Four years on: What have we learned from our Understanding Self-Harm project?
For four years Fullscope have been working with young people, professionals and communities in Cambridgeshire and Peterborough to deepen understanding of self-harm and how young people can be better supported. With funding secured for phase 5, we are reflecting on what we have learned so far and what we’re doing next.
Fullscope were commissioned in 2021 by Cambridgeshire & Peterborough Public Health, funded by NHS England to understand self-harm in children and young people. The project was extended in 2024, through further funding from NHS Cambridgeshire and Peterborough ICB, to March 2025.
Driven by the voices of young people
We were lucky to have a broad brief and freedom to let young people guide our work. Nine young people aged between 14 and 18 worked with us for over a year, and in some cases longer. We used our own model of co-production and held true to principles of freedom of expression, care, respect and empowerment. The young people guided us to a deeper understanding of the issues related to their use of self-harm and how they were impacted, especially by the way that the professional world reacted to their needs.
During the co-creating phase of the Ask Me How I Am film, we commissioned an independent evaluation by Dr Emily Bradfield (Doing Data Differently) to review our co-production process. The findings helped shape both this project and Fullscope’s wider participation work; in 2024, we refreshed our framework for involving young people and families, amplifying lived experience and influencing system-wide co-production. We published a reflection of this process here.
“The careful support of the core team, not only to the young people but to the creative film team too, was vital in making sure everyone felt looked after and safe”
The ‘Ask Me How I Am’ film
At the heart of the project was the creation of a 5-minute animated film, “Ask Me How I Am”. This was devised by the young people as a tool to communicate with others, especially professionals such as GPs and school staff, about their experience of using self-harm and how people react to them.
The film took almost a year to make and was supported by a creative team of award-winning filmmakers, animators and sound engineers. It was very important to the young people that the film would be of high quality and impactful.
‘Ask Me How I Am’ has consistently received extremely positive responses within workshops. Many viewers comment on the emotional impact of the film, whilst also recognising the power of hearing about the experience of self-harm from young people themselves.
The film has been selected for numerous film festivals as well as being shortlisted for awards including the British Animation Awards, winning an Honourable Mention at festivals including the Soho London Independent Film Festival. It was also shortlisted for an award at the NHS Parliamentary Award in the category of Excellence in Mental Health Care.
“I think the film is incredible, such an important creation, a wonderful way to give young people a voice in so many rooms and organisations.”
Understanding Self-Harm workshops
The main aim of the young people was to give professionals and peers a better understanding of the experiences of people who use self-harm and help them to respond in better ways. We consulted with over 60 teachers, GPs, mental health professionals, young people and parents/carers about their learning needs.
The 90-minute workshop was designed and piloted by Juliet Snell of taproot and Carolin Reisert of Centre 33, guided by the young people.
In pilot phases the film was delivered to 547 professionals. Last year we successfully developed and piloted a “train-the trainer” module in partnership with YMCA Trinity, and this is now being rolled out to dozens of colleagues across the NHS, local authorities and the voluntary and community sector.
We have found the workshops are having lasting impacts. In the follow up survey, respondents told us they have changed how they respond to self-harm;
Increased confidence
Increased knowledge about self-harm
Increased awareness of support
Increased understanding of how it feels for a young person
Reduced judgement
More empathy
Impact on whole school approaches e.g. training and review of policies.
We are continuing to develop the workshop- in the most recent year of the project, we have worked with a group of young people to consider how other young people might access the film and have supportive and impactful conversations about self-harm. A draft workshop has been co-created, with an accompanying workbook for young people to take away. The workshop will be further developed and piloted in a range of young people’s settings in the coming year.
97% of participants rated the workshop ‘excellent’ or ‘good’. 96% would recommend the workshops to a colleague.
“We have reflected on our school policy on self-harm and our pastoral approach to supporting pupils”
“Helped me to see beyond self-harm - exploring how the young person was feeling; gave me confidence in responding to young people who self-harm.”
Online resources to extend and deepen learning
We acknowledged that a short workshop could struggle to have lasting impact, and we therefore developed an online resource to help workshop participants revisit the themes of the film and reflect on their own response. The site also contains guidance and links to further learning and information for professionals.
The role of the steering groups
It was important that we were guided by the best knowledge and experience to ensure we were working in an evidence-based and safe way. The young people and our work were supported by two groups: a group of professionals and a group of parents. The professionals group included NHS and voluntary sector mental health clinicians, children and young people practitioners and youth workers, academics from University of Cambridge, school staff and Public Health colleagues. The parents all had experience of supporting a child who used self-harm.
The steering groups were instrumental in guiding all aspects of the project including providing professional and clinical oversight of the co-creation of ‘Ask Me How I Am’, consultation about the film’s potential impacts, supporting the development of the workshops and giving insights into current issues facing professionals working with young people who self-harm, as well as the lived experiences of parent/carers of young people who self-harm.
Learning from research
For some years, Public Health data has shown high rates of A&E attendance and admissions for self-harm among 10–25-year-olds in Cambridgeshire and Peterborough. While this data was a starting point, we wanted to explore more about what was happening locally, particularly in the voluntary sector, and how this compared nationally. Our 2022 report included information about risk factors, local data, and case studies to build a fuller picture. An updated review was published by Public Health in 2025 as part of the Joint Strategic Needs Assessment.
Our reflections
We are hugely proud of what has been achieved in the “Understanding Self-harm” project. The works continues to have daily impact on how professionals perceive self-harm and respond to young people more confidently and compassionately.
The driving force behind its success was the authentic voice and influence of young people. We noticed that for co-production with young people to be truly meaningful, there must be a sharing of power and acknowledgement that the outcomes and outputs will not be known until further into the process. With the right parameters in place, support and guidance, it is the very definition of ‘trusting the process’. We could have done more to be very clear with all of our partners about what we meant by co-production and how decisions in the project could be made, but we are proud of how instrumental and central the young people’s voices were.
The process of making the film was made more difficult at times due to limited contact between sessions that placed pressure on young people to make key decisions quickly, in an ideal world we would have welcomed more time to support relationship-building and reflection. The filmmakers, commissioners and professional supports were nervous at times about the topic and in working with young people with multiple vulnerabilities; this required careful support from the Fullscope facilitators.
There were moments in the project when the striking and challenging content of the film prompted our commissioners to request to edit the film or pause sharing it. Looking back on this difficult moment, this stemmed partly from a misunderstanding about the film’s intended audience and how it would be accessed. In response, Fullscope compiled a detailed overview of the film’s governance and sign-off process and carried out further consultation and feedback collection with professionals. Ultimately we moved on with the film intact, but with a stronger element of caution on providing support to audiences.
“I feel like they say it [attention seeker] because it’s a hard thing for them and they don’t want to have to deal with it themselves so it’s easy to be like ‘oh well, you’re doing it for this reason’ and not actually know the reason.”
The experience highlighted common anxieties linked to both self-harm and co-production:
Persistent stigma and concern about the potential contagion risks of self-harm
Fear from commissioners and funders that co-production might surface uncomfortable truths
Challenges for practitioners in balancing authentic representation of lived experience with meeting system expectations
Despite these hurdles, we have seen that the film has positive and lasting impacts on its viewers, provoking an emotional response in many. We have learned that this is because:
The film stands as a piece of art through its skilled film making by Boundary Picture’s Zan Barberton, and animation by Jospeh Clarke at Oh Studio. High quality art provokes emotional responses.
It comes from authentic youth voice. We consistently hear that the power of the film is in the young people’s voices. The film is based on hours of audio content created with the young people involved, skilfully scripted and edited by the film makers in collaboration with the young people team. The soundscape of the film includes sounds synonymous with youth such as school noises, young chatter and music, which can prove evocative to older viewers.
It directly challenges the viewer. Self-harm is a confronting subject. The film is masterful in the way that it reflects a young person’s general experience of an episode of self-harm in the way that it builds in intensity to a moment of calm, before a return of emotion, worry and guilt, ending with a resolution based on empathy and care. The film also addresses common assumptions about self-harm which contribute to the stigmas associated with it: that it is only cutting; only young girls/women do it; the causes are ‘only’ ever about attention seeking.
As facilitators, it has been fascinating to witness the range of reactions to the film, as they have often reflected the responses that young people with lived experience of self-harm have received from their peers and the adults around them: a desire to close the subject down, not hear more of what young people say about their experience of self-harm out of fear or prejudice. Perhaps also a desire from the adults around the young person to fix everything, make it stop and to make the self-harm go away. As a young person in the film says:
What next?
We write this blog well into our fifth year on the project! In April we were delighted to have secured more funding from the ICB to continue with delivery of our self -harm work:
In July 2025 our first cohort of 12 professionals accessed our “train-the-trainer” module for the professionals’ workshop. They are now able to roll out the workshop in schools, youth settings and health services.
We have recruited a team of 6 youth workers to help us develop and pilot the young people’s workshop in the next 6 months.
The steering group, now merged professionals and parents, continues to support and champion the work and think about how we can amplify the important things we have learned.
If you are a professional and would like to access the workshop contact us
Read the Phase 4 summary