Self-harm

Overview

• Self-harm is harming yourself on purpose. Such as by scratching, cutting, overdosing on medication, biting or burning.
• Self-harm isn’t a mental illness, but it is often linked to mental distress.
• You may self-harm because you find it difficult to cope with your moods or how you feel. Everyone has their own reasons for self-harming.
• Drinking a lot of alcohol or taking drugs may increase your risk of self-harm.
• You are more at risk of accidental suicide through self-harm.
• You’re more likely to self-harm as a young person.
• Your doctor can help if you want to stop self-harming. They might refer you for specialist support.
• Sharing your feelings with someone you trust can help you to self-harm less and make you feel less alone.
• It can be hard to know how to support someone who self-harms. Being patient and listening without judgement can help.

About

What is self-harm?

Self-harm means that you harm yourself on purpose. Self-harm isn’t a mental health condition, but it is often linked to mental distress.

It is common for people to self-harm in secret. You may do this because you feel as though your thoughts and feelings aren’t acceptable to other people. You might feel anxious about what they think.

Self-harm can be both distressing for you and your loved ones. This is because they may not be able to understand why you self-harm.

People self-harm in different ways such as the following:

• Cutting
• Burning
• Scalding with hot water
• Banging or scratching your body
• Sticking sharp objects into your body
• Eating or drinking things that are poisonous
• Not letting wounds heal
• Taking too many tablets, known as an ‘overdose’

You are more likely to self-harm if you take illegal drugs or drink too much alcohol.

Who self-harms?

Self-harm is more common in young people who live with depression and anxiety. But it does affect adults without a mental health problem too.

You are more likely to self-harm if you:

• have a mental health issue such as:
  
  • depression,
  • anxiety,
  • borderline personality disorder, or
  • an eating disorder,
• have a substance abuse issue,
• are female,
• are a young person,
• are in prison,
• are an asylum seeker,
• are a veteran of the armed forces,
• are gay, lesbian or bisexual,
• have lost a loved one through suicide, or
• are a survivor of physical, emotional or sexual abuse as a child or as an adult.

Why do people self-harm?

People self-harm for different reasons. These reasons may change over time.

You might self-harm to:

• deal with strong emotions like anger or sadness,
• punish yourself for things you think you’ve done wrong,
• make yourself feel normal,
• make others aware of how you are feeling,
• distract yourself from feelings, or
• get relief from feelings.

You may self-harm to manage feelings

Being overwhelmed by feelings is a common reason that people self-harm. Often these will be feelings such as sadness, guilt and hopelessness.

You may self-harm because you find it difficult to put your feelings into words. You may find your emotions physically uncomfortable. Or you may be aware of how you are feeling. But you may feel that your emotions are unmanageable or unacceptable.

Physical pain can distract you when you are in emotional pain. For a lot of people self-harm releases tension, brings relief and helps to relieve pressure. Even if you don’t understand why you are feeling this way. ,

You may self-harm to communicate

You may self-harm to try and show others how you feel. Some people may think that you are attention-seeking. This is a common misunderstanding. Most people try to hide their self-harm behaviours from family and friends.

Some people may self-harm to communicate to others how they are feeling. But this might not be the only reason behind the self-harm.

You may self-harm to have control

Self-harm can be a way of feeling in control of your body or your environment.

You may self-harm if you dissociate, so that you can feel real. Dissociation means that you feel like you are detached from yourself, or from reality.

You may self-harm so that you feel ‘normal.’ Self-harm may be a method that you use to stay in control of your day-to-day life.

See our webpage on Dissociation and dissociative disorders for more information.

You may self-harm to punish yourself

You may self-harm to punish yourself for feelings or behaviours that you think are your fault. Even if you didn’t do anything wrong, you may feel like you hate yourself.

This is a common reason why people self-harm. You may not understand why you feel like this. You may not be able to link your feelings to something that has happened.

You may punish yourself through displaced anger. For example, you may be very angry towards a person or about a situation. But you are unable to tell the person how you are feeling or sort the situation out.

Whatever the reason for your self-harm, there is support available to help you. See further down this page for more information.

Self-harm and suicide

Do people self-harm more than once?

Many people self-harm to deal with distress. You may self-harm often or only every now and again. Everyone’s experience is different.

Self-harm can become a normal way of dealing with life’s difficulties because of the temporary relief it brings.

Think about being in a dentist’s chair. Some people may dig their fingernail into their thumb to distract themselves from physical pain or fear. But this is a one-off event. They will stop when the dentist steps away from them. For people with an underlying emotional issue, it’s not so straight forward.

Self-harm only provides temporary relief because the underlying issue is still there.

The earlier you get help, the easier it will be to learn other ways of coping and work towards recovery.

People who have self-harmed for many years can find it difficult to stop and it can take a lot of work. But it’s important to know that many people do learn to cope better and recover.

Is there a link between self-harm and suicide?

People who self-harm don’t usually want to die. You may self-harm to deal with difficulties you face in life, rather than a way of trying to end it.

But self-harm can increase your risk of suicide. You may unintentionally end your life.

Disclosing self-harm

How can I tell someone I self-harm?

You might feel that you are the only one who self-harms. You might feel like people close to you won’t understand. But there are ways to reach out to ask for help.

Sharing your experiences can help your recovery. You don’t have to tell someone in person if you would prefer not to. You can write it in a letter, email, or make a video or audio recording for them.

Below are some things to think about when you are going to tell someone.

Who do I tell?

Decide who you want to tell first. Choose someone you feel comfortable with. Communicating how you are feeling with someone else can help you figure out how you feel about it and if you want to tell others. For example, you may want to tell:

• a friend or family member,
• your GP,
• someone on an emotional support line, where you can remain anonymous if you prefer.

If you’re anxious about telling your GP, your friends and family may be able to support you.

What do I tell them?

Think about what you are going to say before you begin your conversation. It can help if you know what you want to say and how you want to say it. You could try practicing saying it out loud to hear how it will sound to someone else. Or you could record yourself saying it on a device such as your phone and listening back to it.

Whoever you tell might ask you questions. Think about the questions they may ask and how you may answer their questions. They might ask things like ‘why are you self-harming?’ or ‘how long have you been self-harming?’. Remember, only share information that you are comfortable with.

When do I say it?

Try to find the right time to tell someone. Make sure they aren’t distracted with something else. Make sure you’re not upset or angry. Even something as simple as being hungry or tired can make it hard to focus and deal with information. Choose a time that suits you both.

Where do I tell them?

Think about where you are going to tell them. You may want this to be a private place so that others can’t overhear. Pick a place where you feel safe and are both comfortable.

Why am I telling them?

Don’t assume they understand why you’re telling them. Let them know. You might tell them because:

• You want to share that you self-harm.
• You want to share how you are feeling.
• You want support to stop self-harming.

What do I do if they struggle to understand?

Other people may struggle to understand why you self-harm, even some professionals. But this doesn’t mean that they don’t care or don’t want to help you.

Be patient with them. Do your best to answer their questions to help them understand what’s going on for you. This will help them find the best way to support you.

Help and treatment

What professional help can I get?

If you want professional help to manage and recover from self-harm, you can make an appointment with your GP. You may find it difficult to ask for help. But remember that GPs are trained to deal with these conversations and are used to talking about mental health with their patients.

Be as honest as you can be about your self-harm. This will help professionals to find the right support for you. People self-harm for different reasons.

Don’t give up if the first treatment option you try doesn’t work for you. There are different treatment options, other treatments might be better for you.

The National Institute for Health and Care Excellence (NICE) produces best practice recommendations for health care providers to follow to support someone who self-harms. The NHS don’t have to follow them, but there should be good reason if they don’t.

You can access the NICE guidelines by clicking on the following link:
www.nice.org.uk/guidance/ng225/chapter/Recommendations#interventions-for-self-harm

What support will I get from my GP?

Your GP can support you with self-harm. Your GP will listen and discuss with you the best treatment options for you.

Your GP should:

• Offer regular appointments to review self-harm,
• Review any medication you are taking,
• Give you information about social care, voluntary and non-NHS support and self-help resources. Such as finding local support groups, and
• Care for any other mental illness you have, such as referring you to a mental health service if needed.

Prescribing medication
Your GP or healthcare professionals should think about the following when deciding if medication is the best option for you:

• The toxicity of the medication if you are at risk of overdose.
• Your alcohol or drug consumption.
• Your access to other medication prescribed to yourself or others.

Communicating with other professionals who are prescribing you medication.

How do I get referred to a specialist mental health team?

Your GP may think about referring you to a specialist mental health team for a psychosocial assessment if:

• you ask for further support from mental health services,
• your GP is concerned about you,
• your levels of distress are getting worse, are high or are there all the time,
• you are self-harming more often, or more severely, or
• your suicidal thoughts are getting worse.

Mental health services may become responsible for your mental health treatment and care, rather than your GP.

What is a psychosocial assessment?

A psychosocial assessment should be done with you as early as possible following an episode of self-harm.

The assessment will be carried out by a healthcare professional such as your mental health team.

The assessment is there to:

• help you to get the care that you need,
• develop a therapeutic relationship with you,
• begin a shared understanding of why you may have self-harmed,
• give you information about your symptoms or diagnosis, and
• give your family member or carers information about your symptoms or diagnosis. But only if you would like them to be involved.

The assessment should happen in a private area so that you and health professionals can speak without being overheard.

Your needs and preferences should be considered during the assessment. Such as:

• making adaptations for a mental health condition you may have, and
• offering you a healthcare professional of the same sex if you have requested this.

As part of the assessment the health professional will ask you about:

• Things that have happened in the past.
• What is happening for you now.
• If anything has changed for you.
• If there is anything due to happen in the future which may be difficult. Such as an event or specific date.

As part of the assessment the health professional will think about:

• Your wishes, values and what matters to you.
• Any other mental health problems you may have.
• Your treatment and support needs. Such as talking therapy, social care, or rehabilitation.
• Your treatment preferences.
• Treating each episode of self-harm separately. This is because your reason for self-harm may vary from episode to episode
• If your family members or carers should be involved.

Do I get a care plan?

Following your psychosocial assessment health professionals should work with you to either:

• review your existing care plan, or
• develop a new care plan.

Your care plan should be created based on your support needs and safety needs identified during the psychosocial assessment.

Your care plan usually outlines:

• your support needs,
• your safety needs,
• what is needed to support your recovery, such as treatment or social care, and
• which professionals are involved in your care.

You should be given a copy of your care plan. The plan should also be shared with healthcare and social care professionals involved with your care.

Do I get a care coordinator?

If you have frequent episodes of self-harm, or your treatment has not been successful, your care plan should be reviewed.

You will work with professionals from different teams to agree on a joint plan. Your family or carers should also be involved if you agree.

You will also be given a trained professional to coordinate your care and act as a point of contact.

Who will be involved with my care plan?

In 2022 a law called ‘Health and Care Act 2022’ was introduced to make it easier for the NHS and care providers such as social services and the voluntary sector to deliver joined up care.

This means that you may have professionals from different teams working both together, and with you, to give you tailored support.

What is a safety plan?

Your healthcare professional, such as your GP or mental health team, may develop a safety plan with you to help keep you safe. It will be tailored to your needs. It will form part of your care plan.

Your safety plan will include:

• how you self-harm,
• your triggers and warning signs of increased distress, self-harm or suicidal crisis,
• coping strategies that you find useful,
• people or local places that can help distract you,
• family members or friends who can provide support to you in a crisis,
• contact details for services, including out of hours and emergency, and
• keeping your environment safe by working with you to help remove or limit things you would use to self-harm.

You will be given a copy of your safety plan. It can be shared with your family and carers if you agree.

Healthcare and social care professionals will also keep a copy.

How is self-harm treated?

Healthcare professionals will consider other related conditions you may have when planning your treatment for self-harm. This is because there are different guidelines for treating different conditions.

Talking therapy

Your mental health team should offer you specialist therapy for adults who self-harm. Such as cognitive behavioural therapy (CBT) or problem-solving therapy.

Your therapist should work with you to help you find ways to reduce distress that leads to self-harm.

Therapy should:

• start as soon as possible,
• be between 4 – 10 sessions of talking therapy, but more can be offered if needed, and
• be tailored to your needs and preferences.

Medication

Medication should not be offered to specifically treat self-harm. But it may be offered to help with symptoms of other mental health conditions.

Harm Minimisation

Your mental health team might talk to you about harm minimisation strategies if you can’t stop self-harming in the short term but are engaged in longer term mental health support.

Harm minimisation is about working with your mental health team to jointly agree on different ways to help you avoid, delay or reduce self-harm. Such as:

• Distraction techniques or coping strategies.
• Approaches to self-care.
• Wound hygiene and aftercare.

For more information see our webpages on the following:

• Talking therapies
• NHS mental health teams (MHTs)
• Medication – Choice and managing problems

What will happen if I need to go to hospital?

If you go to an accident and emergency department because of self-harm, healthcare staff should:

• assess how serious your injury is,
• arrange any urgent physical treatment,
• assess your level of distress,
• assess if there are any immediate concerns about your safety,
• assess if there are any safeguarding concerns,
• assess your willingness to accept medical treatment and mental healthcare, and
• find out if you have a care plan.

You should be offered a referral to a specialist mental health service or suitably trained mental health professional as soon as possible on arrival.

The health professional will carry out a psychosocial assessment.

See above for more information about psychosocial assessments.

You should be seen and spoken to by a psychiatry professional or a suitably skilled mental health professional every time you go to hospital following an episode of self-harm.

What will happen after I have had my psychosocial assessment in hospital?

Following your psychosocial assessment, you should work with professionals to help decide on the next steps for your recovery. This may include the following.

Stay in hospital
You may be admitted to general hospital overnight, or for a longer period if:

• you were going to go back to an unsafe place. Or
• because you couldn’t be assessed. This may be because you were too distressed or under the influence of alcohol or drugs.

A psychosocial assessment should be done with you as soon as possible.

Referral, review and discharge
You will be discharged when:

• a plan for further management has been created with appropriate services and people,
• a discharge planning meeting has taken place with appropriate services and people, and
• arrangements for your aftercare have been specified, including written communication with your primary care team, such as your GP.

If you frequently attend hospital for self-harm, your care and treatment should be reviewed by different professionals along with mental health services. This is called a multidisciplinary approach.

Can I just get treatment for my injuries?

Health professionals should offer you treatment for any serious injuries, even if you don’t want mental health support.

I don’t want to be in hospital. Can I leave?

Before you leave hospital, health professionals should assess your safety and any mental health concerns.

You won’t be able to leave hospital if:

• Professionals have assessed you and think you lack capacity to make that decision. And they’re concerned about your safety. Or
• You are detained under the Mental Health Act. This will be because professionals think you have a mental disorder and you’re at risk of harm to yourself or other people.

If you meet the criteria for the Mental Health Act you can be kept in hospital, even if you don’t want to be there.

For more information see our webpages on the following:

• The Mental Health Act, and
• Mental capacity and mental illness

What if I am not happy with my treatment and support?

If you aren’t happy with your treatment, you can:

• talk to your doctor about your treatment options,
• ask for a second opinion,
• get an advocate to help you speak to your doctor,
• contact Patient Advice and Liaison Service (PALS), and see whether they can help, or
• make a complaint.

There is more information about these options below.

Treatment options

You should first speak to your doctor about your treatment. Explain why you aren’t happy with it, give specific reasons. You could ask what other treatments you could try.

Tell your doctor if there is a type of treatment that you would like to try. Doctors should listen to your preference. If you’re not given this treatment, ask your doctor to explain why they think it’s not suitable for you.

Second opinion

A second opinion means that you would like a different doctor to give their opinion about what treatment you should have. You can also ask for a second opinion if you disagree with your diagnosis.

You don’t have a right to a second opinion. But your doctor should listen to your reason for wanting a second opinion.

Advocacy

Advocates help you to deal with and overcome issues that you have. They are independent from the NHS and free to use.

They can be useful if you find it difficult to get your views heard.

There are 3 types of advocates that might be able to help if you are unhappy about your treatment.

• NHS complaints advocates can help if you want to make a complaint to the NHS. These are available in all areas.
• Community or mental health advocates can support you to get a health professional to listen to your concerns. These are available in some areas only.
• Independent Mental Health Advocates can help and advise you if you’re detained under the Mental Health Act.

See our webpage on Advocacy for mental health - Making your voice heard for more information.

The Patient Advice and Liaison Service (PALS)

PALS is part of the NHS. They give information and support to patients and can help you to resolve issues.

You can find your local PALS through this website link:
www.nhs.uk/Service-Search/Patient-advice-and-liaison-services-(PALS)/LocationSearch/363.

Complaints

If you’re not happy about your treatment or support, you can make a complaint. This is where your concerns are investigated in more detail.

You can ask an NHS complaints advocate to help you with your complaint. They are free to use and don’t work for the NHS.

For more information see our webpages on the following:

• Second opinions - About your mental health diagnosis or treatment
• Advocacy for mental health - Making your voice heard
• Complaints about the NHS or social services

Helping myself

How can I help myself?

It can be hard to stop self-harming, especially if you don’t have another way of coping with your emotions. But it is possible.

The first step is deciding you want to stop and that you are doing this for you.

You might feel under pressure by others to stop, but it’s your choice. Some people have found it helpful being supported by loved ones to help them stop self-harming.

You could keep a list of reasons of why you want to stop self-harming and why you don’t want to stop.

There are different ways to help reduce or stop self-harm. Everybody is different and what works for someone else may not work for you. Try different things. Whatever you choose, give yourself time, as it may take a while for things to improve.

You can think about telling your friends and family that you are trying to stop or reduce your self-harm. You can let them know if there is anything that they can do to support you.

Delay self-harm

You may self-harm straight away when you are distressed. You can try to delay your self-harm. With this technique, you might not self-harm as badly, as often or at all. This may work because often people react to difficult feelings quickly by self-harming.

Give yourself an aim. For example, ‘I’m going to wait 15 minutes before I self-harm.’ In this time use distraction techniques, such as making contact with someone else or going somewhere different such as your garden. You can gradually increase the amount of time you wait before self-harming.

Non-harmful ways to manage how I feel

Talk to someone who understands. This could be a friend, a relative or another person who self-harms. There may be a local support group you can join or a helpline you can contact.

If you feel that you have to self-harm, try the following instead:

• Write down how you are feeling and then tear it up or rip it up.
• Punch a punch bag or kick something soft.
• Scream into a pillow.
• Go for a walk.
• Play a sport, exercise or go to the gym.
• Bite into a piece of ginger or a chilli.
• Squeeze an ice cube as hard as you can.
• Snap elastic bands on your wrist.
• Form an image of yourself feeling empowered. For example, try imagining yourself as superhero. Or try to remember a time you felt strong and positive about yourself.

You might self-harm for several reasons. Such as you feel the need for punishment, or you’re dissociating, and you want it to end. You can decide on what techniques work for you best.

If you are feeling low or anxious you could try the following:

• Go to a friend or relative’s house.
• Pamper yourself. Have a bath with bath oil.
• Do something active. Clean up or clear out your wardrobe.
• Go for a walk.
• Choose a random object and think of 10 different uses for it.

Before harming, write down the answers to these questions:

• Why do I feel I need to hurt myself?
• What has happened to make me feel like this?
• How do I feel right now?
• Have I been here before?
• What did I do to deal with it?
• How did I feel then?
• What have I done to make myself feel better before?
• What else can I do that won't hurt me?
• Do I need to hurt myself?
• How will I feel when I am hurting myself?
• How will I feel after hurting myself?
• How will I feel tomorrow morning?
• Can I avoid what has made me feel like this, or deal with it better in the future?

The NHS have designed an app called “Calm Harm” to help people resist or manage the urge to self-harm. The app is not an aid to treatment.

Here is the link to download the app: www.calmharm.co.uk

You could also try an app called “distrACT”. Input has been sought from the NHS and different charities to create the app. It gives people easy and discreet access to information and advice about self-harm and suicidal thoughts.

You can download it by searching for the app on your phone or tablet.

Can I self-harm safely?

There is always risk with self-harm. But you might want to lower the physical damage you do when you self-harm. There are some suggestions below.

• Make sure anything you cut yourself with is clean. For example, use new blades. Don’t share blades with other people as this could lead to further complications. Such as getting diseases such as hepatitis B, hepatitis C, HIV and AIDS.
• Think carefully about where you cut. Avoid areas such as the insides of the wrists or the tops of the legs, as it can be risky to cut here.
• Make sure you are up to date with your tetanus jab. Tetanus is a serious infection. Contact your GP surgery if you’re unsure if you need a tetanus jab.
• Don’t self-harm on areas you have lots of scars. Scar tissue may not be as strong as your skin.
• Think about cutting down on or avoiding drugs or alcohol. They can affect your judgement.
• Learn first aid and keep first aid supplies nearby. Such as antiseptic wipes and bandages.
• Have an emergency plan, such as keeping a phone nearby so that you can ring an ambulance if you need to.
• Set yourself limits before you self-harm and stick to them. Such as decide how many cuts you will make and how big they will be. This is a good way of learning the skills you need to stop.
• Think of options that don’t break your skin.
• Try other techniques such as snapping elastic bands on your wrist. This may help if you’re feeling a need for punishment.
• If you self-harm by hitting yourself, put towels, or something else around your fists to soften the blow.
• There is no safe way to self-poison. Think of other options instead of swallowing medication or substances. See the previous section above for ideas.

How can I deal with my scars?

You may have scars from your self-harm. You may feel embarrassed, ashamed or feel guilty about your scars. Accepting your scars can be an important part of recovery. This can take time.

How can I deal with questions about my scars?

If people see your scars they might ask what happened. They may not realise that you have self-harmed. There is no ‘right’ way to respond. You might deal with things differently depending on who asks you.

Be honest
You may want to tell people that your scars were caused by self-harm. You can tell them as much or as little as you want.

You could think about what you want to say if someone asks you.

Avoid the question
If they ask you about your scars you could say “I’d rather not talk about it if that’s OK.”

In the end it’s up to you what you say. You don’t have to explain or justify your scars to anyone. It isn’t anything to be embarrassed about or ashamed of. You could think about some responses you are happy with.

How can I reduce my scars?

There are ways you can treat and disguise scars if you want to. Most scars will fade over time but will never disappear. Not all of these will suit every type of scar. You can talk to your doctor about your scars and how to deal with them.

• Clothes. Long sleeved tops and trousers can hide scars.
• Corticosteroid injections. These are small injections into the scars to help reduce any swelling.
• Scar Plasters. These are silicone plasters you stick directly onto your scar. Such as hydrocolloid dressings. It can reduce swelling and redness.
• Surgery. This may help if the scar is causing issues with your movement or health.
• Dressings. Some bandages may help to reduce the swelling of scars. This is used more when there is a large area such as a burn or skin graft. It will help them become smoother and softer.
• Make-up. You can use special makeup for scars such as cover cream or body makeup. Scar cover cream can be a bit more expensive than normal makeup. There are some online and telephone self-harm services you could ask if they have any more information. Their details are in the Useful Contacts section at the bottom of this page.
• Laser therapy. Can be useful for light scarring, not deep scarring. You could discuss this option with a medical professional.
• Scar creams and oils. There isn’t a huge amount of research into how effective creams like vitamin E, Bio-Oil or coconut oil are for reducing scars. But the massage effect of rubbing them in and the moisture for the skin are good at softening scars.

You shouldn’t use scar plasters, make-up, creams or oils on fresh wounds. Keep fresh injuries clean and infection free. Good first aid or care for your wound can reduce scarring.

Friends, carers and relatives

Information for friends, carers and relatives

You may be feeling all sorts of different things if someone you know self-harms. Here are some tips on how to deal with the situation and support the person you care about.

How do I react when my relative self-harms?

Self-harm is the way the person you care for deals with their distress. People don’t harm themselves to be dramatic, annoy others or to make a point.

Be honest with yourself about how the self-harm makes you feel. It is ok to feel whatever you feel. You may feel frightened, uncomfortable and provoked. Take time to process your feelings around your relative self-harming. Try not to react to stressful or emotional situations with anger or blame.

If your relative wants to talk to you about their self-harm the main thing to do is listen to them. You can offer to support them, but you don’t have to give them advice or come up with solutions. You can ask them what help they want.

Should I learn about self-harm?

You may have a better understanding of what the person is going through if you educate yourself. You could contact mental health and self-harm charities for information. Or read books or join a support group.

What is my role as their carer?

Tell them you care for them if they self-harm or not. If possible, make sure they have a safe place. Be as available as you can be. Set aside your personal feelings about self-harm and focus on what's going on for them.

Be honest and realistic about what you can and can't do. Offer the person support if you think that you can help with something. But don’t feel as though you need to have the answers, being there and listening will be helpful.

You may think about removing sharp objects from the house. This can be an option if the person feels suicidal and you need to do something in a crisis. At other times this may not be helpful as for many self-harm is a coping technique.

Using punishments or trying to make them feel guilty for self-harm isn’t helpful. It is likely to make them feel more alone.

Accepting and understanding that someone is in pain doesn't make the pain go away. But it can make it more bearable for them to know that someone understands.

Be hopeful about the possibilities of finding other ways of coping rather than self-harm. If they are willing, discuss possibilities for treatment with them. But don’t push them into anything. They will decide when they feel the time is right.

Be patient. You might find it difficult if the person rejects you at first, but they may need time to build trust.

What support is available for me?

Take care of yourself. You can be more supportive if you aren’t tired and emotionally drained. Don't be afraid to take a break. If you are a carer, friend or relative of someone who self-harms, you can get support.

You can use online forums, support groups and telephone support services. Support groups for friends and family of people with mental health problems may be useful. While they may not only focus on self-harm, group members will understand how a caring role can affect you.

If you are a carer, you have a right to a formal assessment of your own needs, including physical and mental health. This is known as a ‘carer’s assessment’.

Look in our Useful Contacts section below for contact details of some helpful services or search on the Carers Trust website:

Carers Trust – www.carers.org/search/network-partners;

For more information see our webpages on the following:

• Carer’s assessments - Under the Care Act 2014
• Supporting someone with a mental illness

Further reading

Self-Harm: The ‘Secret Self’
This is a publication by Sane based on research they did. It explains what they found about why people self-harm and ways to support people. You can download it from their website.

Website: www.sane.org.uk/uploads/self-harm.pdf

Self-Harm: A self help guide
Northumberland, Tyne and Ware NHS Foundation Trust have produced a self-help booklet for people who self-harm. You can download it for free from their website.

Website: www.web.ntw.nhs.uk/selfhelp/

DBT self-help
The website has been created by people who have been through dialectical behavioural therapy (DBT) rather than by health professionals

Website: www.dbtselfhelp.com/index.html

The Scarred Soul: Understanding and Ending Self-inflicted Violence – by Jan Sutton
This is a book that has new research, statistics, diagrams, some resources, case studies and practical self-help activities.

101 Distractions from Depression, Self-harm (and other Soul-destroyers) – by Sophia Gill
This book is by someone with lived experience of depression and self-harm. She writes about what helped her distract herself and overcome her self-harming behaviour.

Useful contacts

National Self-harm Network
An online forum where you can chat with other people affected by self-harm.

Website: www.nshn.co.uk

LifeSIGNS
This is a self-injury advice and support organisation. They have information, support forums. They have practical articles like what you can wear in the summer if you don’t want anyone to see your scars.

Website: www.lifesigns.org.uk

ASSISTline
National helpline offering supportive listening service to anyone throughout the UK with thoughts of suicide or thoughts of self-harm. They are open 24/7 for those aged 18 or over.

Telephone: 0800 689 5652
Website: www.spbristol.org/assistline

Changing Faces
Changing Faces is the UK’s leading charity for everyone with a scar, mark or condition on their face or body that makes them look different. They provide advice, support and psychosocial services to children, young people and adults. They have practitioners who can help with things such as how to deal with people’s questions about your scars.

Telephone: 0300 012 0275.
Email: www.changingfaces.org.uk/about-us/support-and-information-line or support@changingfaces.org.uk
Website: www.changingfaces.org.uk

Shout
If you’re experiencing a personal crisis, are unable to cope and need support, text Shout to 85258. Shout can help with urgent issues such as suicidal thoughts, abuse or assault, self-harm, bullying and relationship challenges.

Text: Text Shout to 85258. 24/7 help available.
Website: www.giveusashout.org/

Recover Your Life
This is an online forum that is run by and for people who self-harm. They have information and advice about different issues.

Website: www.recoveryourlife.com

The Samaritans
This is a listening service for anyone in distress including people who self-harm.

Telephone: 116 123. 24/7 help is available.
Address: Freepost RSRB-KKBY-CYJK, PO Box 9090, Stirling, FK8 2SA
Email: jo@samaritans.org
Website: www.samaritans.org/

Rethink Mental Illness - Gloucestershire Self Harm Telephone Support
This is a helpline for people who self-harm, their carers or professionals. Volunteers offer a listening service, along with coping strategies and signposting.

Telephone: 08088 010606
Text: 07537410022
Webchat, see website: www.gloucestershireselfharm.org

Self-Harm Service
This is an NHS national treatment service for people who self-harm a lot and have problems with their relationships with other people. You can’t refer yourself, but you can ask your GP or your community mental health team to refer you. But the service will only accept you as a patient if you meet their eligibility criteria. You should also ask your GP if your local trust has any self-harm services or look on the trust website.

Telephone: 020 3228 2383 / 07974 724 599
Address: Self-Harm Outpatient Service, Outpatient Department, Maudsley Hospital, Denmark Hill, London, SE5 8AZ
Email: shops@slam.nhs.uk
Website: www.slam.nhs.uk/service-detail/service/self-harm-service-shops-279/

© Rethink Mental Illness 2023

Last updated May 2023 (Part review)
Next update July 2024

Version number 6.1

You can access a fully referenced version of this information by downloading the PDF factsheet by using the link at the top of this page.

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