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 self-harming, then talking about the subject can feel harder than talking about other risk taking behaviours such as unsafe sex or alcohol use.
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 self-harm. 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:
- Are you planning to self-harm?
- Are you considering taking your own life?
- 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?
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”
Someone considering suicide doesn’t always show
Click on the statements below for further information:
There is no such thing as a typical person who self-harms. It can be anyone of any age, background or race, regardless of whether they are an extrovert or an introvert.
Some people who self-harm see it as a way of staying alive and coping with the difficulties they are facing. For many, self-harm is not about the inflicting of physical pain but coping with emotional pain.
ChildLine (childline.org.uk / 08001111) and other support lines for children believe that unvented emotions such as anger and frustration may often be behind self-harm, which provides an unhealthy but seemingly cathartic outlet for the build-up of these feelings.
Other factors that can lead to self-harm may include stress arising from a difficult home environment or a general sense of having no control over life.
Self-harm can be a way of seeking relief where many people cope by, say, crying on another person’s shoulder, some people find that self-harm is a way of coping with difficult feelings when they do not know how else to cope with them.
It is essential any talk about suicide is taken very seriously. People who talk about suicide or threaten to take their own life are often thinking about suicide.
You may not think the issues they are facing warrant taking their own life, but remember that their experience is different from yours.
Talking about suicide may be a way to indicate they need support.
Suicide is not inevitable and may be prevented.
Immediate practical help can deflect a person’s suicidal intentions in the short term.
Stay with the person, encourage them to talk about how they feel and help them to plan for the future.
Seek professional and social support to help them in the long-term.
Some young people self-harm on a regular basis while others do it once or occasionally.
For some people it is part of coping with a specific problem and they stop once the problem is resolved. Other people self-harm for years, or whenever certain kinds of pressures and problems arise.
Self-harm can become habitual behaviour for some people. Telling somebody to ‘just stop it’ will not work and could possibly alienate them further. They may find another more dangerous method of coping or they may also feel they are letting people down if they are ubable to stop, which adds to the pressure on them and the sense of failure.
People need help and understanding to recover and to learn other strategies for coping with emotional pain and stressful situations
Thoughts of suicide can happen to anyone regardless of whether or not they have a mental illness.
While people living with mental illness are at increased risk of suicide, the relationship is complex and people who have never experienced a diagnosable mental illness can experience suicidal thoughts.
Most people who are suicidal do express signs of intent but these are often not easy to recognise or understand.
People may indicate their intent directly (e.g. by talking about hurting themselves or telling someone about their plan to take their own life), or indirectly (e.g. by speaking abstractly about death or referencing suicide in poetry or artwork).
If you have concerns you should discuss these with the person, a health professional or another trusted person.
A suicide attempt is regarded as a risk factor and it’s likely the level of danger will increase with each subsequent attempt.
The risk is high for the first three months to a year after an attempt and then declines, but remains throughout the person’s lifetime.
Stripping naked and running down the high street would be attention-seeking, but self-harming is very private and personal. People who self-harm often go to great lengths to cover up their injuries.
The attention that self-harming does bring is often negative.
For some, self-harming is a release that doesn’t – or needn’t – attract the attention of others.
It can be performed in private, dealth with in private and then covered up with clothing. Self-harm is not a manipulative behaviour – many people who self-harm are often unaware of the effect that their self-harming has on others.
People who self-harm often find that this means they are further isolated from everyone because of the shame they feel and the difficulty they experience in being able to talk about what is going on.
People who are thinking about suicide are experiencing intense and overwhelming negative feelings and may not be able to see any other solution.
While it can be difficult to understand, some people believe that they are a burden on others and think their loved ones would be better off without them.
They need personal and professional support, not judgement. Labelling someone’s behaviour can make it more difficult for the person to seek help.
One of the only ways to really know if a person is contemplating suicide it to ask. Asking someone if they are feeling suicidal may seem difficult but it shows you care.
It is often a relief for a person to have someone recognise the seriousness of their distress and to be given permission to talk about it in a caring and non-judgmental manner. Suicide prevention experts generally agree that asking someone whether they are thinking about suicide will not increase their risk.
Refer to the North Yorkshire Self-Harm and Suicidal Ideation Pathway.
Services available to school age children, young people and families
Use the links below for further information about support services in North Yorkshire.