Betsi Cadwaladr University Health Board
North Wales Child and Adolescent Mental Health Service
What is self-harm?
Self-harm is a term used when someone injures or harms themselves on purpose rather than by accident. Common examples include `overdosing' (self-poisoning), hitting, cutting or burning oneself, pulling hair or picking skin, or self-strangulation. Self-harm is always a sign of something being seriously wrong.
Why do young people harm themselves?
Unfortunately some young people use self-harm as a way of trying to deal with very difficult feelings that build up inside. This is clearly very serious and can be life threatening. People say different things about why they do it.
Who is at risk?
An episode of self-harm is most commonly triggered by an argument with a parent or close friend. When family life involves a lot of abuse, neglect or rejection, people are more likely to harm themselves. Young people who are depressed, or have an eating disorder, or another serious mental health problem, are more likely to self-harm. So are people who take illegal drugs or drink too much alcohol.
Many young people who self-harm with a wish to commit suicide also have mental health or personality difficulties; often the suicide attempt follows a stressful event in the young person’s life, but in other cases, the young person may not have shown any previous signs of difficulty.
Sometimes the young person is known to have long standing difficulties at school, home or with the police. Some will already be seeing a counsellor, psychiatrist, or social worker. There has been an increase in the suicide rate in young men over recent years.
The risk of suicide is higher if the young person:
How can I help?
As a parent, it's really hard to cope with a child / young person with self-harming behaviour or who attempts suicide. It's natural to feel angry, frightened or guilty. It may also be difficult to take it seriously or know what to do for the best. Try to keep calm and caring, even if you feel cross or frightened; this will help your child / young person know you can manage their distress and they can come to you for help and support.
This may be difficult if there are a lot of problems or arguments at home. Or, you may simply feel too upset, angry or overwhelmed to effectively help your child / young person. If so, you should seek advice from your GP.
If you are a teacher, it is important to encourage students to let you know if one of their friends is in trouble, upset, or shows signs of harming themselves. Friends often worry about betraying a confidence and you may need to explain that self-harm is very serious and can be life threatening. For this reason, it should never be kept secret.
Where do I get specialist help?
Everyone who has taken an overdose, or tried to kill themselves, needs an urgent assessment by a doctor as soon as possible even if they look OK.
Usually, this means an examination at the nearest Emergency Department (A&E). If you are unsure whether the young person was suicidal or not, it is best to act cautiously and take them to hospital. With overdose, the harmful effects can sometimes be delayed, and treatment with medication may be needed. Paracetamol is the most common medicine taken as an overdose in Britain. It can cause serious liver damage, and each year this leads to many deaths. Even small overdoses can sometimes be fatal.
If the young person is self harming by cutting themselves or other ways, it is still important that they have help. Do speak to your GP who can refer you to your local Child and Adolescent Mental Health Service (CAMHS).
How is it treated?
All young people who attend hospital following attempting suicide or harming themselves should also have a specialist mental health assessment before leaving.
It is often difficult to work out what prompted the young person to self-harm or whether they actually wished to commit suicide or not; mental health professionals have the expertise to make sense of these complicated situations.
It is usual for parents or carers to be involved in the assessment and any treatment. This makes it easier to understand the background to what has happened, and to work out together whether more help is needed.
Assessments in Emergency Departments (A&E) which include a short ‘talking therapy’ session have been shown to help young people come back for ongoing help and support. A lot of young people self-harm or make another suicide attempt if they do not receive the help they need.
Usually, treatment for self-harm and attempted suicide, other than any immediate physical treatment, will involve individual or family 'talking therapy' work for a small number of sessions. They will need help with how to cope with the very difficult feelings that cause self-harm.
Clear plans on how to help and how to keep the young person safe will also be made. Some people who find it very difficult to stop self-harming behaviour in the short term will need help to think of less harmful ways of managing their distress.
Families often need help in working out how to make sure that the dangerous behaviour doesn't happen again, and how to give the support that is needed. This is something your local CAMHS should have on offer.
If depression or another serious mental health problem is part of the problem, it will need treatment. Some young people who self-harm may have suffered particularly damaging and traumatic experiences in their past. A very small number of young people who try to kill themselves really do still want to die. These two groups may need specialist help over a longer period of time.
CALL - Community Advice & Listening Line
Mental health helpline for Wales offering a confidential listening and support service.
Helpline: 0800 132 737 Open 24/7
Provides information and advice on child mental health issues
Provides a free and confidential telephone service for children: Helpline 0800 1111
National Self-Harm Network
UK charity offering support, advice and advocacy services to people affected by self harm directly or in a care role
Provides a 24 hour service offering confidential emtional support to anyone who is in crisis. Helpline: 08457 909090
NHS Direct Wales
Health advice and information service. Telephone 0845 46 47