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 ways of committing suicide and made plans about how to die without being saved
- Has a relative or friend who attempted or committed 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 to what they’re saying, watch what they’re doing. Self-harm is a sign of distress.
Take time to sit down and talk with them before risk-assessing the situation. Focus on engaging and developing a relationship with them.
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.
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.
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 a significant risk of serious harm, they should be referred to the nearest Accident and Emergency department.
You can find additional help online by visiting:
- Samaritans: urgent support
- ChildLine: urgent support for young people
- Selfharm: advice and resources for those affected by self-harm
- MindEd: resources and training on young people’s mental health issues
- Charlie Waller Memorial trust: resources for parents and professionals
- Young Minds: support for young people
- National Self-Harm Network: resources for young people dealing with self-harm
- Oxford University: information for parents
- Mental Health Foundation: Truth about self harm
- Young minds: coping with anxiety
- Young minds: coping with depression
- Young minds: self harm support