What is Self-Harm?
Self-harm is a “coping strategy” that enables the individual to deal with feelings and
Hair pulling (trichotillomania)
Causing bruising to the body
This is by no means an exhaustive list.
The most common ways that people self-harm are cutting their arms or legs, although many people self-harm in other ways. Most admissions to hospital through self-harm are because of overdosing.
What is it not?
Self-harming is not a sign that the young person is mad or bad. It is also not a means of seeking attention. Self-harm is not effective as a long term strategy for managing strong and difficult feelings. Because of the feelings it can trigger in itself, it can actually make things worse in the long-run.
Why Do People Self Harm?
People self-harm to help themselves feel more in control or get an immediate relief from high levels of stress or distress. It is important to remember that selfharm is not attempted suicide but something that people do in order to survive and stay alive.
You may not realise the individual is experiencing these difficulties that can lead to self-harm, it is very often hidden from the rest of the work, individuals can become withdrawn and isolated, and secretive about their feelings and selfharm.
It is not clear why some people self-harm, even without knowing the reasons, however, young people might be clear about what self-harming does for them. Some possible reasons may be: The causes of self-harm are the things that set if off in the first place – not necessarily what makes the individual continue to self-harm.
Abuse (sexual, emotional or physical)
Family financial difficulties
Housing problems relationship trouble
Coming to terms with sexuality
For some individuals, an episode of self-harm may be triggered by a significant life event, but for others the day to day fluctuation in their thoughts and feelings is too much to bare, Sometimes individuals go for months without harming themselves and others self-harm daily. Simple stresses such as being late to lesson or not getting their hair right might be enough to create a tension so overwhelming in the individual that they self-harm to cope with this. For some, shelf harm can became a habit; something they routinely do to survive on a day to day basis because they don’t know what else to do. Sometimes even positive feelings can create overwhelming feelings that the individual does not know how to manage.
How you can help?
For all individuals the starting point for recovery is to become aware of their reasons for, and drives to self-harm, recovery is always possible, however lost and overwhelmed the person feels. Seeking help can be difficult, however, because of the feelings of guilt and shame it can create.
It is really important to remember that self-harm is VERY different to suicidal intent,but at times the two may be close. Someone who is suicidal feels as if they can’t take anymore and their only option is to end their life, whereas someone who selfharms feels that they can’t take anymore (of whatever they are feeling) and their only option is to harm themselves in order to stay alive.
If you tell them to STOP when they’re not ready, imagine what they could feel their only option is.
Most importantly the best way to deal with self-harm is to stay calm, try not to be alarmed or show your fears. There are many things that can help, try and encourage the individual to try some of the suggestions below:
Complete a diary to express how they are feeling, this can also be used to
monitor patterns and identify times when the self-harm has occurred.
Talk to someone
The 10 minute rule – when the urge comes to self-harm try postponing for 10
minutes. This may feel more manageable than telling themselves to not to do
it and may help to reduce the intensity of the emotions.
Scribble on sheets and sheets of paper
Write (stories, poetry, journal)
Cuddle a soft toy
Be with other people
Watch a comedy
Post on web boards and answer others’ posts.
Paint their nails
Eat something sweet
Call a friend and ask for company
Sing/Play an instrument
Punch a punch bag
Snap an elastic band or hair band around the wrist
Let them cry
Go to bed and sleep
Have a relaxing bath
Paly with a pet
Read a book
Encourage to make their own list of things to do instead.
The list is endless
What can you do?
Supporting someone who self-harms can be very difficult and challenging. Knowing that someone you care about is in emotional distress can create many feelings including fear, anger, frustration, helplessness and sadness. Try to make sure you have a way of dealing with your own feelings as the person you are supporting is going to need all the patience, understanding and support you can give.
Recognising their signs of distress and finding a way of talking to them
about how they are feeling.
Listen to their worries and problems and take them seriously.
Offer sympathy and understanding – reduce the shame and isolation
providing an unconditional relationship.
Help them to think of alternative ways of coping and solving problems.
stay calm and in control of your own feelings- try not to be alarmed or
show your fears
Being clear on the risks of shelf harm, making sure they know about
them and know that, with help, they will be able to stop and sort their
problem in another way.
Support them in getting additional help (from GP, school and mental
Remain mindful that even if the child in your care is learning how to
self-regulate, expecting them to manage their emotions alone, no
matter how old they are, is unrealistic.
Treat emotional outbursts from your child, even extreme anger, as an
expression of a legitimate emotional expression, even when it appears
fake and/or unnecessary. Try to avoid the temptation to manage it with
When behaviour has to be stopped (because it is dangerous), the
strength of your love for your child must be as strongly (if not more
strongly) communicated as our disapproval of their behaviour.
Medical treatment for self-harm
Pin point them to a first aid kit and encourage them to look after
themselves by using clean implements to cut with, for example, or not
to cut too deeply to avoid damage to tendons and muscles.
This might be the first step to recovery but must be mutually agreed
and not imposed. We know this may feel very difficult for you, but this
method of patience and care may be very influential in promoting
health and recovery, and may be enough to help the person feel back
in control, accepted and less isolated.
Be aware that going to the GP or A & E for treatment of self-harm is
most likely going to be difficult experience for someone who self-harms
as this is a very public arena for a very private act. If this is the case
the individual should expect to be treated sensitively and with the same
level of care and attention as any other patient. (There are set
guidelines produced for NHS staff to advise them how they should treat
people who self-harm). Unfortunately this is not always the case, and it
will help if you are prepared and able to advocate for the person who
has harmed themselves.
Try and ensure the individual is given a private area to speak to the
health care professional and that they are given a choice of their
treatment – even if their choice is one you disagree with.
If the person is bleeding heavily, has taken an overdose or ingested a
substance, always take to A & E as this could be life threatening.
Support for Young People
Self-harming will only ever be a temporary solution to the emotions they are
feeling and it can become a negative cycle. That is why it is so important to
get help as soon as they can.
Please encourage them to talk to someone about their feelings. Their doctor,
a school nurse or a trusted adult/teacher can help them find the right person
to speak to.
• Text Health for Teens – for helpful and confidential advice, young people
aged between 11-19 can text their Public Health Practitioner (school nurse)
on 07507 329952
• KOOTH on-line counselling is a free counselling service which is
accessible to young people aged 11-25 living within Nottinghamshire
• Papyrus provide confidential help and advice to young people to prevent
suicide www.papyrus.co.uk or 0870 170 4000
• Calm Harm APP – This App provides tasks that help support you to resist or
manage the urge to self-harm. You can add your own tasks too and it’s
completely private and password protected www.stem4.org.uk
• Young Minds www.youngminds.org.uk 0808 8025544
• Child line 0800 1111
• Samaritans 116 123 www.samaritans.org
• Harmless is a user led organisation which provides support, information,
training and consultancy around self-harm. Www.harmless.org.uk. Harmless
run The Tomorrow Project which is a confidential suicide prevention
• www.healthforteens.co.uk has specific guidance on self-harm
Contact details for support
CAMHS Single Point of Access: 0115 854 2299
CAMHS Crisis team: 0115 844 0560
MASH: 0300 500 80 90