Leave judgement at the door when talking about self-harm

Like many harmful coping strategies, self-harm provides short-term relief 

Self-harm is an emotive subject, and one that provokes strong responses from both those who engage in it and those who try to understand it.

Recent research showing a startling increase in self-harm, particularly among young women, has prompted considerable concern and debate.

Evokes a hostile response

The Lancet Psychiatry study looked at data from mental health surveys across England. Almost one in five 16-to-24-year-old women in 2014 reported having self-harmed at some point, compared with 11.7% in 2007 and 6.5% in 2014. Half of those who self-harmed received no support from medical or mental health services.   

Typically, people who self-harm say they encounter hostility from those they approach for help. Perhaps this is understandable as a response to a behaviour that some find baffling and in stark contrast to clients with health issues that are not of their volition.

‘The gap between those who self-harm and those who do not may be smaller than is often assumed’

But the reality for people who self-harm is far more complex than that, and the gap between those who self-harm and those who do not may be smaller than is often assumed.

• RELATED: Hospital admissions for self-harm among girls has doubled in two decades

Self-harm may even be an unhelpful term (and many others have been used), as all of us probably harm ourselves in various ways. We may find we cause ourselves stress by not feeling understood or valued. We sometimes harm our reputations as nurses through indiscreet verbal behaviour or thoughtless actions. In our personal relationships, we may be clumsy or even self-sabotaging in the way we interact with those we love.

Reactions to stress or distress

So harming ourselves – leaving aside unhealthy choices – can be part of who we are. This may be particularly so when we are under stress or distressed.

We may find that at those times we ‘do things that work’, but then the short-terms gains are outweighed by the long-term effects.

‘We need to acknowledge that, like many strategies we all use that are unhelpful in the long-term, it may “work” for the person’

People I have worked with who self-harm describe it as automatic behaviours that provide relief from an unbearable numbness. They explain that in that moment they feel something; sometimes they feel more alive. So how should we respond to such disclosures?

• RELATED: Nurse helped me escape cycle of self-harm

Firstly, it is not helpful to engage in a judgemental or disapproving dialogue. Self-harm is a response to a need to cope with distress, and we need to acknowledge that, like many strategies we all use that are unhelpful in the long-term, it may ‘work’ for the person.

Timely intervention

However, the growing debate about self-harm, and perhaps our increasing readiness to discuss it with people we care for, should not encourage us to become casual about its use as a coping strategy. Intervention can help prevent future suicidal behaviour.

• RELATED: ‘Many nurses don’t know what to say to someone in distress’

A disclosure of self-harm needs a warm non-judgemental response, but also a gentle enquiry as to its nature and severity. We need to explore its form and function and also be prepared to support and refer people to appropriate resources.

Ian Hulatt is consultant editor, Mental Health Practice