Self-harm

Many people who self-harm will eventually stop self-harming on their own. However, a great deal of support and treatment is available. With support it may feel easier to make changes that help reduce or stop you self-harming.

There are many different ways that someone who self-harms can be helped, so any help and treatment can be geared to your own needs and wishes. The help that can be provided includes support from friends and family, help from GPs and other healthcare professionals, including the specialists at the community healthcare team, help and advice from support groups, and different talking therapies.

What is self-harm?

Self-harm is when you deliberately hurt yourself as a way of dealing with difficult feelings, painful memories or overwhelming situations and experiences. This may be causing yourself a physical injury or by self-poisoning (which may be alcohol, drugs or an overdose of a medicine).

After self-harming you may feel a short-term sense of release, but the cause of your distress is very unlikely to have gone away. Self-harm can also bring up very difficult emotions and could make you feel much worse.

Why do people self-harm?

There are many different reasons why people self-harm, including to:

• Express something that they feel unable to put into words.

• Reduce overwhelming emotional pain.

• Have a sense of being in control.

• Escape traumatic memories.

• Punish themselves for their feelings and experiences.

• Stop feeling numb or disconnected.

• Express suicidal feelings without taking their own life.

Risk factors

Risk factors for self-harm include:

• Age. Self-harm is most common in women aged 16-24 years, and in men aged 25-34 years.

• People at social and financial disadvantage.

• Being socially isolated.

• Stressful life events - eg, relationship difficulties, previously in the armed forces, child maltreatment, or domestic violence.

• Bereavement.

• Mental illness - eg, depression, bipolar disorder, or post-traumatic stress disorder (PTSD), or a personality disorder (including borderline personality disorder).

• Chronic physical health problems.

• Alcohol or drug misuse.

• Involvement with the legal system, especially in prison.

Signs and symptoms of self-harm

The types of self-harm include:

• Cuts or burns. This can cause even further distress during hot weather when it is harder to keep cool and keep any cuts or burns covered up.

• Punching yourself.

• Poisoning yourself with medicines.

• Alcohol or drug misuse.

• Eating disorders, such as deliberately starving yourself (anorexia nervosa), binge eating or bulimia.

Because people often try to keep self-harm a secret by covering their skin and avoid discussing the problem, it is often up to close family and friends to notice when somebody is self-harming. The signs may include unexplained injuries and signs of depression or low self- esteem.

How to stop self-harm

• Writing down your feelings can help you to express how you feel.

• Reading about mental health issues and treatment may help by increasing your understanding, and can be reassuring to know you're not alone.

• If you struggle with suicidal thoughts, it may help to make a safety plan to use if you need it. The Staying Safe website has a guide on how to make a safety plan. See the link in 'Further Reading' below.

• Although a friend or family member can often provide a lot of support, often outside support is also needed to help you make positive changes. You may need to try a few different things to find what work for you, and combine self-help with professional support, such as your GP, mental health professionals, talking therapies, support groups, and online support.

• A health professional, including your GP or psychiatrist, will discuss all your options with you, and your views and preferences will be taken into account when making decisions about your treatment. Any treatment you are given will be tailored to your needs and wishes.

How to help someone who self-harms

There are lots of things you can do to help someone you know who self-harms. It is extremely important to provide support and relate to a person who self-harms in a way that:

• Is non-judgemental and has empathy and understanding.

• Relates to them as a whole person, not just their self-harm.

• Lets them be in control of their decisions.

• Reminds them of their positive qualities and things they do well.

• Is honest, including any fears you have.

• Appreciates that distress can make it very difficult for a person to communicate what they need.

It is very important not to:

• Try to force change.

• Act in a way that threatens to take control away from the person who is self- harming.

• Either ignore or overly focus on their injuries.

Take care of yourself

Supporting someone who is self-harming can be a difficult process. Taking care of yourself is essential and will enable you to continue to help the person who is self-harming more effectively.

Have clear boundaries about how much and what sort of support you can offer. Find out what other support is available. Young Minds offers support for parents, and Sane and Self injury Support runs support services for people concerned about someone else's mental health. See links in 'Further Reading' below.

It may be helpful to try a talking treatment such as counselling if you are finding things difficult.

When to seek emergency help

Self-harm doesn't often mean that someone wants to end their life. However, a small number of people who self-harm do go on to take their own lives, either intentionally or accidentally.

Have an honest conversation with your friend or family member about staying safe, including being aware when things are getting too much and knowing when to seek help. The Staying Safe website has a guide on how to make a safety plan. See the link in 'Further Reading' below.

How to prevent self-harm

Try working out if there are any particular triggers, such as feeling a certain way, that lead you to self-harm. Then try to react to any trigger in a safer way.

Try to find less harmful methods of self-injury, such as using ice cubes or rubber bands, and avoiding sharp objects. Try to avoid self-poisoning completely.

Find ways to prevent or distract yourself from self-harm when you feel a strong urge to self- harm. Distract yourself by going out for a walk, listening to music, or doing anything that is harmless and interests you.

Try waiting before self-harming. The need to self-harm will often gradually pass over time.

Try relaxation exercises such as breathing exercises.

Where to get help for selfharm

Whoever is supporting you is there to help you and listen to you. It is important that you don't feel pressured into making decisions, and that anything you decide is realistic for you at the time.

Being totally honest and sharing your thoughts and experiences can make a big difference to how you feel and getting the most out of any help and support you need.

As well as talking about your feelings to friends and family, another option is to contact Samaritans if you need someone to talk to. See the link in 'Further Reading' below.

Both you and any untrained person supporting you will also find help by finding out ways to learn more, such as from an organisation for people who self-harm, such as Self-injury Support, LifeSIGNS and Harmless. See the links in 'Further Reading' below.

Writing down all the things you'd like to say in advance will help you to remember all the things you'd like to say and ask, and may also help you to feel less anxious about expressing your feelings.

Talking therapy involves talking with a professional therapist. Cognitive behavioural therapy, dialectical behaviour therapy and psychodynamic therapy can all be effective, particularly helping you with problem solving. Your GP can often help advise where you can go, or refer you for talking therapies. See also Refer Yourself for Talking Therapy.

Treatment for scars
Some but not all people who self harm prefer not to have any visible scars. There are treatments available for covering and reducing scarring.

How a GP can help with self-harm

Seeing your GP is often the first step to asking for help and discussing your self-harm confidentially. Your GP may:

• Let you know about available treatment, including immediate or urgent help if you are at risk of suicide.

• Provide treatment or specialist referral for any mental health issues, such as anxiety or depression.

• Refer you to a mental health professional. This usually involves a referral to the local specialist community mental health team (CMHT) or, for younger people, the Child and Adolescent Mental Health Services (CAMHS), which can include psychiatrists, psychologists, social workers, occupational therapists and community psychiatric nurses.

• Provide information about local and national sources of support, groups, and voluntary organisations.

• Monitor your physical health, including advice, treatment (camouflage) or referral to help with scarring.

Specialist mental health services

Specialist mental health services can provide further information and help, including:

• Helping you to to reinforce and develop coping strategies to reduce or stop self- harm, such as relaxation and distraction techniques.

• Providing advice and support that can help you deal with scarring.

• Providing psychological treatments (talking therapies), such as cognitive behavioural therapy.

• Helping you to develop an individual care plan, including to improve how you function in your social life and with studies or work.

• Managing any associated mental health problems.

• Providing a crisis plan that outlines self-management strategies, contact numbers and information about what to do and who to contact in a crisis.

Further information and support

See the links in 'Further Reading' below for sources of information and support.

Support groups hold regular meetings with others who have similar experiences to you. Support groups can be led by someone who self-harms, or facilitated by a person trained in helping people who self-harm.

Online support is an option if you don't feel ready to see someone face to face. Email, text, information or forum support is offered by many self-harm services, such as National Self Harm Network, Self injury Support, LifeSIGNS, and The Mix, and Sane. See links in 'Further Reading' below.