Self-Harm: Getting Help and Staying Safe

Self-harm means intentionally hurting your own body. The NHS describes it as something people do to cope with very difficult feelings, painful memories or situations that feel impossible.

It can happen once, occasionally or often. It is not a diagnosis in itself, and it does not tell you everything about a person’s life or their future.

Self-harm is not automatically a suicide attempt. Many people who self-harm do not want to die.

Some people do have suicidal thoughts as well, and a person’s intention can change quickly. Any concern about suicide should be asked about directly, calmly and taken seriously.

Reasons differ from person to person. The NHS describes self-harm as a way of coping, expressing or gaining a sense of control when feelings are overwhelming.

Pressures that may be part of it include trauma, abuse, bullying, grief, isolation, physical pain, mental health difficulties, relationship problems, discrimination, caring pressures, housing problems, money worries or simply having no way to say how bad things feel.

Not everybody who self-harms has experienced the same cause, and some people cannot name a reason at all.

People often describe rising tension, panic, anger, numbness, shame, emptiness, self-blame or a feeling of being trapped. Some describe feeling nothing at all, or feeling far away from themselves.

Noticing what tends to come first can help somebody and their clinician plan what to do at that point instead.

Some people feel temporary relief or calm. Many then feel guilt, shame, fear of being found out, worry about injuries, or distress that the underlying problem has not changed.

None of those feelings mean somebody deserves less care or a lecture.

If self-harm brings short-term relief, it can become the thing a person reaches for whenever distress rises, even when they want to stop. That is not weakness or failure.

Support that looks at what is driving the distress — rather than only the injury — gives people the best chance of other ways through.

Self-harm is not always visible, and how often it happens, or how serious an injury looks, does not measure how much distress a person is in or how much support they deserve.

Somebody who appears to be coping well at work, school or home may still be struggling badly.

Self-harm is not “attention-seeking”. Even where communicating distress is part of the reason, the distress and the need for help are real.

It affects people of any age, gender, background, income or occupation. It is not a phase, a fashion or a character flaw, and nobody should be shamed for it.

Many people hide self-harm because they fear judgement, losing control of what happens next, or being treated as a problem rather than a person.

A calm, private question and a promise not to react with anger often does more than any investigation. Never search somebody’s room, phone or body for proof.

Alcohol and drugs reduce inhibition and can make impulsive acts more likely and more dangerous, and they can make an overdose or an injury far more serious.

If somebody has been drinking or using drugs and has harmed themselves, treat the situation as more serious rather than less, and get medical help.

An injury can be more serious than it looks, and untreated wounds can become infected or heal badly. Having it looked at also opens the door to support for what is underneath.

Call 999 for a serious injury, bleeding that will not stop, any overdose or poisoning, unconsciousness or difficulty waking, a seizure, difficulty breathing, severe confusion, or when somebody cannot keep themselves safe.

Go to your nearest A&E department for an injury that needs urgent assessment or treatment, or when you have been advised to attend. If travelling is unsafe, call 999 instead.

Use NHS 111 when you are unsure how urgent something is, or need advice out of hours. In England call 111 or use 111 online; in Scotland call NHS 24 on 111; in Wales call 111.

A GP practice nurse or a pharmacist can advise on a minor wound, dressings and signs of infection. A GP appointment is also the usual route into longer-term support.

Get medical advice if a wound becomes more painful, red, swollen, hot or smelly, if there is pus, if you feel feverish or unwell, or if healing stops. Do not wait to see whether it settles.

An overdose or poisoning always needs emergency assessment, because some effects appear hours later. Hospital staff will decide what monitoring, tests or treatment are needed.

Do not make somebody vomit, and do not try to manage it at home.

Before you leave hospital, you can ask what happens next, who will contact you, what to do if things get worse, and whether a mental health assessment has been arranged.

Asking for that in writing is reasonable, and it helps if you have to chase it.

A GP or nurse can advise on wound care, and on what may help with marks or scarring over time. What is available on the NHS varies locally, so ask about your own area.

This page does not give treatment instructions or medication doses.

Where you can, tell staff:

• what happened and when;
• whether anything may have been taken, and what;
• any medicines you take, including ones bought without a prescription;
• any alcohol or drugs involved;
• any health conditions or allergies;
• whether you are having thoughts of suicide now;
• what would help you feel safer during the appointment.

You can write this down, show a written note or ask somebody to speak for you.

A GP is the usual starting point. They can treat injuries, talk about what is happening, refer you for assessment or therapy, and review any physical health problems.

You can write down what you want to say and hand it over, or show a message on your phone. You can bring a trusted person, ask for a longer or a double appointment, and ask for the outcome in writing.

You do not have to describe details you do not want to describe.

An assessment is a conversation about your life, your feelings, your safety and what you need. It should feel collaborative rather than a test to pass.

You can ask who is doing the assessment, what happens with the information, and what comes next.

Talking therapies can help with the distress behind self-harm. In England, NHS Talking Therapies takes GP referrals and self-referrals for common problems such as anxiety and depression.

Scotland, Wales and Northern Ireland arrange psychological therapies differently, so please use your GP or your national urgent route to find the correct local service.

Where difficulties are more complex or long-standing, a community mental health team may become involved, usually after a referral and an assessment.

You can ask who your named contact is and how to reach the team when things get worse.

Children and young people are supported by specialist services, reached through a GP, a school or another professional. Waiting times and local arrangements differ.

While waiting, Childline and YoungMinds can help, and urgent routes still apply.

If you take prescribed medication, a review can look at whether it is helping, side effects, and safer supply arrangements.

Please do not start, stop or change prescribed medication without professional advice.

Free, confidential local services support people with alcohol or drug use, and you can usually self-refer without a GP.

When the pressure underneath self-harm is practical or has been caused by somebody else, dealing with that matters as much as any treatment.

A safety plan is a short, practical plan made with a professional or a trusted person: warning signs, what helps, who to contact, and what to do when things escalate.

It should be reviewed when circumstances change, and you should have your own copy.

If you feel dismissed, you can ask for a second opinion, ask for the reasons in writing, bring an advocate, or contact the service’s patient advice or feedback team.

If your situation is urgent, use the urgent route for your nation, or 999, while you do that.

You can ask for an interpreter, a British Sign Language interpreter, easy-read information, longer appointments, written summaries, quieter waiting arrangements or contact by text or email rather than telephone.

Once you are safe, you can raise a concern or make a formal complaint about how you were treated. NHS complaints processes differ across the four nations, so use the process for the service involved.