Self-harm is when someone intentionally damages or injures their body.

There are many different ways people can intentionally harm themselves;

• Cutting or burning their skin
• Punching or hitting themselves
• Poisoning themselves with tablets or toxic chemicals.

In most cases, people who self-harm do it to help them cope with overwhelming emotional issues, which may be caused by:

• Social problems - such as being bullied, having difficulties at work or school, coming to terms with their sexuality, debt or unemployment.
• Trauma - such as physical or sexual abuse, the death of a close family member or friend, or having a miscarriage.
• Psychological problems - such as having repeated thoughts or voices telling them to self-harm, disassociating (losing touch with who they are and with their surroundings), or borderline personality disorder.

Self-harm is more common than many people realise, particularly among young people, where it is estimated that 1 in 10 self-harm at some point.

This figure is likely to be much higher, as many people who self-harm do not seek help. With time, space and support people often find other solutions to cope with how they feel, or these feelings are resolved.

Self-harm is a risk factor for suicide, and over half of people who die by suicide have a history of self-harm. However, many more people self-harm than die by suicide, and it is important to note that many people who self-harm do not want to end their lives.

If you have felt like harming yourself or are harming yourself, it may feel as though you don’t have anyone to talk to - even friends or family. But there may well be someone who can listen to you. It may help to:

• Tell a friend or relative
• Contact your GP (or mental health team if you have one)
• Go to the emergency department

If you are self-harming your GP can refer you to healthcare professionals at a local community mental health team, or a team based in the hospital with the emergency department for further assessment. This assessment will result in your care team working out a treatment plan with you to help with your distress.

Health professionals know it is not always possible to stop straight away. You may feel ashamed of self-harming. Just talking about your worries, fears and distress with someone you can trust can make you feel better. It can also help you get things clearer in your mind, to feel more hopeful, and to think about possible solutions.

Treatment for people who self-harm usually involves seeing a therapist.

They will help you to discuss your thoughts and feelings, and to understand how they affect your behaviour and wellbeing. Your therapist can also teach you coping strategies to help prevent further episodes of self-harm.

If you’re badly depressed, or have any other mental health problems then you may be advised to take antidepressants or other medication. Self-harm is often linked to anxiety and depression.

Self-harm is often a way of dealing with emotional pain, so it is worth trying to identify what feelings make you want to hurt yourself. Once you are aware of your triggers, you can take positive steps to reduce or stop the urge to self-harm.

• Distract from the urge to self-harm.

Once you know your triggers, you can try and express your feelings in other ways. For example, hitting a pillow can help cope with anger, or having a cold shower can help you stop feeling numb.

• Write a ‘safety plan’ for yourself.

This could include details on what you can do for yourself, and who you can speak to if you need support. It can help to have something written down, and it is more likely to work because you choose the kind of support you feel most comfortable with.

• Look after your physical health as well as your mental health.

Getting enough sleep, eating healthily and exercising regularly can help you feel more positive.

• Ask for help and support.

You don’t have to cope with all of your problems alone. It is important to find support. If you’re under 18 speak to an adult you can talk to and trust.

If you feel like you need support outside of your immediate family, think about speaking to another relative, your teacher, school counsellor, school nurse or your social worker (if you have one), or contact and organisation like Childline (0800 1111)

In the longer term, try different techniques to build your self-esteem. Practising positive self-talk can help, as can identifying and challenging any negative beliefs you may have about yourself.

People often try to keep self-harm secret because of shame or fear of discovery.

It’s often close family and friends who first notice when somebody is self-harming, and approaching the subject with care and understanding is very important.

If you think a friend or relative is self-harming, look out for any of the following signs:

• Unexplained cuts, bruises or burns, usually on their arms, wrists, thighs and chest.
• Keeping themselves fully covered at all times, even in hot weather
• Signs of depression, like low mood, tearfulness or a lack of motivation or interest in anything
• Self-loathing and expressing a wish to punish themselves
• Not wanting to go on and wishing to end it all
• Becoming very withdrawn and not speaking to others
• Signs of low self-esteem, like blaming themselves for any problems or thinking they’re not good enough for something.
• Signs they have been pulling out their hair.
• They may also have problems with drugs or alcohol, or have issues with eating.

People who self-harm can seriously hurt themselves, so it is important to try and encourage them to speak to a GP about the underlying issue.

The following organisations may be able to provide support to people who are distressed, experiencing suicidal thoughts or who self-harm and their families:

Samaritans - samaritans.org

24/7 service which gives you a safe, confidential space to talk about how you are feeling, your life and how to find your own way forward.

Papyrus - papyrus-uk.org

A professionally staffed helpline (0800 068 4141) provides support, advice and information to young people worried about themselves or a friend. There are also many vulnerable resources on their website.

Mind - mind.org.uk

Provide information on a range of topics, including self-harm, depression and anxiety. They also provide information on advocacy and getting help.

Heads Above the Waves - hatw.co.uk

A not-for-profit organisation working to raise awareness of depression and self-harm in young people by promoting positive ways of dealing with bad days.

Young Minds - youngminds.org.uk

A charity committed to improving the emotional wellbeing and mental health of children and young people.