Responding to Self-Harm Behaviour
Your First Response is Important
Take all threats of self-harm and suicidal behaviour seriously.
At all times treat the young person with dignity and respect, be empathic and non-judgemental.
Remember it is likely that the reason for the behaviour is an attempt to cope with strong, overwhelming feelings.
First Response
Your first response to a disclosure of self-harm or suspected self-harm is an important one. Your verbal response and body language can promote trust and encourage the young person to open up.
Stop, breathe, stay calm and patient
Suspecting, or discovering that, a young person is self-harming can cause an overwhelming array of emotions like panic, anger, sadness, frustration. All of these are normal reactions but are likely to impact your initial interaction with the young person and may be counterproductive to encouraging an open and honest discussion. Take a breath, try to put your feelings to one side for now and focus on what the young person needs.
Find somewhere quiet and private
Encouraging the young person to talk will require time, patience and a quiet, private space. Talking about self-harm won’t encourage them to engage in more self-harming behaviour. Start the conversation by expressing that you are worried about them and want to check if they are okay. Tell them what you have noticed about their behaviour, that you are there and ready to listen and help. If they have disclosed to you their self-harm behaviour it is good to acknowledge this – thank them for coming to you, reinforce how hard that must have been and reassure that they have done the right thing by seeking help.
Encourage them to talk but follow their lead
Talking about self-harm can be tough for everyone involved. Try to be patient, take your time and try not to push for more information than they are willing to give. Allow or encourage the young person to do most of the talking. Be caring in your verbal and non-verbal communication. Use active listening skills and phrases such as ‘that sounds really difficult, tell me more about that.’
Ask them if they have self-harmed
You may think you don’t need to as it may be obvious or they may have shown you their wounds. However, even if they tell you explicitly or show you it is advisable to clarify what they have said and that they have made the wounds themselves. This ensures there is no misunderstanding and focuses the conversation moving forward. If you suspect that the young person has self-harmed but they don’t offer this information, sensitively but directly ask the question.
“I’ve noticed you wearing long sleeves more often and you don’t seem your usual self. Sometimes when people are having a hard time they can self-harm. Have you been self-harming?”
“I noticed some marks on your arm, I’m worried about you and want to help. Are you hurting yourself?”
Focus on listening and be genuinely interested in what they have to say
It might be hard because of your own strong feelings about it but only by listening can you really hear and understand their experience. Try not to panic, avoid offering solutions and instead just listen.
Thank them for talking to you and acknowledge how difficult it must have been
You may well be the first person they have discussed this with. It’s important to acknowledge how big a step this is for them.
Reassure that you want to help them find other ways of managing difficult times
You cannot necessarily fix this for them but reassuring them that you want to help and that you are not dismissing their feelings will be crucial in their recovery.
Common Traps
It is common for those supporting a young person who is self-harming to think:
I must fix this or I must stop this behaviour
This person needs a specialist not me
Neither of these are helpful. It is not your job, and neither is it realistic to expect you, to fix or stop the behaviour. Rather your role is to listen and help the young person think more clearly about the function of the behaviour and explore other coping strategies. Furthermore, while the person may benefit from a specialist service, the young person is choosing to speak to you and that makes you the most helpful resource to this person at this moment in time.
Other Things to Avoid
Generally speaking, when a young person is talking to you about their self-harm this is positive so try not to worry too much about saying the wrong thing, rather, focus on listening and follow their lead.
However, if possible avoid:
- Telling them to stop
This is unlikely to make them stop and may result in the young person disengaging from your conversation. Recovery takes some time and this request could reinforce their low self-esteem and shame. Remember for many young people it’s an addiction and should be managed in the same way as any other addiction.
“Many young people fear a loss of agency and control when disclosing self-harm. This could include concerns that supporting adults will seek to stop them from self-harming completely, when individuals may still view self-harm as a way of coping with difficult emotions and experiences.” (Samaritans 2020)
- Showing disgust or judgement
Any young person who feels judged is less likely to open up and be honest.
- Talking too much
As adults we often want to help by fixing young people’s problems and this can lead to us talking more than them and offering solutions. Instead, try to be comfortable with silences, focus on listening and ask open questions.
- Asking why
Asking why is different to asking what is helpful about the self-harming. “Why” can communicate judgement and the young person might genuinely not know why they do it so will be unable to answer this in any helpful way.
- Asking them to consider the impact of their behaviour on others
This is likely to reinforce feelings of low self-esteem and self-worth. They will already feel guilt and shame and it is likely to make them feel worse if they feel they are letting others down.
- Telling them all the reasons they should be happy and positive
This dismisses the complexity of the reasons behind the self-harming behaviour. Exploring what these might be will far more effective than trying to convince the young person that they should feel differently.
Establish type of self-harm, frequency and severity
In gathering a full picture of the self-harm behaviour, potential triggers, risks and protective factors, asking direct questions about this can be helpful. If this has not been raised naturally during the course of your initial discussion, try to establish:
- Where on your body do you self-harm?
- What do you use?
- How do you care for your wounds?
- Have you ever hurt yourself more than you planned?
- Have your wounds ever become infected?
- Do you have anything with you just now that you could use to hurt yourself?
