Are you the parent, partner, relative, friend
​of someone who self-harms?

Finding out or being told that your loved one self-harms is guaranteed to shock you. The first thought in your mind is "why?" often followed by "it can't be!", "how did this happen?" and the classic "what did I do wrong?"

Being scared, worried and even disgusted is normal. How can they do that to themselves on purpose? No matter how you feel about it, try to remain calm. Overreacting will help nobody, it will only serve to push you and your loved one apart. What is usually kept hidden is now no longer a secret. For whatever reason and in whichever way, it's now out in the open. The person who self-harms is probably already devastated you found out - as well as embarrassed and scared about what will happen next - will expect the worst and at the same time hope for acceptance and understanding. 

Every person and every family is different. But here are some suggestions what to do and what not to do:

Do not:

• 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. 
• 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
• say anything if you don't know what to say
• make assumptions - it's fine not to understand
• jump to conclusions - it may be nobody's fault
• ask them to stop - it's not that simple
• make them promise to stop - even if they try really hard they're almost certain to fail and failure will increase guilt
• threaten them in order to stop - it just increases the fear and will almost certainly push the behaviour underground
• add guilt - they're already feeling bad enough
• 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
• throw their 'tools' away unless they ask you to
• prevent them from self-harming by force 
• remove all opportunities and methods - their mind will go into overdrive and every object becomes a way to hurt themselves
• treat self-harm as a disorder or a disease, it does not need treating
• make them self conscious of their scars - they already are

Do:

• listen - building trust is the only way forward
• remember it's a coping method, a way to deal with situations, emotions and thoughts
• remember it's an indication they are in distress and struggling with a situation or emotions
• be honest - if you don't understand, tell them
• be honoured if they told you - telling someone takes a lot of courage and trust
• 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. They will find it extremely difficult to tell you without a prompt.
• try to work on identifying the triggers with them. 
• 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
• help them put together a list of distractions that help reduce the self-harm urges
• 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
• 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 is never safe. Remove access to all medication and/or cleaning products or similar. 
• 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
• offer to talk about it 
• continue offering your support if they wish to stop self-harming but be prepared for slip-ups, they're part of the process
• be there no matter what - even if they continue self-harming or have slip-ups while trying to stop. 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 will start dropping before long. 
• 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!
• help them reach out to you when they are struggling.
• 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) or any method that they find acceptable to show you when they are struggling.
• be proud of yourself if they turn to you for help when feeling distressed.
• remind them, this will pass, things will ease, even if they cannot see that at that moment.
• reassure them.
• help them accept their scars (if they have any). Provide a safe home where they do not need to hide them.
• 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.
• use their words: a 'cut' is always a cut and never a scratch. Show them you are listening.
• encourage safe self-harm by making sure they have access to clean blades or 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!)
• 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 for 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 actually 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 is never safe.
• 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. 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 superficial 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.
• ask questions such as 'did it help?' or 'do you know what made you feel this way?' Sincere questions will hopefully provide you with honest answers (even monosyllabic ones) and allow you to work together more.
• remember that managing self-harm takes time. Managing can lead to stopping without adding stress and guilt. 
• 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.
• check out the resources section. 
• Check out our Understanding self-harm sessions or come to our support groups (Leeds and surrounding areas). 

---