend to AVOID:
- Don’t deliver an ultimatum.
- Don’t accidentally reinforce the behavior.
- Don’t join in.
The name on the incoming call is from the counselor at school, yet the voice is the sweet child that left the house a few hours prior. The confession on the other end of the phone catches your breath and rolls you over like a steam roller. Yet the cool, calm and composed inner self understands that the phone call is a cry for help. When parents have a teen cutting, they are referred to outside mental health counseling. Typically, families see changes when everyone gets involved in helping their son/daughter. While administering professional assistance, here are parent tips to help yourself and your child:
- Accept your own emotions. If you know or suspect that your teen is cutting, it’s natural to feel a whole range of emotions. You might feel shocked, angry, sad, disappointed, confused, or scared. You might feel hurt that your teen didn’t come to you for help or feel guilty that you didn’t know about it. All of these emotions are completely understandable. But it’s not your fault, and it’s not your teen’s fault.
- Learn all you can about cutting. Find out all you can about cutting, why teens do it, and what can help them stop. Some teens cut because of peer pressure — and once they start, they can’t easily stop. Other teens feel pressure to be perfect and struggle to accept failures or mistakes. And still others contend with powerful moods like anger, sadness, worthlessness, and despair that feel hard to control or too heavy to bear. Cutting is sometimes the result of trauma and painful experiences that no one knows about.
It can hurt to think that your child might experience any of these feelings. As difficult as it is, try to keep in mind that exploring what pressures prompt your teen to self-injure is a necessary step toward healing.
Communication Is Key
- Talk to your child. It can be hard to talk about such a painful topic. You may not know what you’re going to say. That’s OK. What you say won’t be nearly as important as how you say it. To open the conversation, you might simply say that you know about the cutting, and then convey your concern, love, and your willingness to help your child stop.
It will probably be hard for your teen to talk about it, too. He or she might feel embarrassed or ashamed, or worried about how you’ll react or what the consequences might be. You can help ease these worries by asking questions and listening to what your teen has to say without reacting with punishment, scolding, or lectures.
Let your teen know that cutting is often related to painful experiences or intense pressures, and ask what difficult issues your teen may be facing. Your teen might not be ready to talk about it or even know why he or she cuts. Even if that’s the case, explain that you want to understand and find ways to help.
- Don’t be surprised if your teen resists your efforts to talk about cutting. He or she might deny cutting, get angry or upset, cry, yell, or storm off. A teen might clam up or say that you just don’t understand. If something like this happens, try to stay calm and patient. Don’t give up — find another time to communicate and try again.
- Seek professional help. It’s important to seek assistance from a qualified mental health professional who can help you understand why your teen cuts, and also help your teen heal old hurts and develop new coping skills.
Therapy can allow teens to tell their stories, put their difficult experiences into words, and learn skills to deal with stresses that are part of life. Therapy also can help identify any underlying mental health condition that needs evaluation and treatment. For many teens, cutting is a clue to depression or bipolar (mood) problems, unresolved grief, compulsive behaviors, or struggles with perfectionism.
It’s important to find a therapist your teen can feel open and comfortable with. If you need help finding someone, your doctor or a school counselor might be able to provide guidance.
Offer encouragement and support. While your teen is getting professional help, stay involved in the process as much as possible. Ask the therapist to guide you in how to talk with and support your teen. And ask your teen how you can best help.
For example, it may help to:
- Let your teen know you’ll be there to talk to when feelings are painful or troubles seem too hard to bear.
- Help your teen create a plan for what to do instead of cutting when pressures get strong.
- Encourage your teen to talk about everyday experiences and put feelings, needs, disappointments, successes, and opinions into words.
- Be there to listen, comfort, and help your teen think of solutions to problems and offer support when troubles arise.
- Spend time together doing something fun, relaxing, or just hanging out. You might take a walk, go for a drive, share a snack, or run some errands.
- Focus on positives. While it helps to talk about troubles, avoid dwelling on them. Make sure what’s good about life gets airtime, too.
Set a good example. Be aware that you can influence how your child responds to stress and pressure by setting a good example. Notice how you manage your own emotions and deal with everyday frustrations, stress, and pressure. Notice whether you tend to put others down, or are self-critical or quick to anger. Consider making changes in any patterns you wouldn’t want your teen to imitate.
Be patient and be hopeful. Finding out that your teen is cutting may be the beginning of a long process. It can take time to stop cutting — and sometimes a teen doesn’t want to stop or isn’t ready to make the changes it involves.
To stop cutting takes motivation and determination. It also takes self-awareness and practicing new skills to manage pressures and emotional distress. These things can take time and often require professional help.
As a parent, you might need to be patient. With the proper guidance, love, and support, your teen can stop cutting and learn healthy ways to cope.
Most youth cut because of deep underlying issues, not for attention or to commit suicide. Self-harm is a way of expressing and dealing with deep distress and emotional pain. They can’t feel the good or the bad, so they cut just to be able to feel something. They become addicted to the feeling that they get from it, because to them it’s like a release. They are not able to process their pain properly. The problem with cutting, at least in the middle school age group is if too much focus is put on it then it can sometimes cause some to do it for the attention they receive. If not addressed properly, it can become an addiction. Counseling is very important to deal with this and parents need to be informed.
You may also need the help and support of a trained professional as you work to overcome the self-harm habit, so consider talking to a therapist. A therapist can help you develop new coping techniques and strategies to stop self-harming, while also helping you get to the root of why you cut or hurt yourself. Families receive support during family therapy.
Will my Insurance Cover the help needed?
Please remember, there’s no one single or simple cause that leads someone to self-injure. In general, self-injury is usually the result of an inability to cope in healthy ways with psychological pain related to issues of personal identity and having difficulty “finding one’s place” in family and society.
According to Mayo Clinic, your first appointment may be an office visit with your family doctor, another primary care doctor, a school nurse or a counselor. But because self-injury often requires specialized mental health care, you may be referred to a mental health provider for evaluation and treatment.
Check your description of plan benefits to see what co-pays and/or deductibles apply to your treatment option. Mental Health is not required to be offered through an insurance plan. However, if mental health is available, the same limits apply as the medical benefits. In 2008, the Mental Health Parity and Addiction Equity Act was passed requiring coverage of services for mental health, behavioral health and substance-use disorders to be comparable to physical health coverage. That means that insurers must treat financial requirements equally.
For example, an insurance company can’t charge a $40 copay for office visits to a mental health professional such as a psychologist if it only charges a $20 copay for most medical/surgical office visits. The parity law also covers non-financial treatment limits. For instance, limits on the number of mental health visits allowed in a year were once common. The law has essentially eliminated such annual limits. However, it does not prohibit the insurance company from implementing limits related to “medical necessity.”
It is also important to ask the Mental Health provider is your Insurance Plan is accepted prior to the visit. Psychologists and other mental health providers choose whether or not to accept insurance, and what companies they contract with.
Check with your human resources department or insurance company for specific details about your coverage. Here are some important points to consider:
- Check to see whether your coverage uses provider networks. Typically, patients are required to pay more out-of-pocket costs when visiting an out-of-network provider. Call your insurance company or visit the company’s website for a list of in-network providers.
- Ask about co-payments. A copay is a charge that your insurance company requires you to pay out of pocket for a specific service. For instance, you may have a $20 copay for each office visit. In the past, co-pays for mental health visits may have been greater than those for most medical visits. That should no longer be the case for insurance plans subject to the parity law.
- Ask about your deductible. A deductible is the amount that you must pay out-of-pocket before your health insurance makes any payments. Depending on your deductible, for instance, you may have to pay $500 or even $5,000 out-of-pocket before your insurance company will begin making payments on claims. As a result of the parity law, your deductible should apply to both mental and physical health coverage.
- Talk to your provider. When you call to schedule an appointment with a mental health provider, ask if he or she accepts your insurance. Also ask whether he or she will bill your insurance company directly and you just provide a copayment, or if you have to pay in full and then submit the claim to your insurance company for reimbursement. If your provider does not accept insurance, ask about his or her payment policy.
It is necessary to talk with your Insurance Agent to see how a Mental Health assessment may affect the coverage of Life Insurance.
What do I do without Health Insurance?
Check with your school for options to get your child assistance with mental health. There are several options available for assistance within the school including the counselor and social workers. Check with the school counselor, there may be grant money to assist in getting outside assistance through the district. If this is not an option, contact the local Mental Health America Affiliate to discuss options including:
- Case Management
- Support Group
- Complementary & Alternative Medicine
- Self Help Plan
- Peer Support
To help prepare for your appointment:
- Make a list of symptoms you’ve had, including any that may seem unrelated to the reason for the appointment.
- Note your key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins, herbs or supplements that you’re taking.
- Take a family member or friend along, if possible, for support and to help you remember information.
- Be ready to provide accurate, thorough and honest information about your situation and your self-injuring behavior.
Known as talk therapy or counseling, psychotherapy can help you identify and manage underlying issues that trigger self-injuring behavior. Therapy can also help you learn skills to better manage distress, help regulate your impulsiveness and other emotions, boost your self-image, better your relationships, and improve your problem-solving skills. In addition to individual therapy sessions, family therapy or group therapy also may be recommended.
Additional Assistance Available
The middle school and high school counselors are always available to talk about any concerns you have. If you are worried about a friend who is cutting, please find the help of a trusted adult. It is scary to tell someone about a friend you are worried about. Sometimes students are worried that their friend will be mad at them, but know that you are doing the right thing in getting your friend the extra help and support from trusted adults.
If you, your friend or a loved one is having suicidal thoughts or is in emotional distress, get help right away. Take all talk of suicide seriously. Here are some options:
- Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor.
- Seek help from your doctor, a mental health provider or other health care professional.
- Reach out to family members, friends, teachers or spiritual leaders for support.
Other Enhanced Insurance articles related to Miscellaneous Health Insurance:
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