Self-Injury Awareness Day falls on 1 March every year, giving us an opportunity in the days and weeks around this time to highlight the need to respond meaningfully to self-harm. Here, the team at St Patrick’s Mental Health Services (SPMHS) looks at the importance of understanding self-harm and providing supportive, non-judgemental responses.
What does ‘self-harm’ mean?
According to the Health Service Executive (HSE): [i]
“self-harm is when somebody intentionally damages or injures their body. It's usually a way of coping with or expressing overwhelming emotional distress.”
Self-harm can take different forms.[ii] It is not a mental health condition or diagnosis, but may be linked with other mental health difficulties, such as depression, substance misuse or eating disorders.[iii]
People do not necessarily self-harm because they are having suicidal thoughts, but there is a strong association nonetheless between suicidal risk and self-harm, and self-harm should always be taken seriously.[iv]
While acknowledging that there is an association between self-harm and suicidality, here, we are focusing primarily on self-harm as outlined in the HSE’s definition above. However, If you would like more information on suicide and self-harm, including how to support someone else or get support yourself, you can find it here.
Why do people self-harm?
There is no one ‘type of person’ or reason why people self-harm. We know from research, however, that certain groups of people are ‘higher-risk’ when it comes to self-harm. For example, higher rates have been found among diverse groups, including adolescent girls, young people who are attracted to the same sex, middle-aged men experiencing economic stressors, and members of the Traveller community.[v] Research indicates that respective factors related to self-harm among these groups vary and can include distress linked with issues such as struggling with body image pressures or sexual identity, dealing with unemployment and substance misuse, or experiencing trauma or adverse life circumstances.[vi]
A key commonality is often that self-harm may be an attempt to cope with a very painful emotional state.[vii] Where this is the case, getting support to deal with self-harm may then involve trying to make sense of the reasons behind it, and, importantly, finding new ways to manage emotions and cope with difficulties. Psychological support and other interventions, whether on an individual or group basis, can be extremely helpful, and can include learning new coping strategies and ways to ‘self-regulate’ our emotional state. Evidence-based approaches include dialectical behaviour therapy, compassion focused therapy and forms of cognitive behavioural therapy.[viii]
If self-harm is linked to another mental health difficulty, such as an eating disorder, depression or substance misuse, it will be necessary to get support and help to work on these underlying mental health needs. As noted above, self-harm can be linked with suicidal thoughts also, and, where this arises, seeking urgent support is essential.
Practical strategies that may help a person who is struggling with self-harm include understanding triggers, and distracting, delaying and finding safe alternatives to release energy or feelings. These kinds of strategies are listed by the HSE on its website here.
How do we strengthen responses to self-harm?
For the past five years, we have organised an annual Self-Harm Awareness Conference in partnership with Pieta, aiming to provide a platform to raise awareness of self-harm, share learning and increase knowledge.
Our 2020 conference took place on 28 February, with the day reminding us that statistics show that self-harm is not abating, and, in fact, is increasing among certain groups and especially young people. It is therefore vitally important that initiatives such as the HSE National Clinical Programme for Presentations of Self-Harm at Emergency Departments continue to be developed, and that accessibility to services is improved overall for people who may be in crisis.
The conference also gave us an opportunity to embed greater understanding among health professionals, education providers, parents and others who work directly with or support people who are self-harming. This is not only essential to improve responses, but also to decrease the potential distress a person may experience when they do not feel equipped to deal with the situation they are in.[ix] Sharing and learning from different perspectives, knowledge and experiences is vital if we are to meaningfully address this issue in society.
Increased understanding and supportive, non-judgemental approaches are also key if we are to develop trauma-informed health services.[x] While not all people who self-harm have experienced trauma, it can be a risk factor.[xi] Trauma-informed care means an approach to services that is strengths-based; it is “grounded in an understanding of and responsiveness to the impact of trauma, that emphasises physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment”.[xii] Recognising the meaning and function behind self-harming behaviours, and acknowledging that actions such as self-harm are often an attempt to deal with experiences and feelings that may feel unbearable, is all central to a trauma-informed approach and to supporting meaningful recovery.
How can I get support for self-harm?
Asking for help is a sign of strength. The sooner we get help and support, the better it is for our mental health. If you are worried about self-harm, talking to someone you trust and feel comfortable with is important. Most often, visiting your GP will be the best first step you can take.
There are also lots of helplines available for more help and support, which you’ll find below.
Get help and support
Below, you'll find a number of different helplines and support services if you need help to respond to self-harm and other mental health concerns. You can also view HSE information on self-harm and the Royal College of Psychiatrists self-harm information on their respective websites, for more information about self-harm.
SPMHS Support and Information Line
To speak to an experienced mental health nurse, you can call our helpline. Local phonecall costs apply. Call 01 249 3222 from Monday to Friday, 9am to 5pm: a call-back facility is in operation outside of these hours. You can also visit the Getting Help section of our website for more information about mental health issues and support.
If you or a family member are self-harming or having suicidal thoughts, or if you've been bereaved by suicide, you can contact Pieta’s 24-hour helpline for support. Call 1890 130 022 or 1800 247 247.
HSE Your Mental Health Infoline
Freephone the Your Mental Health Infoline at any time to find supports and services near you: this is available on 1800 111 888.
The Samaritans’ helpline aims to provide emotional support at any time when you may need it. Call 116 123, 24 hours a day.
You can find the references used in this piece below.
[ii] National Office for Suicide Prevention, Self-harm and young people – An information booklet for parents and concerned adults.
[iv] Townsend, E. (2014), Self-harm in young people. Evidence-Based Mental Health 17 (4), pages 97-98.
[v] National Self-Harm Registry Ireland (2019), National Self-Harm Registry Ireland Annual Report 2018; Higgins, A., Doyle, L., Downes, C., Murphy, R., Sharek, D., DeVries, J, Begley, T., McCann, E., Sheerin, F., Smyth, S. (2016), The LGBTIreland Report; Clements, C., et al (2019), Self-harm in midlife: analysis using data from the Multicentre Study of Self-harm in England, British Journal of Psychiatry; and Houses of the Oireachtas (2020), Seanad Public Consultation Committee Report on Travellers Towards a More Equitable Ireland Post-Recognition.
[vi] National Self-Harm Registry Ireland (2019), National Self-Harm Registry Ireland Annual Report 2018; Higgins, A., Doyle, L., Downes, C., Murphy, R., Sharek, D., DeVries, J, Begley, T., McCann, E., Sheerin, F., Smyth, S. (2016), The LGBTIreland Report; Clements, C., et al (2019), Self-harm in midlife: analysis using data from the Multicentre Study of Self-harm in England, British Journal of Psychiatry; and Houses of the Oireachtas (2020), Seanad Public Consultation Committee Report on Travellers Towards a More Equitable Ireland Post-Recognition. The Children’s Society (2019) The Good Childhood Report 2019
[viii] Arensman, E., An understanding of suicide and self-harm; and Cleare, S., Gumley. A., O’Connor, R. (2019), Self-compassion, self-forgiveness, suicidal ideation, and self-harm: A systematic review, Clinical Psychology and Psychotherapy 26 (1), pages 511-530
[ix] Mughal, F. et al (2020), Role of the GP in the management of patients with self-harm behaviour: a systematic review, British Journal of General Practice.
[x] Sweeney, A. et al (2018), A paradigm shift: relationships in trauma-informed mental health services. BJPsych Advances 24 (5), pages 319-333.
[xi] Fliege. H. et al (2009), Risk factors and correlates of deliberate self-harm behavior: A systematic review. Journal of Psychosomatic Research 66 (6), pages 477-493
[xii] SAMHSA (2014), Trauma-informed Care in Behavioural Health Services.
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