Workforce Guidance: How to Respond to Self-Harm and Suicide Ideation
As a professional you are seen as a safe person by young people and by parents and carers. If a young person has come to you, or you think they may be selfharming, then talking about the subject can feel harder than talking about other risk taking behaviours such as unsafe sex or alcohol use.
Refer to North Yorkshire Self-Harm and Suicidal Ideation Pathway – INSERT LINK
However, many of the same principles apply. You need to:
• Listen and explain the limits to confidentiality.
• Reassure the young person it is OK to talk about it.
• Stay calm and don’t judge the young person for their actions.
It can be very hard to stay calm if someone has disclosed that they are hurting themselves but remember that they see you as someone they can tell and you don’t need to have all the answers. It is OK to say you need to
go and find out more information. The young person’s GP (General Medical Practitioner) can offer confidential and regular support for a wide range of health problems including the psychological distress and physical injuries of selfharm. Quick access to advice and, if necessary, an appointment should usually be available for urgent matters.
If someone has seriously injured themselves or taken an overdose it is important that they get immediate medical treatment from the Emergency Department (also known as accident or emergency or A&E). In an emergency call an ambulance on 999.
“The most important thing is not to tell people to stop, but to listen to them, find out what they need to stop and help them find ways of achieving that”
Questions you could ask include:
- What is happening for you?
- Is this affecting you?
- What help do you need?
- What would you like to happen next?
- Sometimes when people feel like this they have thoughts of suicide. Is that happening to you?
- Are you planning to self-harm?
- Are you considering taking your own life?
It is OK to say you need to go and find out more (see more information section). As a professional it is your role to work out the best response for the young person, proportionate to the level of self-harm or the issues behind the self-harm. It is useful if you understand your own relationship to potential risky behaviour. For example, what do you do to cope with daily stress and distress?
It might be useful to get the young person to think of a time when they felt like self-harming but had not done so. What had they done instead? Try to help the young person come up with things that might work for them. If this is not possible some suggestions could be made.
They could consider the following:
- Talk to someone – if they are on their own perhaps they can phone a friend.
- Distract themselves by going out, singing or listening to music, or by doing anything (harmless) that interests them.
- Relax and focus their mind on something pleasant – their very own personal comforting place.
- Find another way to express their feelings such as squeezing ice cubes (which can be made with red juice to mimic blood if the sight of blood is important), or just drawing red lines on their skin.
Young people have reported that the first time they speak to a professional they want to be treated with care and respect, but sometimes the response can actually make their situation worse, for example if they are told to simply stop self-harming or if suicidal thoughts are dismissed as attention seeking.
“My doctor looked at me differently once I told her why I was there. It was as if I were being annoying and wasting her time”
Isolated young people with little or no support systems in place are particularly vulnerable and a cause for concern. These include young people who are homeless or those who are not in school, education or employment. Young people who have little or no support in their family, perhaps because of parental
mental or physical illness, parental substance misuse or family relationship breakdown may also be more vulnerable.
“I self-harm because I am alone and don’t connect with people, but I don’t want to kill myself”