Managing self-harm – practical responses

When young people harm themselves their families are faced with practical issues about hiding sharp objects and pills, dealing with wounds and being alert to further episodes of harm. These were important concerns for the parents and carers we spoke to.

Many were advised by the Child and Adolescent Mental Health Service or their General Practitioner to hide anything which could be used for self-harm. Although they tried to do this, several acknowledged that it was impossible to prevent the young person finding a way to self-harm. Sarah Z, Jim and Jo-Ann took razors and scissors away but their children found other methods of cutting.

Annette hid anything her son might use to harm himself.

Age at interview 54

Gender Female

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Charles would have liked advice on practical ways of minimising risk.

Age at interview 61

Gender Male

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Jane Z disagreed with clinicians’ advice to remove all potential methods of harm. It implied that she didn’t trust her child, and that parents could be blamed.

Age at interview 49

Gender Female

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Sometimes hiding sharp objects and pills caused problems – Sandra forgot where she’d put things, Anna, Jackie and Jane S had difficulty finding sharp knives when they were needed in the kitchen, and Jane’s husband had to switch to an electric razor so there were no razor blades in the house.

Although parents realised it was impossible to hide all means of self-harm, trying to do this felt like something positive they could do. Liz told us: ‘We’d been advised to move anything that was potentially dangerous from her room but, actually, they can use anything. We did it because I needed to feel that I was doing something, but it’s a bit of a nonsense really, because if you want to cut yourself, you can cut yourself.’ Jane S said that her daughter’s younger sister ‘made it her business going around hiding everything, which was her way of coping.’ Nicky would regularly go through her daughter’s room and throw away all her blades. ‘I know it’s futile’, she admitted, ‘because I know she’d go out and buy more, but I suppose my rationale was at least there is a small window between her realising she hasn’t got anything to cut with and her being able to go out and acquire something else. That was part of my coping strategy, I suppose, in having some modicum of control over it all.’

Other parents told us of strategies they used to prevent self-harm. Tam let her daughter use her eye-liner sharpener, but only when she could see her doing this. When Sandra’s daughter seemed to be recovering Sandra gradually put out some of the things she’d hidden, and when her daughter didn’t use them for self-harm she brought out the rest.

Another practical aspect of self-harm which worried many parents was dealing with the injuries which resulted from it. Wounds varied in severity – while some needed relatively little care and could be treated at home, others were so bad that the young person had to be rushed to hospital. Bernadette had to dress her son’s serious burns herself, with help from the practice nurse. Joanne was given packs of bandages by the nurses at her GP’s surgery. ‘Now I’m quite immune to it,’ she told us. ‘I can see her arm slashed and I will just stick it back together myself. I’m quite a professional’. Jo, a nurse, found caring for her daughter’s wounds a positive experience: ‘I felt like I was being a mother, a rescuer, a professional, a carer, something nice in her life’.

Jane S felt terrible that her daughter hadn’t felt able to come to her when her wounds were infected because she thought Jane wouldn’t understand.

Age at interview 54

Gender Female

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Sometimes Ann’s daughter’s wounds were so bad that she needed to go to hospital.

Age at interview 47

Gender Female

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Several parents stressed the importance of self-care. ‘If you’re going to damage yourself’, Jackie advised, ‘make sure that you’re doing it in as safe a way as possible.’ Jackie and Tracey warned their children about the risks of wounds becoming infected. Alexis ‘went into practical mode. Maybe practical mode was easier to deal with than emotional mode, it’s ‘okay, we have to look after these cuts’. So you buy your Savlon and you buy your cotton wool and you look after the cuts because that’s the easy bit.’ The Child and Adolescent Mental Health Service team showed Ruth’s daughter how to care for her wounds. Nicky and Jackie pointed out that some people might be shocked that clinicians and websites were giving information about how to harm yourself, but they agreed that safer cutting was important.

When a young person has harmed themselves their family is usually very worried that they may do it again. Parents we spoke to were no exception: Susan Y said she was checking her daughter every day, making her keep the bathroom door open, and looking to see if there were any more scars. Pat was ‘in a state of red alert constantly’. Fiona feared for her son: ‘I’m sort of watching him like a hawk with part of me but I don’t want him to feel that I’m watching his every move.’ Other parents also tried to hide this monitoring from their children.

Annette thinks it is important to be attentive at all times. She was on twenty-four hour red alert’ but didn’t want to aggravate her son.

Age at interview 54

Gender Female

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Sandra and her husband were vigilant, but didn’t want their daughter to think they were checking up on her.

Age at interview 49

Gender Female

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Jackie is still on guard’ even though it is over a year since her daughter last harmed herself.

Age at interview 40

Gender Female

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Fears and worries about self-harm

When young people harm themselves families are often worried that they may go on to die by suicide. Although there is evidence that people who...