Responding to an incident of self-injury

Refer to any plans you have been given and contact relevant supports provided by the agency you are working for to guide your responses to self-injury.

There are various things you can do to support a young person during the different stages of the process of self-injury. 

When the young person is thinking about self-injuring

Ask about it

When you think a young person is considering self-injury open up the conversation.  Start by asking them how they are feeling or what are they thinking about.  Don’t assume they are going to self-injure but maybe reflect that when they have been like this in the past, that is what they have done, so they may be thinking about it.

Distract

If they are too distressed consider asking them to delay for a short period.  This gives you the time to validate the young person’s feelings and help them feel more in control and less distressed.   At the same time a risk assessment should be conducted in a sensitive manner.  This may result in urge to self-injure reducing or they may still wish to go ahead.

Suggest alternatives

If the urge remains, you may suggest practical alternatives that might meet their needs or reduce their distress. Consider what has helped in the past.

Reduce the harms

If they still intend to self-injure then steer them to the least harmful ways or provide them with appropriate equipment / self-care pack if within your policy.  Reassure them you are available to them and would like to continue the conversation. Agree with the young person that you will need to check on them in 30 mins.

Consider distraction from pain or self-soothing and relaxation.

When the young person is in the act of self-injuring

• Approach them in a calm and respectful manner
• Ask them if they are ok?  Talk to them
• Stay within the general area so you can monitor them and be aware of what is happening

After they have self-injured

• Reassure them and respond in calm and respectful manner and request to see the injury
• Assess extent of injury and provide appropriate care
• Assess the environment and dispose of implements
• Remember that often young people will feel guilty, angry and /or ashamed after self-injury, so be sensitive
• If it is the first time the young person has self-injured it is a crucial opportunity to provide some education and de-mystifying self-injury.  This will help reduce their shame or guilt and normalise the behaviour as a coping mechanism.
• Try and explore the self-injury with the young person.  They may be open to engaging in this straight away or it might be better to leave it until the following day.  Whatever the case, reflecting on things like the context of the self-injuring behaviour, the triggers, outcomes of the behaviour and possible strategies to try in the future are all a great opportunity for learning and understanding for both you and the young person.
• Reflection at this time is a great opportunity to develop a support plan with a young person that is based on a joint understanding on their past and recent self-injuring behaviour.  When developing such a plan also look at times when they felt the same emotions or triggers and didn’t self-injure.

What NOT TO DO

There are some things that will only make the situation worse and be damaging to your ongoing relationship for the young person and often mean they won’t be open in the future. So try to avoid:

• Adopting an authoritarian approach
• Attempting to ‘rescue’ the young person
• Seeing the young person as ‘mad’ or ‘bad’
• Giving simplistic explanations about what may be going on for the young person
• Becoming overly-responsible and/or accountable for the young person’s self-injuring
• Tell them to stop or force them to talk about it
• Make assumptions about ‘why’

Focus on the behaviour rather than the individual

Look After Yourself

To be the best support to the young people in your care, you need to also look after yourself.  Dealing with self-injury can be challenging and demanding.  Having good self-care strategies and support is important.