Self-mutilation between young people and adolescents: impacts on learning in high school.

This is a descriptive, quantitative research that sought to outline the profile of young people who have self-injurious behavior in the municipality of São José de Ribamar and to identify whether the impacts of this behavior on school learning. The study was carried out through the random application of an online form to adolescents and young people. The results indicated that 27% of the respondents practice or have already practiced self-mutilation, the majority being female, without adequate medical monitoring. The survey further identified that. it appears is important to carry out actions by the school that contribute to the identification of students who practice self-mutilation and to carry out preventive measures for this public within the school.


INTRODUCTION
More and more frequently, self-mutilation is an illness that has mainly affected young people and adolescents. According to Nock (2010), the growth in behavior is evident self-injurious in recent years, with a higher rate among adolescents and young adults. It is a practice that aims at the deliberate destruction of own body tissue without suicidal intent (IZADI-MAZIDI et al., 2019).
Some studies are beingin order to understand the causes and reasons that lead to the practice of this act. According to Rocha (2015) when a young person or adult is selfmutilating, he is in a disturbed psychological state, without this, however, representing a suicidal ideation.
Since it is more frequent among adolescents and young people, the school has become an essential study environment, as it is there that we find the greatest concentration of these incidences.
This article aims to present the results of a survey carried out to identify the profile of young people who practice self-mutilation in the municipality of São José de Ribamar and to identify the impacts on learning from the perspective of these young people.
The Municipality of São José de Ribamar has 164 thousand inhabitants (IBGE 2010), of which approximately 16 thousand are young people aged 15 to 19 years. As for the number of young people who have self-injurious behavior, there is still no statistical data in the municipality.
This study carried out a statistical survey by sampling the profile of the young person who practices self-mutilation and the impacts on learning. Initially, a bibliographic review on self-harm among young people and adolescents in public schools based on research published in national and international events included in the Google Scholar and CAPES repositories. The data showed that research on selfmutilation is constant, thus evidencing a greater concern of the scientific community in trying to understand and help solve this problem.
As a second part of the research, an online form was sent to 250 young people living in the municipality of São José de Ribamar (MA). The research sought to answer the following questions: What is the prevalence of self-mutilation among adolescents and young students of public schools in the city of São José de Ribamar (MA)?
What are the impacts on school learning of high school students from public schools in São José de Ribamar that self-mutilate?
The results indicated that almost 27% of the respondents presented some type of harmful behavior, triggering anxiety, anguish and family traumas as triggers. We emphasize that research on self-mutilation in adolescents becomes relevant not only because it presents data, but also because, knowing the phenomenon, we can propose alternatives for prevention, early detection, evaluation and effective intervention to face this problem.

OBJECTIVES
The research entitled "Self-mutilation between adolescent young people from public schools: Impacts for learning in high school" had as its general objective: To know the prevalence of self-mutilation among young high school students from public schools in the city of São José de Ribamar (MA) and the impacts on the school learning of these students.

Specifics:
Identify, through the application of questionnaires, students who practice selfmutilation, as well as identify the failure and retention rates among this group; Identify students who are attended or are undergoing medical treatment (psychological, therapeutic, etc.) accompanied by the school.
Identify the measures taken by schools when there are cases of self-harm in the school.

METHODOLOGY (OR MATERIALS AND METHODS)
This research is an exploratory study Qualitative in nature from the perspective of addressing the problem and in Quantitative approach that used descriptive statistics to obtain and process data.
As an initial step, we carried out a bibliographic survey whose objective was to conduct a survey of the existing bibliography on the subject (self-mutilation among adolescents), through published studies and research that presented similar problems and / or that dealt with the subject in focus.
The second stage was the Field Research. Data collection occurred through the application of an online form sent to young people and adolescents aged 14 to 25 years living in the municipality of São José de Ribamar.
The online form was prepared through the google application containing 9 questions.

STEPS CARRIED OUT
The research was developed through the following described steps: • Bibliographic Study: The objective was to carry out a bibliographic survey on the subject; • Knowledge of the Research Universe and sample: • Elaboration of data collection instrumentsthe instrument was elaborated considering the main objective and the specific objectives of the research, deemed necessary to cover the entire research question. This stage was organized in substages: • Formulary elaboration with closed questions. In order to preserve the subjects' identity, the questionnaire had no elements of identification of the respondent.
• Questionnaire Testing -Pre-Test to identify the need to make adjustments to the questionnaire; • Application of the Questionnaire -The questionnaire was sent to groups of students from public schools in the municipality of São José de Ribamar through a communication application (whats App).
• Tabulation of collected data; • Analysis, comparisons, data discussions and conclusion: As a data analysis technique, it was decided to use Descriptive Statistics.
• Preparation of the final report.

SELF-MUTILATION BETWEEN PUBLIC SCHOOL STUDENTS
Interpreted as an emotional wound, self-mutilation has become more and more common in the lives of adolescents and young people in Brazil and draws attention because it is an intentional but silent disease. According to Nock (2010), "Self-harm is more prevalent among teenagers and young adults, usually involves cutting or notching the skin and has a consistent presentation in several countries".
Self-injury has existed for a long time, and it is possible to identify various descriptions of self-injury in biblical texts, different sources such as records of clinical cases, literary, etc. (GUERREIRO, SAMPAIO, 2013).
This increase in social, clinical and scientific interest in cases of self-mutilation helps us to understand whether they have an impact on the school performance of adolescents.
At school, the symptoms of adolescence appear disguised by the name of anxiety, borderline disorder, dyslexia, depression; but, in fact, what we find most often are subjects who express their discomfort through the body, which is why the so common cases of self-mutilation, especially in girls. Teachers, in most cases, are asked to respond to these so-called psychological demands and, in some way to deal with these symptoms, however, they find themselves paralyzed and without knowing how to act. There is a certain inconsistency because, on the one hand, teachers are charged by the management to develop practices that include (meaningful learning, considering error, etc.) and, on the other, they need to complete extensive content at the end of a year. This is one of the examples of the teacher's discomfort when dealing with these impasses. " (LOPES, TEIXEIRA, 2019) For Almeida (2018, p) the Self-mutilation is nothing more than any intentional behavior involving direct aggression to the body without conscious intention of suicide and not socially accepted within the culture itself or for display, practiced by individuals who have few coping strategies, difficulty in regulating affection and limited problem-solving ability, prevailing mainly among school-age adolescents, a period in which this public is facing an identity crisis.
Researcher Skegg (2005)  As for the rates of attendance or monitoring of individuals with self-injurious behavior, Rocha (2015) highlights that because they happen in more private situations, they are usually not included in public health reports, being largely underreported.

SELF-INJURIOUS BEHAVIOR
The survey was conducted using an electronic form sent via a communication application (Whats App) containing 9 questions with closed questions. The form was sent in the period from October to November 2020. It is worth noting that the data collection was carried out at random using a group of young students from public elementary and high schools.
There is no way to count how many submissions were made, however 94 responses were collected, the results of which are presented below.
Regarding the age of the respondents, the data are shown in Graph 1:  (2019) The majority of survey participants (65%) are young people aged 15 to 17 years.
As for gender, 52.7% are female and 47.3% are male. Still on the profile of the respondents, 90.2% of the respondents answered that they are students from public schools and only 9.8% declared to study in private schools. This data serves as a guide for future preventive and educational work to be developed by the public school involving the theme. The research sought to identify self-injurious behavior among young people and the impacts on learning.
The stratification was carried out based on the answer indicated in question no. 4 (do you practice or have you practiced self-mutilation? A) Yes; b) No; c) No but, I know someone who exhibits self-mutilation behavior.
The responses revealed that 28.7% of the 94 respondents have already practiced self-mutilation, 18.1% know someone who practices or practiced self-mutilation and 53.2% stated that they do not or have never practiced self-mutilation (Graph 3). Regarding the age of the interviewees who answered to practice or have already practiced self-mutilation, we found that the majority (79%) are between 14 and 16 years old, 15% are 17 years old and 8% are 25 years old.
As for gender, 65% are female and 35% male. This data is consistent with several national and international studies that identified the prevalence of the disorder in However, we emphasize that a more in-depth look at the consequences of selfinjurious behavior for young people's school life is lacking in studies and research that address the topic.
As a continuation of the previous question, it was requested to mark the option that would indicate the consequence(s) more recurrent in his school life, from the occurrence of self-injurious behavior. The majority pointed out "other" consequences (85%) choosing not to point out "Failed in courses" or "Failed in grade / year". This data indicates the need for a more in-depth study on the subject. Reflecting on the consequences of self-mutilation, in addition to school problems such as retention or failure, Lopes and Teixeira (2019) highlight that the symptom of self-mutilation at school, can have serious consequences for the subject and institution, with regard to a certain type of paralysis in production, difficulty in socializing and inadequacy in the school space.
Asked whether the school in which they studied has knowledge of self-injurious behavior, 81.5% replied that they did not, 11.1% indicated that they are accompanied by the school's psychology or pedagogical sector and 7.41% stated that the school has knowledge but that is not accompanied by any professional. According to Cardoso (2019) "self-mutilation has been shown to be a public health problem due to its increasing exposure and manifestation in society." In this way, the school as a social institution cannot turn a blind eye to this problem, constantly seeking to develop educational and guidance projects such as prevention and welcoming the student who practices this behavior. According to Cardoso (2019) the students, mainly from public schools, may have a high risk of self-mutilating behavior, with or without suicidal ideation.
As for the triggering factor of self-mutilation (question 8), respondents indicated more than one triggering feeling, being that the most marked options were: feeling of guilt (77%), anxiety (77.1%) and anguish and family traumas (74%). According to Cardoso (2019) "self-mutilation is a way of expressing the unspoken through the language expressed by the body. " For the author, mutilations hide a series of individual meanings and sufferings that differ from one person to another. This suffering is often linked to problems such as anxiety, guilt and anguish. In this context, Lopes and Teixeira emphasize that, in school symptoms of adolescence appear disguised "by the name of anxiety, borderline disorder, dyslexia, depression" (2019, p 6).
In a study of young people and adolescents in Hungary, researchers found that self-harm "afeta several teenagers and is often comorbid with other psychiatric disorders" (HORVÁTH, MÉSZÁROS, BALÁZS, 2015) Question 9 "You received specialized medical care due to self-mutilation behavior", among the 26 respondents, 92.3% stated that they do not have any specialized medical follow-up as shown in Graph 8. It is important to point out that, in the specific case of the school institution, actions must be taken to identify, guide and notify competent authorities when cases of self-mutilation arise. In 2019 the Federal Government It instituted the National Policy for the Prevention of Self-mutilation and Suicide by means of Law No. 13,819, of April 26, 2019. According to the Law in its Art. 6, Items I and II: Suspected or confirmed cases of self-inflicted violence are subject to compulsory notification by: I -public and private health establishments to health authorities; II -public and private educational establishments to the tutelary council.
The referred Law aims, among others, "guaranteeing access to psychosocial care for people in acute or chronic psychological distress, especially those with a history of suicidal ideation, self-harm and attempted suicide" (BRASIL, 2019, Art 3).
For Geoffroy and Alberti (2015 apud LOPES, TEIXEIRA, 2019) at school, spaces of speech and dialogue can be created with the aim of rescuing the dimension of desire in educational action. For the authors, it is essential to guarantee a listening space that is confidential.
According to the study Self-mutilation: a public health problem? presented by Senator Carlos Henrique Neto, at the CPI of the Federal Senate in 2017, "people who self-mutilate experience negative emotions with greater frequency and intensity, with more difficulties in regulating these emotions" (NETO, 2017).
According to Almeida et al (2018, p.6) The pleasure of cutting is then the result of the possibility of relieving psychological tension by replacing a biological tension that happens with the return of the destruction impulse to the body itself.
For Lopes and Teixeira (2019) there is always an attempt to draw attention to the problems they are facing. This because In adolescents who practice self-mutilation, there is something that calls the Other's gaze to their cut, despite the attempt to hide them, for example, with bracelets or bands. An invitation is made to look to know what is behind these props (LOPES, TEIXEIRA, 2019) In this way, young people try to draw attention to their pain and their problem. It is a silent cry, often unheard of by the main caregivers of young people: their parents.
According to the document "Suicide and self-harm treated from the perspective of the family and the meaning of life" prepared by the Ministry of Women, Family and Human Rights, family participation is essential in monitoring cases of self-harm and suicides , in the same way that they emphasize that Scholars from different fields (...) understand that risk processes related to the family context stand out among the factors that predispose the occurrence of both. Most adolescent victims of suicide faced some family problem or suffered from needing protection or some kind of psychosocial support. (BRAZIL, 2019, p 25) Finally, the document highlights that One of the main strategies for the prevention of suicide and self-harm is the elaboration of pain through discourse. At this point, dialogue, listening and acceptance become central, as it allows the person to express and understand the extent of the problem. (BRAZIL, 2019, p 26)

SUMMARIZING
This study sought to gather data on two issues that are so challenging in the current scenario: the profile of young people who practice self-mutilation and the impacts on school learning. This theme was addressed in an attempt to bring to light this problem that has been characterized as a pandemic for many theorists who research the theme.
About the impacts on learning in high school students from public schools in the city of São José de Ribamar -MA, the research showed that the majority of adolescents and young people who exhibit self-injurious behavior recognize that there are damages to their school life that go beyond retention or failure in disciplines.
In this context, it is up to the school to intensify actions aimed at addressing the theme, discussing and enabling reflections on this behavior.
The school can expand its curriculum, adapting it and making it more flexible, making exceptions so that young people can move through other spaces in the school than just the classroom, although it is worthwhile as a time of study, whether that space is the library, a music room, arts as an additional place within the school to improve the well-being of students.
We found that self-injurious behaviors are a public health problem and that is why it is necessary to invest more in research on the topic, in order to fill the data gap as a percentage of adolescents and young people who practice self-mutilation, the percentage of young people attended or under treatment, among others.
Finally, we understand that there is a need for greater investment in public policies that specifically target prevention and health promotion for this population that practices self-mutilation.