Self-harm can affect anyone at any age. However the majority of people seen in services are aged between 11 and 25. The relationship between self-harm and suicide is complex, but can be thought of in the following ways:
- Self harm is self-poisoning or self-injury, irrespective of the apparent purpose of the act
- Suicidal behaviour comprises both death by suicide and acts of self-harm that do not have a fatal outcome, but which have suicidal intent.
- Suicide is death resulting from an intentional, self-inflicted act.
Self harm may take many forms such as:
- Cutting
- Burning
- Skin picking
- Abrasion
- Risk taking
- Overdose
- Hair pulling
- Self hitting, punching, head banging
Research has shown that many people who harm themselves are struggling with intolerable distress or unbearable situations. A person will often struggle with difficulties for some time before they self-harm.
These may include:
- Concurrent mental health difficulties such a depression, anxiety, substance use, eating disorders, and complex reaction to trauma
- Low self esteem
- Relationship problems with partners, friends, and family
- Significant adverse life event such as divorce, bereavement, loss of job
- Gender or sexuality questioning
- Socio-economic deprivation
- Historical or current physical, emotional or sexual trauma
Through self-injury, the person may be trying to:
- Manage or reduce severe distress or anxiety and provide a sense of relief
- Provide a distraction from painful emotions through physical pain
- Feel a sense of control over his or her body, feelings, or life situations
- Feel something – even if it is physical pain, when feeling emotionally empty
- Express internal feelings in an external way
- Communicate depression or distressful feelings to the outside world
- Be punished for perceived faults
Someone may be more likely to self harm if they feel:
- that people don’t listen to them
- hopeless
- isolated, alone
- out of control
- powerless.
Please see the Primary Care Management section for more details on approaches and resources.
Referral Guidelines
People who have taken an overdose or have otherwise seriously self-harmed should be sent directly to A&E.
For people who require an emergency psychiatric assessment please see the Emergencies Mental Health (Adults) page.
The individual work of the Self Harm Service (SHS) is primarily for people who are inpatients of the Royal Edinburgh Hospital, but management advice is available for colleagues, either by emailing Merrick Pope (email global address book) or phoning 0131 537 6390.
NICE guidelines are available for both the short and long term management of self-harm.
The guidance highlights the need to establish a respectful, non-judgemental therapeutic relationship and to undertake a full psychosocial assessment, including of the person’s needs. It is critical to assess the risk of suicide and establish whether the person has an underlying mental health diagnosis.
Evidence suggests talking therapies can be effective in the long term for people who self harm. Useful links can be found at the Psychology & Behavioural SERVICES (Adult) pages on RefHelp. If the person has an awareness of underlying reasons for using self harm as a way of coping then they can be directed to a service which matches this, again details available on RefHelp.
Management advice is available for professionals by contacting the Self Harm Service, either by emailing Merrick Pope or phoning 0131 537 6390
Scarring can impact on someone’s self confidence, self esteem, and how others perceive them. The SHS offers a skin camouflage clinic, where the person will be matched with the best colour of creams for their skin tone and taught how best to apply to give long lasting finish. For more information email Merrick Pope or phone 0131 537 6390, or to make a referral please complete and return this form H:\RED CROSS\Skin Camouflage Clinic Royal Edinburgh Hospital.doc link not working
The Penumbra Edinburgh Self Harm Project offers a user-led support service for people who self-harm (age 16+ years). The service provides support to individuals, significant others and professionals. http://www.penumbra.org.uk/service-locations/east-area-services/edinburgh/self-harm-project link not working
Self Injury Support
https://www.selfinjurysupport.org.uk offer text, phone and webchat support https://www.selfinjurysupport.org.uk/our-support-services as well as information and a wide range of resources for exploring distractions and alternatives to self harm https://www.selfinjurysupport.org.uk/Pages/Category/self-help-resources
Lifesigns
http://www.lifesigns.org.uk offer a moderated online support forum http://www.lifesigns.org.uk/forum as well as information and a resources for exploring distractions and alternatives to self harm http://www.lifesigns.org.uk/help
Royal College of Psychiatrists
RCP have a section of their site where people can find out further information about self harm https://www.rcpsych.ac.uk/mental-health/problems-disorders/self-harm
Mind
https://www.mind.org.uk/information-support/types-of-mental-health-problems/self-harm/#.XNQFshS2ncs
Their page includes information, tips for self help and guidance for significant others.
Edinburgh Carers Council
The Edinburgh Carers Council provides an individual advocacy service, collective advocacy and training opportunities to those who support someone with mental health difficulties https://www.edinburghcarerscouncil.co.uk
CAPS (Collective Advocacy Promotion Service)
http://capsadvocacy.org provide an advocacy service as well as a range of free mental health courses http://capsadvocacy.org/learn
