Suicide--self harm

1 in 10 people will self-harm by taking tablets; cutting, burning, piercing or swallowing objects. It is more common in young people, women, gay and bisexuals and in some sub-cultures. Some people self-harm regularly - it can become almost an addiction.

What makes people self-harm?It usually happens in a state of high emotion and inner turmoil. This may be caused by abuse; feeling depressed; feeling bad about yourself or relationship problems. You may do it because you feel that people don't listen to you; hopelessness; isolation, feeling alone, out of control or powerless. People who self-harm are more likely to have been abused in childhood.

How does it make you feel?Self harming can help you to feel in control and less tense. So, it can be a 'quick fix' for feeling bad.

What help is there?
Talking: Talking can help you to feel less alone, to see your problems more clearly.

Self-help groups: People with the similar problems can provide support and practical advice – and, believe it or not, sharing your problems in a group does help

Help with relationships: Group therapy can often help you to sort out difficulties in getting on with other people

Talking Therapy: Problem solving, Cognitive Behavioural or Psychodynamic psychotherapy;

What works best?
All these treatments help. Some evidence suggests that problem-solving therapy may be best.

What if I don't get help?
1 in 3 people who self-harm will do it again within a year. People who self-harm are 50 times more likely to kill themselves. The risk increases with age and is much greater for men. Cutting can cause scarring, numbness or paralysis.

How can I help myself ?
When you want to harm yourself: If you can ride out how you feel without self-harming, the feelings will usually go after a few hours. You can talk to someone, distract yourself by going out, sing or listen to music, or do anything (harmless) that interests you. Try to relax and focus your mind on something pleasant. Find another way to express your feelings such as squeezing ice cubes (make them with red juice to mimic blood if that helps), or draw red lines on your skin. Give yourself some 'harmless pain' - eat a hot chilli, or have a cold shower. Focus on positives. Be kind to yourself – get a massage. Write a diary or a letter, to explain what is happening to you – no one else needs to see it.

When the urge has gone: Think about the times that you have self-harmed and what (if anything) has helped. Go back in your mind to the last time when you did not want to self-harm, and move forward in your memory from there. Where were you, who were you with, and what you were feeling? Try to work out why you began feeling like you did. Did your self-harm give you a sense of escape, or relief, or control? Try to work out something to do that might give you the same result, but that doesn't damage you. Make a recording by talking about your good points and why you don't want to self-harm. When you feel bad, play this back to remind you of the parts of you that are worthwhile. Make a 'crisis plan' of what to do when you feel bad.

I don't want to stop
OK, but reduce the damage. If you cut, use clean blades. Find ways of hurting yourself that don't damage your body (see above)

If you can say YES to at least 3 of the questions below, it's worth trying to stop?
Are there at least two people who are willing to help me stop?
Do I have friends that I can go to if I get desperate?
Have I found at least two safe ways that reduce the feelings that make me self-harm?
Can I really say to myself that I want to stop hurting myself?
Can I tell myself that I WILL tolerate feelings that make me want to self harm?
Is there a professional who will give me support and help in a crisis?

If I harm myself and need treatment?
You have the right to be treated with courtesy and respect by the doctors and nurses in the Accident and Emergency department. Many departments have a psychiatric liaison nurse, or a social worker, who can talk with you. Staff may want to go through a questionnaire with you as a way of judging how at risk you are.

What can I do if I know someone who self-harms?
Listen to them without being critical. This can be very hard if you are upset or angry. Try to focus on them rather than your feelings – this is hard.
Try to understand their feelings, and then move the conversation to other things.
Take the mystery out of self-harm by helping them find out about self-harm on the internet or at the library.
Help them to think about their self-harm not as a shameful secret, but as a problem to be sorted out.

Don't
Try to be their therapist – you have enough to deal with as their friend.
Expect them to stop overnight – it's difficult and takes time.
Get angry this may make them feel worse. Talk calmly about the effect it has on you - in a way that shows how much you care for them.
Struggle with them when they are about to self-harm – it's better to walk away and to suggest they come and talk about it rather than do it.
Make them promise not to do it again or make your involvement conditional on them stopping.



Self-Harm
This provides information about self-harm and is for anyone who is harming themselves, or feels that they might. We hope it will also be helpful for their friends and families.

What is self-harm?
Self-harm happens when someone hurts or harms themselves. They may:
take too many tablets;
cut themselves;
burn their body;
bang their head;
throw their body against something hard;
punch themselves;
stick things in their body;
swallow inappropriate objects.

It can feel to other people that these things are done coolly and deliberately – almost cynically. But someone who self-harms will usually do it in a state of high emotion, distress and unbearable inner turmoil. Some people plan it in advance, others do it suddenly. Some people self-harm only once or twice, but others do it regularly - it can become almost like an addiction.

Some of us harm ourselves in less obvious - but still serious - ways. We may behave in ways that suggest we don't care whether we live or die – we may take drugs recklessly, have unsafe sex, or binge drink. Some people simply starve themselves.

Other words that are used to describe self-harm
These terms are inaccurate and going out of use:
Deliberate self-harm (DSH) - the word 'deliberate' unhelpfully blamed self-harm as a reaction to painful feelings.
Suicide/Parasuicide - most people who self-harm do not want to kill themselves, so these terms are misleading.
Who self-harms?
About 1 in 10 young people will self-harm at some point, but it can occur at any age.
It is more common in young women than men.
Gay and bisexual people seem to be more likely to self-harm.
Sometimes groups of young people self-harm together - having a friend who self-harms may increase your chances of doing it as well.
Self-harm is more common in some sub-cultures – "goths" seem to be particularly vulnerable.
People who self-harm are more likely to have experienced physical, emotional or sexual abuse during childhood.

Research probably under estimates how common self-harm is, and surveys find higher rates in communities and schools than in hospitals. Some types of self-harm, like cutting, may be more secret and so less likely to be noticed by other people. In a recent study of over 4000 self-harming adults in hospital, 80% had overdosed and around 15% had cut themselves. In the community, these statistics would probably be reversed.

What makes people self-harm?
Emotional distress – people often struggle with difficulties for some time before they self-harm:
physical or sexual abuse;
feeling depressed;
feeling bad about yourself;
relationship problems with partners, friends, and family.

If you feel:
that people don't listen to you;
hopeless;
isolated, alone;
out of control;
powerless – it feels as though there's nothing you can do to change anything.

Using alcohol or drugs – it may feel that these are as out of control as the rest of your life.
If you want to show someone else how distressed you are or to get back at them or to punish them. This is not common – most people suffer in silence and self-harm in private.

How does it make you feel?
Self-harm can help you to feel in control, and reduce uncomfortable feelings of tension and distress. If you feel guilty, it can be a way of punishing yourself and relieving your guilt. Either way, it can become a 'quick fix' for feeling bad.

Are people who self-harm mentally ill?
Most people who self-harm are not mentally ill. However, some may be depressed, or have severe personality difficulties, or be addicted to alcohol and drugs. But they all still need help - the risk of killing yourself increases after self-harm. Everyone who self-harms should be taken seriously and offered help.

Getting help
A lot of people who self-harm don't ask for help. Many young people who self-harm know that they have serious problems, but don't feel that they can tell anyone – so they don't talk to friends, family, or professionals. Other young people don't feel that they have serious problems - they use self-harm as a way of coping, but their situation stays the same.

What's more, less than half of those who go to hospital after self-harming are seen by a specialist in this area. You are less likely to be seen by a specialist if you are young, if you cut yourself, or if you have taken an overdose.

Danger signs
Those who are most likely to harm themselves badly:
use a dangerous or violent method;
self-harm regularly;
are socially isolated;
have a psychiatric disorder.
They should be assessed by someone with experience of self-harm and mental health problems.

What help is there?
Talking with a non-professional
Many people find that it's helpful just to talk anonymously to someone else about what is happening to them. Knowing that someone else knows what you are going through can help you to feel less alone with your problems. It can also help you to think about your difficulties more clearly – maybe even see ways of solving them that you wouldn't think of on your own. You can do this on the internet or by telephone (see contacts section at the end of this leaflet).

Self-help groups
A group of people who all self-harm meet regularly to give each other emotional support and practical advice. Just sharing your problems in a group can help you to feel less alone - others in the group will almost certainly have had similar experiences.

Help with relationships
Self-harm is often the result of a crisis in a close relationship. If this is the case, help with the relationship will be needed rather than help with self-harm.

Talking with a professional
For people who use self-harm to cope with other problems, one-to-one treatments can help. These include:
Problem solving therapy;
Cognitive psychotherapy;
Psychodynamic psychotherapy;
Cognitive behavioural therapy.

Family meetings
Where this is appropriate, family meetings with a therapist can help to relieve the tiring, daily stress for everyone in the family.

Group therapy
This is different from a self-help group. A professional will lead (or facilitate) the group in a way that helps the members to deal with problems in getting on with other people.

What works best?
There is little evidence to say that any one of these therapies is better than any of the others for self-harm, although what evidence there is supports problem-solving therapy.

What if I don't get help?
About 1 in 3 people who self-harm for the first time will do it again during the following year.
About 3 in 100 people who self-harm over 15 years will actually kill themselves. This is more than 50 times the rate for people who don't self-harm. The risk increases with age and is much greater for men.
Cutting can give you permanent scarring, numbness, or weakness/paralysis of fingers.

How can I help myself ?
When you want to harm yourself
The feelings of self-harm go away after a while. If you can cope with your upset without self-harming for a time, it will get easier over the next few hours. You can:
Talk to someone – if you are on your own perhaps phone a friend.
If the person you are with is making you feel worse, go out.
Distract yourself by going out, singing or listening to music, or by doing anything (harmless) that interests you.
Relax and focus your mind on something pleasant – your very own personal comforting place.
Find another way to express your feelings such as squeezing ice cubes (which you can make with red juice to mimic blood if the sight of blood is important), or just drawing red lines on your skin.
Give yourself some 'harmless pain' - eat a hot chilli, or have a cold shower.
Focus in your mind on positives.
Be kind to yourself – get a massage.
Write a diary or a letter, to explain what is happening to you – no one else needs to see it.

When you don't feel like harming yourself

When the urge has gone, and you feel safe, think about the times that you have self-harmed and what (if anything) has been helpful.
Go back in your mind to the last time when you did not want to self-harm, and move forward in your memory from there.
Where were you, who were you with, and what you were feeling?
Try to work out why you began feeling like you did.
Did your self-harm give you a sense of escape, or relief, or control? Try to work out something to do that might give you the same result, but that doesn't damage you.
How did other people react?
What did you do about the feeling?
Could you have done anything else?
Make a tape or MP3 recording. Talk about your good points and why you don't want to self-harm. Or, ask someone you trust to do this. When you start to feel bad, you can play this back to remind yourself of the parts of you that are good and worthwhile.
Make a 'crisis plan' so you can talk to someone instead of self-harming. Being able to get in touch with someone quickly can help you control your urge to self-harm. While you are talking, your wish to harm yourself may start to go away.

What if you don't want to stop self-harming?

If you decide that you don't want to stop self-harming, you can still:
reduce the damage to your body (for example, use clean blades);
keep thinking about possible answers to the things that make you harm yourself;
every so often, re-visit your decision not to stop.

Self-harm can be very damaging physically and psychologically – in the end, you'll do better by stopping.

There are a number of questions to ask yourself to see if you are ready to stop. If you can honestly say YES to half of the questions below, or more, then why not try stopping?
Are there at least two people who are willing to help me stop?
Do I have friends that know about my self-harm, who I can go to if I get desperate?
Have I found at least two alternative safe ways that reduce the feelings that lead me to self-harm?
Am I able to tell myself, and to believe it, that I want to stop hurting myself?
Can I tell myself that I WILL tolerate feelings of frustration, desperation, and fear?
If necessary, is there a professional who will also give me support and help in a crisis?

If I harm myself and need treatment?
You have the right to be treated with courtesy and respect by the doctors and nurses in the Accident and Emergency department. Many Accident and Emergency departments now have either a psychiatric liaison nurse, or a social worker, who will be able to talk with you about how you are feeling, and to see if there are any further ways of helping. They should be able to consider all your needs, whatever they may be, and to write an assessment of them. You should be able to go through this with them and, if you disagree with their assessment, to write this in the notes. Staff may want to go through a questionnaire with you as a way of judging how at risk you are.

What can I do if I know someone who self-harms?
It can be very upsetting to be close to someone who self-harms - but there are things you can do. The most important is to listen to them without judging them or being critical. This can be very hard if you are upset - and perhaps angry - about what they are doing. Try to concentrate on them rather than your own feelings – although this can be hard.

Do
Talk to them when they feel like self-harming. Try to understand their feelings, and then move the conversation to other things.
Take some of the mystery out of self-harm by helping them find out about self-harm perhaps on the internet at the local library.
Find out about getting help - maybe go with them to see someone.
Help them to think about their self-harm not as a shameful secret, but as a problem to be sorted out.

Don't
Try to be their therapist – therapy is complicated and you have enough to deal with as their friend, partner or relative.
Expect them to stop overnight – it's difficult. and takes time and effort.
React strongly, with anger, hurt, or upset - this is likely to make them feel worse. Talk honestly about the effect it has on you, but do this calmly - in a way that shows how much you care for them.
Struggle with them when they are about to self-harm – it's better to walk away and to suggest they come and talk about it rather than do it.
Make them promise not to do it again or make your involvement with them the basis for an agreement for stopping.
Make yourself responsible for their self-harm or become the person who is supposed to stop them. You must get on with your own life as well. Make sure you talk to someone close to you, so you get some support.