How to help someone who is self harming

Self-harm is the direct, deliberate act of hurting or injuring your body, but without necessarily wanting to die. It’s a way some people cope with intense or very difficult emotions, or overwhelming situations and life events. Common ways of self-harming include:

• cutting skin on wrists, arms or legs
• biting and scratching at skin
• head banging and punching self
• burning of skin
• hair or eyelash pulling
• taking overdoses of drugs or medication
• taking poisonous substances
• inhalation of a harmful substance.

Self-harming is not uncommon. If you self-harm you are not weak or crazy or attention-seeking. It just means you are overwhelmed by how you are feeling right now and this is a way you hope will help you feel better.

After self-harm you may feel better for a while, but the feeling won’t last long. If you keep self-harming it can make things worse. It could harm your physical or mental health, or damage your relationships with other people. Self-harming behaviours can become addictive and hard to stop.

Tell someone what is going on

If you self-harm, you may feel embarrassed about it, or worry that other people will judge you or try to make you stop if you tell them about it. Many people who self-harm keep it a secret for this reason.

If you’re harming yourself it’s very important to talk to someone you trust. If you don’t want to talk to your health professional or someone you know, you can call a helpline where you will remain completely anonymous, yet be able to talk to someone who understands what you are going through.

• Call Lifeline on 0800 543 354
• Call Youthline on 0800 376 633, or text 234
• Call Healthline on 0800 611 116
• Call Samaritans on 0800 726 666
• Contact a doctor or your local mental health crisis service

Anyone can be at risk of self-harming behaviours, but self-harm is more common in young people. Women are more likely than men to be hospitalised for self-harm.Self-harm can be linked with different kinds of difficult emotions, or overwhelming situations and life events. There is no clear reason why some people self-harm and others do not. It can be connected with difficult experiences including:

• pressures at school or work
• physical, sexual or emotional abuse
• bullying
• money worries
• bereavement or grief
• friends, family or whānau members who don't support their sexuality or identity
• relationship breakups or losing friends
• an illness or health problem
• childhood trauma, abuse or neglect
• intense or difficult feelings, such as depression, anxiety, anger or numbness, that might be experienced as part of a mental illness
• being part of a group that self-harm
• problems in connection with family, whānau, friends or community.

If you have seriously injured yourself, taken poisonous substances or overdosed on medicine or medicines, it is important you see a doctor immediately. Call 111 and ask for an ambulance, or go to the emergency department (ED) at your nearest hospital.

It’s important to remember that you can seek help to stop self-harming. With support you can learn new ways to cope with your feelings without hurting yourself, even if you have been self-harming for a long time.If you are worried about your immediate safety when you have hurt yourself, or are trying not to hurt yourself, do the following:

When you are ready, the best thing you can do to stop self-harming is to see a doctor or mental health professional. They will listen to you in private, and ask some questions about you and your situation. This is so they can help you and, together, you can develop a plan of action for changing the self-harming behavior and looking at any underlying mental health issues.If you have harmed yourself and are taken to hospital you will be seen by doctors who will help you while you are there. They will refer you to specialist mental health professionals when you leave hospital.

The kinds of treatment options that your health professional will discuss with you include:

Supportive counselling helps many people who self-harm to understand what the underlying issues are around their behaviours.

Talking therapies can help change the thoughts that lead to self-harm. Your doctor will explain which type of talking therapy is most suitable for you.

Your doctor may prescribe antidepressants or other medications if you have an underlying mood disorder. Finding the right medication can be a matter of trial and error – there is no way to predict which will be effective for, and tolerated (have fewer troublesome side effects) by, any one person.If you are breast feeding no medication is entirely safe. Before making any decisions about taking medication at this time you should talk with your doctor about the potential benefits and problems.If you are prescribed medication you are entitled to know:

• the names of the medicines
• what symptoms they are supposed to treat
• how long it will be before they take effect
• how long you will have to take them for and what their side effects (short and long-term) are. 

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

It's really important to look after your physical wellbeing. Your doctor will confidentially treat any injuries you have. They will also talk to you about staying as healthy as you can. This is important because you will cope better mentally if you are physically healthy.

It’s up to you to decide when to stop self-harming. It’s also up to you to decide if and who you want to talk to. Remember though, that it’s a lot easier on yourself if you can find someone you trust to talk things through with.

Some other suggestions to help you stop hurting yourself include:

• Keep taking any medication your doctor prescribed for you.
• Cut down on or stop taking alcohol and recreational drugs.
• Keep your house safe - get rid of pills, weapons etc that you could use to hurt yourself.
• Learn your patterns of self-harm – keep a diary and note down what happened to make you feel that way. Over time you will see a pattern.
• Learn what your triggers are – the things that make you want to hurt yourself – it could be places, certain behaviours in other people, times of day etc. Use your diary to note these down as well.
• If you are part of a group with people who self-harm, find other people to be with and do things that you enjoy with.
• Learn how you feel before you want to hurt yourself – physical sensations such as a racing heart, shallow breathing, feeling ill; feeling as though you aren’t in your body; or strong emotions like anger, or sadness or desperation.
• Think about what sort of things you can do to distract yourself if you feel the urge to hurt yourself – try exercise, music, talking on a helpline, having a very cold drink, draw or paint. No matter how strange it may be, if it works for you it’s important.
• Look after yourself – get enough sleep, good food and exercise.
• Find a support group.
• Don’t ignore any bad feelings you have – have a plan for those times.
• Keep attending all your appointments with your mental health professional.

If you've noticed scars, marks, or behaviour that concerns you, but you are not sure whether the person is self-harming, talk to them. Ask them if they would like to talk about what’s going on for them and be patient.

Remember they might not want to open up straight away, but letting them know you are there for them is a big help. Show them you care, and that you are concerned.

Many people who self-harm will try to keep it a secret. Although there can be obvious signs, such as exposed cuts or burns, or attempts at overdosing, many signs are less obvious.They can include:

• unexplained injuries, such as scratches or burn marks
• health complaints such as stomach pains and headaches 
• wearing clothes inappropriate to conditions, e.g. being covered up all the time, even in summer 
• dramatic changes in mood, especially in adolescence, or in adults with previous history of self-harm 
• changes in eating and sleeping patterns
• losing interest in friends and social activities 
• breakdown in regular communications with family, whānau or friends
• washing own clothes separately 
• no longer interested in favourite things or activities
• problems with relationships
• low self-esteem 
• avoiding situations where they have to expose arms or legs, e.g. swimming 
• withdrawing from usual life.

Many young people who think about self-harm have experience of depression, so it’s important to recognise the signs of depression in teens:

• excessive irritability or change in mood
• boredom
• seeing their friends less often
• dropping out of regular activities
• lowered grades or interest in schoolwork.

Teenagers at risk of depression and suicide include those with family members who have depression, those in an unhappy family environment and those who drink excessive amounts of alcohol.

Aggressive, impulsive boys, especially loners, are at risk, as are some very high-achievers who may be under pressure to do even better.

If someone tells you they are self-harming or they want to hurt themselves, take them very seriously.

• If they are seriously hurt or have taken any poisonous substances get help immediately. Call emergency services on 111 and ask for an ambulance, to take them to the emergency department (ED) at your nearest hospital. 
• If you are worried they might be suicidal, ask them. It could save their life. Asking about suicide will not put the thought in their head. 
• Ask them directly about their thoughts of suicide and what they are planning. If they have a specific plan, they need help right away. If the person is feeling unsafe, or you think they are at high risk, don’t leave them alone. You could ask someone else to be with them when you need to leave or need time out.
• Ask them if they would like to talk about what’s going on for them and be patient. Remember they might not want to open up straight away, but letting them know you are there for them is a big help.
• Support them to access professional help, like a doctor or counsellor. Go with them if possible.

To support someone trying to stop self-harming, it’s important to identify the support they need, and also the support you need to be a source of strength for them. Know that you can’t do everything, and you don’t need to deal with this by yourself – remember it’s ok to ask for help.

• You might need to be prepared to have difficult conversations about what's going on in their life and how they are feeling.
• Be prepared to be there, offer support and stay involved. Keep talking to them and don’t avoid talking about the hard things in their life.
• If they don’t want to talk with you, ask other people you both trust to support them – friends, family or whānau members, youth workers or others. 
• Help them to access professional help, like a doctor or counsellor. You could offer to go with them or help them to make an appointment.
• If they would like you to, help them to make a plan of different ways they could cope when they feel like hurting themselves.
• Let them make their own decisions about reducing or stopping their self-harm. Try not to judge their behaviour, but try to understand why they are self-harming.
• Encourage and support them to do what they enjoy and connect with others.
• Accept them for who they are and let them know you care.
• Support them to make plans for their future, solve problems and set goals.

Remember to take care of yourself when you are caring for others.

• Make sure you’re getting enough sleep, eating properly and exercising.
• Be kind to yourself, and take time out when you need to. Being in this situation can be very difficult, and you can’t do everything.
• Find someone you can talk to about this – a friend or family member you trust, or a counsellor.

It’s important to involve others to help you and the person you're supporting – don't try to do everything yourself.

To build a support network:

• Ask the person you're supporting to tell you what they need, what works for them and who should be involved.
• Bring the group together in a safe space.
• Your support network might include elders, kaumātua, kuia, spiritual leaders or community groups they're part of, as well as friends, family and whānau. 
• Talk openly and honestly about the situation.
• Develop a plan together to support the person – identify how different people can help. Get professional help if you need it. Talk to your local doctor, medical centre, community mental health team or counselling service.