What is self-harm?
Self-harm is a term used when someone injures or harms themself on purpose rather than by accident. Common examples include overdosing (self-poisoning), hitting, cutting or burning oneself, pulling hair or picking skin, or self-strangulation. Self-harm is always a sign of something being seriously wrong.
Why do young people harm themselves?
Some young people use self-harm as a way of trying to deal with very difficult feelings that build up inside them. This is clearly very serious and can be life-threatening. People say different things about why they do it.
- Some say that they have been feeling desperate about a problem and don't know where to turn for help. They feel trapped and helpless. Self-injury helps them to feel more in control.
- Some people talk of feelings of anger or tension that get bottled up inside, until they feel like exploding. Self-injury helps to relieve the tension that they feel.
- Feelings of guilt or shame may also become unbearable. Self-harm is way of punishing oneself.
- Some people try to cope with very upsetting experiences, such as trauma or abuse, by convincing themselves that the upsetting event(s) never happened. These people sometimes feel ‘numb’ or ‘dead’. They say that they feel detached from the world and their bodies, and that self-injury is a way of feeling more connected and alive.
- A proportion of young people who self-harm do so because they feel so upset and overwhelmed that they wish to end their lives by dying by suicide. At the time, many people just want their problems to disappear, and have no idea how to get help. They feel as if the only way out is to kill themselves.
Who is at risk?
An episode of self-harm is most commonly triggered by an argument with a parent or close friend. When family life involves a lot of abuse, neglect or rejection, people are more likely to harm themselves. Young people who are depressed, or have an eating disorder, or another serious mental health problem, are more likely to self-harm. So are people who take illegal drugs or drink too much alcohol.
Many young people who self-harm with a wish to die by suicide also have mental health or personality difficulties; often the suicide attempt follows a stressful event in the young person's life, but in other cases, the young person may not have shown any previous signs of difficulty.
Sometimes the young person is known to have long-standing difficulties at school, home or with the police. Some will already be seeing a counsellor, psychiatrist or social worker. There has been an increase in the suicide rate in young men over recent years.
The risk of suicide is higher if the young person:
- Is depressed, or has a serious mental illness.
- Is using drugs or alcohol when they are upset.
- Has previously tried to kill themself, or has planned for a while about how to die without being saved.
- Has a relative or friend who tried to kill themself.
How can I help?
- Notice when the young person seems upset, withdrawn or irritable. Self-injury is often kept secret but there may be clues, such as refusing to wear short sleeves or to take off clothing for sports.
- Encourage them to talk about their worries and take them seriously. Show them you care by listening, offer sympathy and understanding, and help them to solve any problems.
- Buy blister packs of medicine in small amounts. This helps prevent impulsive overdoses. Getting pills out of a blister pack takes longer than swallowing them straight from a bottle. It may be long enough to make someone stop and think about what they are doing.
- Keep medicines locked away.
- Get help if family problems or arguments keep upsetting you or the young person.
- If a young person has injured themself, you can help practically by checking to see whether injuries (cuts or burns for example) need hospital treatment and if not, by providing them with clean dressings to cover their wounds.
As a parent, it is really hard to cope with a child/young person with self-harming behaviour or who attempts suicide. It is natural to feel angry, frightened or guilty. It may also be difficult to take it seriously or know what to do for the best. Try to keep calm and caring, even if you feel cross or frightened; this will show your child you can manage their distress and they can come to you for help and support.
This may be difficult if there are a lot of problems or arguments at home. Or, you may simply feel too upset, angry or overwhelmed to effectively help your child/young person. If so, you should seek advice from your GP.
If you are a teacher, it is important to encourage students to let you know if one of their friends is in trouble, upset or shows signs of harming themself. Friends often worry about betraying a confidence and you may need to explain that self-harm is very serious and can be life-threatening. For this reason, it should never be kept secret.
Where do I get specialist help?
Everyone who has taken an overdose or tried to kill themself needs an urgent assessment by a doctor as soon as possible, even if they look OK. Usually, this means an examination at the nearest emergency department (also known as A&E). If you are unsure whether the young person was suicidal or not, it is best to act cautiously and take them to hospital. With overdose, the harmful effects can sometimes be delayed, and treatment with medication may be needed. Paracetamol is the most common medicine taken as an overdose in Britain. It can cause serious liver damage, and each year this leads to many deaths. Even small overdoses can sometimes be fatal.
If the young person is self-harming by cutting themself or in other ways, it is still important that they have help. Speak to your GP who can refer you to your local child and adolescent mental health services (CAMHS).
How is self-harm treated?
All young people who attend hospital following attempting suicide or harming themselves should also have a specialist mental health assessment before leaving.
It is often difficult to work out what prompted the young person to self-harm or whether they actually wished to die by suicide or not; mental health professionals have the expertise to make sense of these complicated situations.
It is usual for parents or carers to be involved in the assessment and any treatment. This makes it easier to understand the background to what has happened, and to work out together whether more help is needed.
Assessments in emergency departments (A&E) which include a short ‘talking therapy’ session have been shown to help young people come back for ongoing help and support. A lot of young people self-harm or make another suicide attempt if they do not receive the help they need.
Usually, treatment for self-harm and attempted suicide, other than any immediate physical treatment, will involve individual or family ‘talking therapy’ work for a small number of sessions. They will need help with how to cope with the very difficult feelings that cause self-harm.
Clear plans on how to help and how to keep the young person safe will also be made. Some people who find it very difficult to stop self-harming behaviour in the short term will need help to think of less harmful ways of managing their distress.
Families often need help in working out how to make sure that the dangerous behaviour does not happen again, and how to give the support that is needed. This is something your local CAMHS should have on offer.
Long-term specialist help
If depression or another serious mental health problem is part of the problem, it will need treatment. Some young people who self-harm may have suffered particularly damaging and traumatic experiences in their past. A very small number of young people who try to kill themselves really do still want to die. These two groups may need specialist help over a longer period of time.
Further reading and references
- Bailey S, Shooter M (eds) The Young Mind: An Essential Guide to Mental Health for Young Adults, Parents and Teachers. RCPsych Publications, 2009
- Changing Minds - A Multimedia CD-ROM, Royal College of Psychiatrists CD
- Self-harm: The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care (CG16), NICE, 2004
- Self-harm: longer-term management (CG133), NICE, 2011
- Ougrin D, Zundel T, Ng A, et al. Trial of Therapeutic Assessment in London: randomised controlled trial of Therapeutic Assessment versus standard psychosocial assessment in adolescents presenting with self-harm. Arch Dis Child 2011; 96: 148-53
- Hawton K, Harriss L. Deliberate self-harm in young people: characteristics and subsequent mortality in a 20-year cohort of patients presenting to hospital. J Clin Psychiatry 2007; 68: 1574-83
- National Self Harm Network
Content used with permission from the Royal College of Psychiatrists website: Self-harm in young people: information for parents, carers and anyone who works with young people (March 2012, due for review March 2014). Copyright for this leaflet is with the Royal College of Psychiatrists.