Dos & don'ts

Some people will find some of these dos and don'ts puzzling, surprising or even infuriating. Many people think that a tough approach is the way to go. That approach almost never works. Similarly, abstinence often fails if it's aimed for without a good number of better strategies and a solid support network. The family member's or friend's role here is to be part of this support network, to create the safe, accepting environment where the person who self-harms can open up, explore alternatives and work on what's behind the self-harm. Trust and communication are the goal. So please do not reject these dos and don'ts because they are hard to accept or understand. At the same time, do not worry if you've already done some of the don'ts, any damage you think might have been caused can be repaired. Just try again. Show your loved one that you're there to stay. 

Don't	show disgust - it'll make opening up extremely difficult. It's not easy to hide such reactions but please try. Honest reactions in moderation (shock, surprise, fear) are expected and even hoped for. They can even reassure them that you are listening. ​​
​Don't	overreact - the situation is emotionally overcharged enough. It's understandable to be upset but keeping as calm as you can will be much more helpful and encourage them to open up
Don't	ask why. It's too big a question and it's hard to know whether you want to know why they self-harm altogether, why they did it that particular time, why they find it helpful etc. They might not be able to answer any of these because they don't know or they're not ready to open up
​Don't	say anything if you don't know what to say
​Don't	make assumptions - it's fine not to understand
​Don't	jump to conclusions - it may be nobody's fault
​Don't	ask them to stop - it's not that simple
​Don't	​make them promise to stop - even if they try really hard they're almost certain to fail and failure will increase guilt
​​Don't	​threaten them in order to stop - it just increases the fear and will almost certainly push the behaviour underground
​​Don't	​add guilt - they're already feeling bad enough
​​Don't	​take their self-harm "tools" away (unless there is a strong indication of suicidal intent) - it'll make their brain incredibly inventive and look for different methods
​​Don't	​throw their "tools" away unless they ask you to
​​Don't	prevent them from self-harming by force ​
​​Don't	​remove all opportunities and methods - their mind will go into overdrive and every object becomes a way to hurt themselves
​​Don't	​treat self-harm as a disorder or a disease, it does not need treating
​Don't	make them self conscious of their scars - they already are
Don't	use words such as "self-harmer" or "cutter", self-harm is what they do, not who they are.

Do	listen - building trust and is the only way forward
Do	​​remember it's a coping method, a way to deal with situations, emotions and thoughts
Do	​​remember it's an indication they are in distress and struggling with a situation or emotions
Do	​be honest - if you don't understand, tell them
Do	​be honoured if they told you - telling someone takes a lot of courage and trust
Do	look out for this kind of behaviour: panic attack symptoms, difficulty paying attention, mood dropping, retreating inside, needing to be alone, manic behaviour, being severely agitated. It could be an indication that they're experiencing self-harm urges. Approach them, ask them (e.g. "are you struggling?") They will find it extremely difficult to tell you without a prompt
Do	try to work on identifying the triggers with them
Do	help them put a log of triggers together by identifying what happened just before the urges started. Use our trigger log - bear in mind that the triggers are just that, triggers, and not necessarily what is behind their distress. You may be able to find out what is behind their self-harm together but sometimes a therapist (one with experience working with people who self-harm) might be an option.
Do	help them put together a list of distractions and ideas that help reduce the self-harm urges
Do	​suggest the 'not now, later' idea by delaying hurting themselves for 5 minutes combined with distractions. Then if they are managing, they could add another 5. Sometimes the urges ease. Remain with them if they want you to
Do	allow them the opportunity to self-harm if distractions and talking isn't helping - no matter how hard that is for you. It's safer to self-harm when they still have some control over what kind of damage they'll cause than letting the urges reach unmanageable levels and losing all control. Safe self-harm can only be practised when causing external damage. Overdosing and self-poisoning are never safe. Remove access to all medication and/or cleaning products or similar
Do	​help them get to the root of the problem - you may be able to help a lot more than you think when working on the root
Do	offer to talk about it but do not insist. If they turn your offer down, just leave the offer standing and make sure they know you're there for them when they're ready
​Do	continue offering your support if they wish to stop or manage self-harming but be prepared for slip-ups, they're part of the process
Do	be there no matter what - even if they continue self-harming or have slip-ups while trying to stop or manage it better. Self-harm may increase once the disclosure has been made because it's out in the open. It is still progress and, with your help, frequency and/or severity will start reducing before long
Do	​respect their "tools" - if they wish to give them to you treat them with respect and keep them safe for them - make sure they know that!
Do	help them reach out to you when they are struggling
Do	agree on a code word they can text you when distressed and urging, use a mood gauge system (e.g. a scale of 1-10, a traffic light or other colour coded system) or any method that they find acceptable to show you when they are struggling
Do	be proud of yourself if they turn to you for help when feeling distressed
Do	remind them they'll have better times again, that things will ease, even if they cannot see that at that moment
Do	reassure them
Do	help them accept their scars (if they have any). Provide a safe home where they do not need to hide them
Do	remove the hiding and shame and reduce the guilt. Guilt feeds the self-harm cycle and makes things worse for everybody but provides zero benefits
Do	​use their words when describing an injury: for example, a "cut" is always a cut and never a scratch. Show them you are listening. If unsure, use the word "wound" or "injury"
Do	​encourage safe self-harm by making sure they have access to clean blades or know how to clean what they're using - it's better than using any old sharp object and inviting infections. You are showing them you are on their side and trust them despite how hard it is (and it is extremely hard!)
Do	​encourage self-care of wounds - if necessary, teach them to clean/disinfect their wounds and how to dress them to keep them clean. Either make sure there are enough dressings in the 1st aid cabinet or put a 1st aid kit together with them that they can have available (with maybe some disinfectant wipes and plasters). A safe self-harm kit with their "tools" and 1st aid supplies is a proven method to reduce self-harm. When the option is there, the person feels more in control which reduces the urges. Safe self-harm can only be practised when causing external damage. Overdosing and self-poisoning are never safe
Do	​encourage them to seek medical attention if required. In case of children, you'll have to go with them but you don't have to be there as their "guardian" but more as a key person of their support network. It's extremely difficult and embarrassing for anybody to turn up at A&E or minor injuries with self-inflicted wounds. Discuss the experience with them afterwards if they're willing. In some cases receiving medical treatment may even be a deterrent to them preferring to cause less damage to avoid further such experiences. But if medical attention is required, having your support will make sure they get it. Make sure they can tell the difference between  wounds that can be treated at home and wounds that require medical attention. In case of overdosing and self-poisoning rush them to hospital or call 999
Do	​ask questions such as "did it help?" or "do you know what made you feel this way?" Sincere, direct questions could provide you with honest answers (even monosyllabic ones) and allow you to work together more
Do	remember that managing self-harm takes time. Managing can lead to stopping without adding stress and guilt
Do	​focus on trust and openness. There is always a psychological reason behind self-harm. The self-harm behaviour is a symptom, an indicator of distress. The goal is to deal with the root of the problem
Do	​accept that some people will be unable to stop self-harming. This doesn’t mean they cannot function or be useful and productive. Help them find their way, find something that can make them feel they have a purpose. That alone will help them feel better and not require to use self-harm as often
Do	check out the resources section ​
Do	​join our support group (virtual groups are open to anybody in the UK) ​