How to talk to children about self-harm

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It can be extremely distressing to find out someone you love is self-harming. Consultant psychiatrist Dr Andrew Hill-Smith reassures parents on what to say and when to hold back.

It is very distressing to find out that someone you care about is self-harming. Feelings of shock, confusion, guilt or even anger are common and this is not surprisingly, given the upsetting emotions this kind of behaviour exposes. 

Young people often sense that these are likely to be their parents' reactions, so they can hide what their self-harm, so as not to distress. The silence is a sign that they could feel ashamed, so it's really important to be as compassionate and non-judgemental as possible. This could be hard if you are feeling shaken or alarmed so take the time to settle yourself.

Why do children self-harm?

Self-harming happens for a range of reasons, most commonly as a way of managing high levels of distress or difficult feelings. But it can also be an attempt to communicate unhappiness. Take the time to ask questions and find out what is fuelling the behaviour. 

What questions should I ask?

Asking too many questions could feel invasive, so judge how much you can probe by thinking about your relationship with your child. Although asking questions can be daunting, you may want to ask whether your child has thoughts about wanting to die as it's important to assess how risky the situation may be.

Try asking your child about their mood, confidence, anxiety, whether they're eating and what they're doing online. Most advice suggests that it is important to work towards open communication about online activity rather than attempting to control it. 

Many young people find their own solutions to distress and self-harm with the help of friends, teachers or school counsellors. If you think the risk of harm is high or there are significant mental health problems such as depression or an anxiety disorder, then you may want to ask your GP for a referral to a child and adolescent mental health service.    

There are no right ways to help with self-harm, no easy answers. But a few things do seem to be important:

  • creating and encouraging positive and supportive relationships, including with family members
  • being compassionate and not reacting with too much alarm
  • working with your child to find solutions to problems that fuel the distress
  • being available to listen and, if your child is not communicating with you, trying to ensure there is someone they can talk to
  • being interested in, and concerned about, their progress

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