Thoughts of Self-Harm

Thoughts of self harm do not always mean that someone intends to end their life, but they should never be dismissed. You do not need to judge how serious the thoughts are before helping yourself or someone else reach appropriate support.

Thoughts of self harm mean thinking about deliberately hurting yourself. The thoughts may be brief, recurring, unwanted or linked to intense emotional distress. They deserve support even when no physical harm has occurred. Some people describe an urge to punish themselves, escape overwhelming feelings or express distress they cannot put into words. Others may not understand why the thoughts are happening. You do not need to identify the reason before asking for help. You also do not need to wait until the thoughts become stronger or more frequent. Self harm and suicide are not the same Self harm means deliberately injuring or poisoning yourself. People may self harm for different reasons, and not everyone who self harms intends to die. Suicidal thoughts involve thinking about ending your life. Thoughts of self harm and suicidal thoughts can occur separately, but they can also overlap. You should not try to decide from appearance or behaviour alone whether someone is suicidal. Any disclosure of self harm or suicidal thoughts should be taken seriously and connected with appropriate support. What you may notice in yourself You may find yourself thinking about hurting yourself, wishing to punish yourself or feeling unable to manage overwhelming emotions. You may feel trapped, ashamed, hopeless, numb or disconnected from other people. You may begin withdrawing from people you usually trust. You may find it increasingly difficult to explain how you feel or believe that other people would not understand. You might also notice thoughts such as not wanting to be here, wanting everything to stop or believing that others would be better without you. These thoughts require support, particularly when you feel unable to remain safe. You do not need to compare your thoughts with anyone else's experience. There is no minimum level of distress that you must reach before contacting someone. What you may notice in someone else A person may tell you directly that they are thinking about harming themselves. They may speak about feeling hopeless, trapped, worthless or unable to continue. They may become unusually withdrawn, tearful, irritable or distant. They may lose interest in activities, stop communicating or show a marked change from their usual behaviour. You may notice unexplained injuries, repeated efforts to keep the body covered or signs that the person is concealing distress. These signs can have other explanations and do not prove that someone is self harming. Some people show no visible warning signs. A calm appearance, ordinary conversation or continued attendance at work or school does not confirm that someone is safe. Warning signs are not a scoring system No single sign tells you exactly what someone will do. Having several signs does not allow you to calculate a level of risk, and having no visible signs does not rule out serious distress. Do not count symptoms or place someone into a low, medium or high risk category. NICE advises that self harm risk tools and global risk categories should not be used to predict future self harm or suicide. Your role is not to perform a mental health assessment. Your role is to notice concern, take it seriously and help the person reach appropriate support. How to respond when someone tells you Try to remain calm and give the person time to speak. Listen without interrupting, arguing or immediately trying to solve the problem. Acknowledge what they have told you. You might say that you are glad they told you, that you are taking them seriously and that they do not have to manage the situation alone. Avoid describing the person as attention seeking, selfish or manipulative. Self harm thoughts usually indicate significant distress, even when you do not understand the reason. You can ask how they would like to be supported. You can offer to sit with them while they contact a GP, NHS 111 or Samaritans. Do not promise to keep the disclosure secret if you believe someone is in immediate danger. Explain calmly that you need to involve emergency help because their safety matters. You do not need to be a mental health professional or have perfect words. Listening, taking the disclosure seriously and helping the person contact support can be valuable. Asking directly is appropriate If you are worried about someone, it is reasonable to ask whether they are thinking about harming themselves or ending their life. Use clear, calm language rather than hints or euphemisms. Asking directly does not mean that you must assess or classify their risk. It opens a conversation and allows the person to tell you what they are experiencing. Do not question them repeatedly or demand explanations. Listen to their response and help them contact professional or emergency support as appropriate. When immediate emergency help is needed Call 999 or go to A&E if someone's life is in immediate danger. This includes serious self harm, an overdose, being about to act on thoughts of self harm or suicide, or being unable to remain safe. Ask someone nearby to call 999 if you cannot make the call yourself. If you are supporting someone else, stay with them when it is safe for you to do so until emergency help takes over. Any physical injury or suspected poisoning may also require urgent medical treatment. Do not delay emergency care while trying to decide whether the person's intention was self harm or suicide. Urgent help when there is no immediate danger In England, call NHS 111 and select the mental health option when urgent mental health help is needed but there is no immediate danger. NHS 111 can connect you with appropriate crisis support. You can also ask for an urgent GP appointment. If the person already receives care from a mental health team, contact that team using the crisis details they have provided. You can call NHS 111 because you are concerned about someone else. You do not need to make the decision alone. Talking to a GP Contact a GP if you are having thoughts of harming yourself, even if you have not acted on them. A GP can listen, consider your wider needs and connect you with appropriate mental health support. You can ask someone you trust to help arrange the appointment or accompany you. You may find it easier to write down what you want to say or show the clinician a written message. Be as honest as you can about what you are experiencing. You do not need to understand the cause or explain everything perfectly before asking for help. Samaritans Samaritans provides free listening support at any time of day or night. You can call 116 123 from any phone. You can contact Samaritans when you are thinking about self harm, when you feel overwhelmed or when you need someone to listen. You can also call if you are worried about someone else. Samaritans is a listening service rather than an emergency service. Call 999 or go to A&E when someone is in immediate danger or needs urgent medical treatment. Supporting someone does not mean managing everything alone You may care deeply about the person and still feel frightened, uncertain or overwhelmed. You are not expected to provide clinical care or remain solely responsible for their safety. Encourage professional help and involve emergency services when necessary. You can also speak to a GP, NHS 111 or Samaritans for guidance about your own concerns. Continue to treat the person with dignity. Check in with them where appropriate, but do not make promises that you cannot keep or accept sole responsibility for preventing harm. Thoughts of self harm may occur alongside "Low Mood", "Anxiety", "Poor Sleep" or "Panic Attacks", but no symptom pattern should be used as a self assessment or prediction tool.

Thoughts of self harm are a signal to connect with support, not a problem for you to score or classify. Notice concerning words or changes, listen without judgement, and use the appropriate route: 999 or A&E for immediate danger, NHS 111 or an urgent GP appointment for urgent help, and Samaritans when someone needs confidential listening support.