Theme: Self-Harm


Melanie is a 15-year-old girl who lives at home with her mother. She has no siblings and her parents separated when she was 8. Her father lives close by but he is a heavy drinker and is not very supportive; she does not have a close relationship with him.

Recently Melanie’s schoolwork has deteriorated and over the past six months she has started missing school. Melanie has started drinking alcohol and using cannabis every weekend,

Melanie has been in a relationship with her girlfriend Joanna for the past two weeks. A weekend ago she had a physical altercation with girl whom she accused of flirting with Joanna,and allegedly punched her so hard she fractured her ribs.

Past medical / psychiatric history:

Melanie has a history of asthma but has not experienced an episode for 5 years. She currently does not have any medical concerns. There is a paternal history of substance abuse but no other history of mental illness within the family. A former boyfriend of Melanie’s mother was ‘sexually inappropriate’ with Melanie when she was around 12-13 years. He is however, in prison for other offences and Melanie’s mother reports that the family have moved on and it is no longer discussed,

Current presentation:

When at home Melanie withdraws into her room, she states that she loves her mother but “she is an alcoholic who loves pedophiles” so shouldn’t be telling her how to live her life.. Melanie has felt low in mood for about the last six months and has been thinking about suicide a lot but has made no definite plans yet. On two occasions, in the last fortnight, Melanie has made cuts to her legs and abdomen with a razor, she found this quite satisfying as it helped to relieve the ‘pain’ she was feeling.

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