It can be incredibly difficult to support someone who is self-harming; it can feel frightening, uncomfortable, and beyond control. The first step is to understand it, to open up communication, and then to follow-through with support.

What is Self-Harm?

Self-harm is when somebody intentionally damages or harms their own body, and can include cutting or burning the skin, as well as punching or hitting themselves. Some people would also consider the following to be forms of self-harm; starving or restricting calorie intake, overeating, purging, putting oneself in risky situations, scratching, skin-picking, and hair pulling, excessive use of alcohol or drugs, and other such behaviours.

People don’t self-harm to be dramatic, to annoy others, or to make a point to others. A person who self-harms will often describe it as a way of coping with overwhelming and difficult emotions, often stemming from painful experiences. It is a way of transforming emotional pain into physical pain which, in the short-term, can feel easier to handle.

For some people, it becomes addictive, and is a way of re-establishing control over their emotions, which feel too big to handle.

Self-harm is more common than many people realise, especially among younger people. NHS England estimates that around 10% of young people self-harm at some point. However, it is not just young people that self-harm – it can impact people of all ages.

Where to start?

Not all people who self-harm are aiming to end their life. In fact, many people who self-harm do so as a way of coping with difficult situations and emotions so that they can continue to live. However, more than half of people who die by suicide have a history of self-harm, according to NHS England.

With this in mind, if you feel that there is a suicide risk, the first step should be to remove the means to carry out the self-harm (i.e. sharp objects or pills) from the environment. However, if you do not feel that there is a suicide risk, it might not be useful to remove such objects as you are removing someones coping strategy without replacing it with a healthier one.

Determining whether there is a risk of suicide or not is going to take some very open and frank conversation between yourself and the person that you are supporting. Don’t shy away from asking the serious questions, however be gentle and understand that the person probably hasn’t spoken to many people, if anyone, about some difficult thoughts and feelings that they might be dealing with.

It can be very difficult for a person to stop self-harming, and it may take them some time to do so. They might need to gradually reduce the harming (either in terms of the frequency or the severity of the harm). This is called harm minimisation, and will require a great deal of open communication. Using punishment or guilt is not likely to be helpful as it can cause feelings of isolation and shame.

Honest Conversations

As mentioned, it is likely that there are going to be some difficult conversations to come. Self-harm is often a way of dealing with difficult emotions and, if the person is to reduce or stop self-harming, then they will need to find a different way of getting their emotions out. So, here are some tips for handling honest and difficult conversations;

1. No judgement; Having these conversations might reveal some quite confronting and scary thoughts and truths. It is important that you and the individual feel safe and not judged when opening up. Try not to cut the other person off when they are talking, try not to place judgement on what they are saying.
2. Open-ended questions; It is important that the individual feels fully heard. This is a conversation that they may not have had before, and it is likely that they have been bottling up these negative feelings for a while. This needs to be a space in which they can express these feelings without fear of being judged negatively, without fear of being shut down, and without fear of further isolation.
3. Understanding rather than solutions; As much as you might want to support the individual with platitudes such as “It’ll all get better soon”, often these can be unhelpful and can be experienced as being shut down. This conversation is about allowing the other person to be understood, it’s about you learning what the other person is experiencing rather than giving them advice. Ask questions that open up the bigger deeper conversations rather than cutting them off with advice. They might well know that self-harming is not the best solution, but they might currently feel unable to cope any other way.
4. Leave frustration at the door; If you have never experienced self-harm (or someone who self-harms) before, you might find it to be frustrating. It is okay to acknowledge this feeling, but it can be unhelpful to express this feeling to the individual. Expressing frustration is likely to leave the other person feeling judged and isolated, and they will be less likely to open up to you.
5. Be gentle; It is likely that the individual has not talked to many people about these feelings, if anyone at all. Therefore the conversation might be incredibly painful, tearful, stilted, or even heated. 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. They might not be ready to open up to you right away, but knowing that someone is there when they are ready can be immensely helpful.
6. Seek professional help; self-harm can be an incredibly difficult thing to deal with, and the emotional hurt and pain can leave both of you feeling overwhelmed. It is always advisable to seek professional help for the individual, and for yourself, either through a private counsellor or through the NHS or a local mental health organisation.

Looking after yourself

Supporting someone with any mental health issues can be incredibly difficult, and it is therefore important to look after yourself through this process.

Remember that you are just one person. You cannot do it all. You cannot hold the weight of this on your own and you deserve to seek support too. Whether you confide in a friend, family member, or professional, you need someone who can support you while you are supporting your loved one.

It is also important to set clear boundaries about what support you can offer so as not to burn yourself out. Talk to the individual about seeking some professional support such as seeing their GP or a counsellor.

Work through your own feelings regarding the self-harm. It is okay to feel upset, scared, angry, frustrated, or whatever you might be feeling, but it is important to process these emotions and thoughts in order to be able to help your loved one without them feeling judged or guilty.

If you feel you need to talk to a qualified professional in a safe, non-judgmental environment, call 020 8673 4545 or email [email protected] and the reception staff will book an appointment with one of our therapists. We have centres in Clapham and Tooting.