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Self-harm

Self-harm is when someone injures or harms themselves on purpose. Common examples include `overdosing' (self-poisoning), hitting, cutting or burning themselves, pulling hair, picking skin and self-strangulation.

Self-harm affects one in five children and young people and spans the divides of gender, class, age and ethnicity.

Some young people use self-harm as a way of trying to deal with very difficult feelings that build up inside. It’s always an expression of emotional distress. However, it’s not always a symptom of a mental health disorder.

People say different things about why they self-harm:

  • It helps them to feel more in control
  • It helps to relieve the tension they feel
  • It’s a way of punishing themselves
  • It’s a way of feeling more connected and alive

There are many signs you can look out for which can indicate if a young person is in distress and maybe harming themselves, or at risk of self-harm. The most obvious are physical injuries:

  • You observe injuries on more than one occasion
  • You observe injuries that are too neat to be accidental
  • You observe injuries that are inconsistent with how the young person said they happened

Other warning signs include:

  • Secrecy or disappearing at times of high emotion
  • Long or baggy clothing covering arms or legs even in warm weather
  • Increasing isolation or unwillingness to engage
  • Avoiding changing in front of others during PE, shopping or sleepovers
  • Absence or lateness
  • Low mood or irritability
  • Negative self-talk about feeling worthless
  • Appearing hopeless/aimless

The risk of serious self-harm or suicide is higher if the young person:

  • Is depressed, or has a serious mental illness
  • Is using drugs or alcohol when they’re upset
  • Has previously tried to kill themselves, or has researched suicide and made plans about how to die without being saved
  • Has a relative or friend who attempted or died by suicide
  • Has attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) which impact on understanding and impulsive behaviour

If you think a young person might be self-harming, the most important thing to do is to remain calm and listen to them. Self-harm is often seen as a coping mechanism, albeit an unhealthy one, to adversities and distressing emotions that are difficult to comprehend.

Be empathetic and non-judgemental. The young person is in a vulnerable situation and they need to feel safe when asking for help. Be mindful of body language. Opening up about self-harm is difficult and the young person is looking for signs of judgement so it’s important not to show those.

If they’re not engaging in the conversation, focus on talking to them about other things to encourage them to feel more comfortable in talking about sensitive topics with you.

Working with a young person who has disclosed they are self-harming is vital. Don’t take control away from them by telling them what to do.

Listen

Listen to what they’re saying, watch what they’re doing. Self-harm is a sign of distress.

Empathise

Take time to sit down and talk with them before risk-assessing the situation. Focus on engaging and developing a relationship with them.

Ascertain

What is the intention behind the self-harm? Is there an identified trigger? What were they expecting to happen after self-harming? It’s okay to ask them some questions and, if they’re having difficulty expressing themselves verbally, try another means of communication such as asking them to write how they’re feeling.

Reflect

Show them that you’ve listened. Summarise what they said. Don’t tell them to stop self-harming if they don’t feel able to. Do talk to them about what they might do instead to manage the distressing emotions. Alternative methods such as ice cubes, drawing on skin or exercise can be helpful.

Normalise

Don’t be afraid to speak about mental health. It’s vital to break the stigma and okay to use the term self-harm in conversation.

Be honest with them and say that if you feel they’re at serious risk, you’ll need to share your concerns with a healthcare professional, who might be better able to help. If they don’t want you to share information, try to find out why and address their concerns. Where possible, involve them in making decisions.

To support young people in times of distress, you’ll need to set up regular meetings with a trusted adult, such as a school counsellor or a form tutor who can provide support and guidance.

If the young person is self-harming by cutting or harming themselves in ways that don’t immediately seem serious, it’s still important that they seek help from their GP or other healthcare professional.

If there are indications of serious physical harm, they should be referred to the nearest Accident and Emergency department.

A young person should only be taken to A&E (or call for an ambulance) if they require urgent life-threatening emergency medical attention such as if they have: 

  • Recently taken an overdose
  • Ingested harmful liquids
  • Cut themselves significantly (deep cut/s and/or bleeding profusely)
  • Burns that are blistering/red
  • Lost consciousness 

If no medical intervention is required but you require urgent advice about a young person’s mental health and risk, call NHS 111.  

NHS 111 can help if you have an urgent physical or mental health problem and you’re not sure what to do. The service is available 24 hours a day, 7 days a week for people who need help fast, but it is not an emergency.

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