This guidance is specifically for identifying and responding to suicide risk, however, it is important to acknowledge self-harm. It is important to recognise that suicide and self-harm are very different, and often have very different objectives behind them.
Self-harm is when somebody intentionally damages or injures their body. It can be a way of expressing deep emotional feelings, or a way of coping with traumatic events. Self-harm is an expression of personal distress, rather than an illness, although it can be linked to other mental health conditions [5].
We know self-harm can be a risk factor for suicide and for some people, the line between a suicide attempt and an act of self-harm is blurred. Some people may not be sure of the outcome they intend, or their desired outcome may change either over time or even within a single episode. However, for many people, self-harm is a way to manage difficult emotions and circumstances and they do not have suicidal intent [6].
We all have a role to play in supporting young people who self-harm. Scotland’s Self-Harm Strategy and action plan sets out a vision for people who have self-harmed or are thinking of self-harm, to receive compassionate, recovery-focused support, without fear of stigma or discrimination. The Self-Harm Strategy was informed by the diverse expertise of people with lived experience of self-harm and recognises the complex nature of self-harm. The varied reasons someone might self-harm means there should be a range of support and services available to meet diverse needs [7]:
- Informal support: when individuals seek help for self-harm, many want to be supported by someone they know and trust, who can listen to them, validate their feelings, and work alongside them to find ways to improve their wellbeing – all at their own pace. For many people this valuable support would be given by a family member, partner, friend, or other trusted person.
- Community-based support: this can include responses and support given by staff in education, youth work, housing, criminal justice, social work or third sector organisations. Developing communities’ and services’ knowledge and confidence in responding to self-harm will be set within the broader context of the Time, Space, Compassion approach and supporting people experiencing poorer mental health, trauma or distress.
- Healthcare support: for those looking for healthcare support for self-harm, their GP should be the first point of contact. However, the principle of ‘no wrong door’ means that irrespective of the service, a person seeking support should be guided to the right place.
