Question 1

What is self-harm? Signs and causes

Accepted Answer

What is self-harm? Signs and causes

An overview of definitions of self harm, information on common causes and some ideas for those looking to stop self harm as well as treatment recommendations.

View

Question 2

Guide to support students through COVID-19

Accepted Answer

Read the Rehab Clinics Group's new findings on student mental health and guide to help students cope here.

Question 3

Amy Cook - Lived Experience Support Worker

Accepted Answer

Amy joined Self Injury Support in December 2020 as a Lived Experience Support Worker, part-time. LE Support workers are part of the A&E follow-up service, supporting individuals who have attended the A&E department following self-harm.

Amy also works for the NHS and has done for the past 12 years. She has experience supporting people in mental health crisis and has previously volunteered for Samaritans and Linkage charities. In order to maintain good mental health, Amy enjoys exercise, music and allotmenting.

Question 4

Caz Walsh - Training Admin Assistant

Accepted Answer

Caz has a background in psychology and graduated in 2019. She now helps out with administration relating to the training courses offered by SiS, alongside working in mental health services. She is passionate about improving education and reducing stigma around mental health and self-harm, and is proud to be part of an organisation that is here to help.

Question 5

Mel Bates - Support Services Assistant

Accepted Answer

Mel joined Self Injury Support in September 2020, having volunteered on the helpline for 6 years. She has experience in support work and volunteer co-ordination.

Question 6

Volunteer Involvement Policy

Accepted Answer

Who We Are and What We Do

Self injury Support (SiS)is a national organisation that supports girls and women in emotional distress. We particularly help women who harm themselves, often called self-injury.

We have carried out extensive research with women who self-injure. Through our work we have developed a deep understanding of the reasons individuals harm themselves and of the things they may need to help them overcome their self-injury.

We also have wide experience of the concerns and needs of workers in different settings and disciplines, and in developing good working practice.

Involvement of volunteers

Volunteers are essential to our work and form an invaluable part of the organisation. Volunteering roles are distinct from paid roles but complement the work we do overall.

Self injury Support recognises and values the contribution volunteers make to the organisation. As Self injury Support benefits from the skills, experience and enthusiasm of volunteers, we believe that volunteers should also be able to benefit from their involvement with us.

We are committed to providing relevant opportunities and appropriate support, and regularly review our policies and practices to ensure we achieve this.

Self injury Support seeks to involve volunteers to:

Contribute to the provision of services by Self injury Support
Contribute to projects delivered by Self Injury Support
Ensure our services meet the needs of all our current and prospective clients
Provide new skills and perspectives
Enable people to contribute to wider society and to benefit from their involvement

Self injury Support believes:

Volunteering is a valid activity in its own right
Volunteering is not a substitute for paid work.

Volunteering should be a positive experience

Recruitment

Self injury Support aims to make volunteering opportunities available to all sections of the community. We aim to make recruitment and selection materials available in a format accessible to any individual or group, upon request. We also:

Have an open and transparent system for the recruitment of volunteers
Offer all potential volunteers the opportunity to find out more about the role before committing themselves
Ask all potential volunteers to complete an application process which we aim to make as informal and friendly as possible
Request references where appropriate

Require applicants for roles involving contact with children, young people or vulnerable adults to agree to relevant background checks
If we are not the best match for a volunteer we will try to signpost them to other appropriate organisations

Volunteer Role Descriptions

Each volunteer role will have a role description which gives an outline of the basic tasks. These role descriptions will be discussed with each volunteer and adaptations or changes can be negotiated in line with volunteer and organisational needs.

Volunteering is an activity undertaken through choice and although we ask volunteers to sign a volunteer agreement, we do not enter into any contractual agreements with volunteers. Volunteers are free to leave their roles at any time.

Expenses

All volunteers are entitled to have agreed travel and other out of pocket expenses reimbursed on the production of proof of expenditure. Details of expenses claims are in the Volunteer Induction Pack.

Induction and Training

Self injury Support will:

Provide all volunteers with an induction, and a copy of the Volunteer Induction Pack
Provide all volunteers with an opportunity to discuss the induction information and any issues with their supervisor

Provide training for the role as appropriate
Encourage all volunteers to participate in further relevant training and development opportunities where there are funding and resources available

Support and Management

Volunteers will be assigned a supervisor who will be the volunteer’s first point of contact. This person is responsible for providing ongoing supervision, support and guidance.

Self injury Support will provide volunteers with adequate and appropriate facilities, equipment and resources to enable volunteers to fulfil their roles.

Problems or Concerns

We hope that any problems or complaints can be dealt with by the supervisor of the volunteer through the usual support and supervision systems in the first instance.

We also operate a Volunteer Disciplinary and Complaints Policy which can be found in the Volunteers Induction Pack.

Insurance

Volunteers are covered by employer’s liability whilst they are engaged in authorised activity on Self injury Support’s behalf.

Health and Safety

Volunteers are included within Self injury Support’s Health and Safety Policy and are expected to work in line with appropriate health and safety guidance at all times. Health and safety will be included as part of the induction.

Equal Opportunities and Diversity

Self injury Support is committed to equal opportunities and the promotion of diversity in respect of both paid staff and volunteers.

We seek to protect volunteers and staff from harassment and discrimination as outlined in our Equal Opportunities Policy included in the Volunteer Induction Pack.

Confidentiality and Data Protection

Volunteers are expected to adhere to the same requirements for confidentiality as paid staff. Self injury Support will maintain personnel files (which may be paper or electronic) for all volunteers which may include: personal contact and emergency contact details, application and selection information, records of support, supervision and training activities and any complaints or grievances made or received.

All personal data will be treated in accordance with Data Protection legislation, and volunteers are entitled to have access to personal records relating to their own involvement.

Question 7

Sabita Burke - Communications Project Assistant

Accepted Answer

Sabita is an English Language and Linguistics graduate with a mixed background including journalism, publishing, marketing and mental health support work. She now runs the communications and marketing for Self Injury Support and deals with everything from social media to email newsletters and more. She hopes to raise awareness of self harm and the organisation's services.

Question 8

I need to feel physical pain as my emotional pain is overwhelming or I feel I deserve it

Accepted Answer

Things people have told us they do in this situation are:

Bite into a chilli
Hold ice cubes
Snap an elastic band or hair band on your wrist

Question 9

I need to feel able to care for and nurture myself

Accepted Answer

Ideas people have given us over the years include:

Cuddling a soft toy/pillow
Allowing yourself to cry
Sleeping
Taking a shower or bath
Playing with a pet
Drinking hot chocolate
Wearing your pyjamas and watching daytime TV
Having a massage or massaging your own hands and feet

Question 10

I need to communicate that I am not OK – to myself and/or others

Accepted Answer

Some ideas people have suggested to us are:

Draw yourself or around your arm on a piece of paper, draw the harm you are imagining then destroy the picture
Take a photo of yourself when you are feeling upset, write all over it how you are feeling then destroy the picture.
Writing poetry, journals, letters, stories
Doodling or scribbling on paper
Drawing or painting

Question 11

I need to feel connected to my body; to feel something

Accepted Answer

Some suggestions in this situation are:

Take a hot shower and use a good exfoliating body wash and a sponge or glove and scrub!
Chewing leather
Grounding exercises
Dancing
Singing
Anything that involves repetitive action – colouring, stroking a pet, tapping your fingers on a table

Question 12

I need to release pent up, unbearable emotions

Accepted Answer

Some suggestions people have told us about over the years include:

Punching a punch bag or cushion
Having a pillow fight with the wall
Shouting and screaming
Ripping up paper into small pieces
Chopping up plastic bottles
Taking your anger out on a soft toy
Throwing socks against the wall
Stamping your feet (with boots on)
Making and listening to a playlist that matches your emotions

Question 13

Delaying Self-Harm

Accepted Answer

Delaying is a form of harm minimisation where the aim is to recognise urges to self-harm and to try not to act on them straight away.

Delaying self-harm is not about telling yourself that you can't self-harm, but about trying to wait until urges and emotions are less strong, so you feel more in control and are able to control the level of self-harm.

It often doesn't feel like it at the time, but powerful emotional states and urges to self-harm do pass or reduce with time.

Here are some suggestions that might help you to delay self-harm. Again different things work for different people, so don't beat yourself up if this doesn't work for you right now.

Being Aware of Triggers

Some people find it helpful to think about when they get urges to self-harm and if there are any specific things which make them start thinking about self-harm such as:

specific events or experiences
times of the day, month or year
seeing certain people or going to certain places
specific smells, tastes, sounds, images or types of touch
or any other patterns they notice about their urges to self-harm

If you are aware of the types of things that trigger your thoughts and feelings of self-harm then you might be able to use that awareness to notice your feelings earlier, and slow down the process that leads from feeling urges to actual self-harm.

You might also find over time that you're able to remove yourself from a situation you are finding triggering or do some other activities which help get you out of a triggered mindset e.g. exercise, loud singing, screaming into a pillow

Creating a Safe Space in Advance

It can be hard to think clearly if you are distressed or trying to deal with self-harm urges, but some people find it helpful to create a 'safe space', where there is nothing available to harm yourself with - this could be:

a specific chair
corner of the room
inside a cupboard
anywhere you can stay until you feel less unsafe

As soon as you become aware of urges to self-harm you can go to the space. You could also put activities there that you know will help to distract you.

Surfing the Urge

When you notice urges you may be able to tell yourself that you will wait a short time:

choose (possibly in advance) how long you think you can wait e.g. 30 seconds or 5 minutes - any time is an achievement, but try to choose something you think you can manage
you might want to plan an activity that you know will distract you in advance and keep it somewhere you can access it easily
see if you still want to harm yourself at the end of this time, if you do then you can
if you get to the end of the time and you think you can wait longer you can wait for that time again
over time you may be able to extend this time and make it longer

If you are able to delay sometimes and not others, try not to beat yourself up - it might not always feel possible and that's OK.

At times when you can't delay then other harm minimisation techniques might be helpful

Keeping Implements in Awkward Places

Some people find it helpful to put what they use to self-harm in a place that is difficult to access, to try and delay self-harm.

This might involve:

an inaccessible place - keeping implements in a place that is difficult to get into such as a high cupboard or somewhere that needs to be accessed with a ladder
another person - asking someone else to keep things for you and you have to ask for them to use them
awkward storage - storing implements inside something that takes a long time to remove, such as layers of wrapping paper or clingfilm or freezing them in a block of ice

Similar to delaying by distraction/surfing the urge, the aim is to slow down the process that leads to self-harm, not necessarily to stop it, and some people find they still need to self-harm when they get what they need and others find it creates enough of a delay for the urges to pass.

There are no wrong or right ways to use these techniques - simply use them in ways which are helpful to you and don't use things which you don't find helpful.

This page from LifeSigns walks you through how to try a fifteen-minute delay

Question 14

Where You Harm and What You Do

Accepted Answer

Understanding more about your body and the type of self-harm you do can help you to think about how to reduce harm and risk.

It might be help to consider the following three areas:

Developing Awareness of What and Where

One way to reduce harm is to learn which ways of self-harm are less risky than others.

This can be about considering:

the location on your body
the depth or severity of the injury
what you use to self-harm
the length of time you self-harm for

and whether you can reduce risk by changing any of these things.

Making Small Changes

Small steps make a difference and any reduction in harm is a huge achievement.

For example, you might feel able to consider:

harming yourself on a part of your body away from major blood vessels
using a clean implement
making a smaller injury than usual
reducing the length of time you harm yourself for

It is important to consider what feels possible to you.

Different things will feel possible for different people.

Building Your Knowledge

Knowing some basic anatomy so you are aware of places on the body that are safer to harm in relative terms can be part of this.

The basic principles of this approach are that:

the more fleshy, softer parts of the body are safer
avoiding major blood vessels and arteries, joints and injuring across tendons and muscles is essential to minimise risk of serious injury and blood loss

This resource produced by the National Self Harm Network gives more information on anatomy and physiology in relation to self-harm

Question 15

Broken Bones

Accepted Answer

It can be difficult to distinguish between a bone, joint or muscle injury so if in doubt, treat the injury as a broken bone.

The main aim is to prevent further injury.

If you suspect a broken bone:

Support the limb with your hand.
Avoid moving the injured part if possible.
Secure and support the injured part. You can use rolled up blankets, cushions, clothes or whatever you have handy.
Arrange for travel to hospital.

If this is not possible or in the case of suspected spinal or neck injury, call 999.

Find more information here:

https://www.redcross.org.uk/first-aid/learn-first-aid/broken-bone

Question 16

Strains and Sprains

Accepted Answer

Strains and sprains should be treated initially by the ‘RICE’ procedure:

R rest the injured part

I apply ice or a cold compress
C comfortably support the injury
E elevate the injured part

This treatment may be sufficient to relieve the symptoms, but if you do not know how severe the injury is, treat it as a broken bone and seek medical advice.

More information can be found here:

https://www.redcross.org.uk/first-aid/learn-first-aid/strains-and-sprains

Question 17

Overdoses

Accepted Answer

ALWAYS seek urgent medical attention without delay

One tablet over the prescribed amount is too many
What may not harm one person may be fatal or cause serious damage to another. Everyone is different. The damage an overdose will cause can depend on many factors
You may not seem to be affected by the number of tablets you have taken on one occasion but that does not mean you won’t be affected if you do it again with the same number. You may appear fine but it is always possible that you have caused damage that is unseen, and may still need to be checked out.

If you find an unconscious person who has taken an overdose they should be put into the recovery position – on their side with their head tilted back and their chin lifted.
Call an ambulance, keep monitoring them - checking that their airway is open and they are breathing

More information can be found at:

https://www.redcross.org.uk/first-aid/learn-first-aid/unresponsive-and-breathing

Question 18

Burns and Scalds

Accepted Answer

With burns and scalds the aim of first aid is to stop the burning process and protect the wound.

Firstly cool down the burn by placing it under cold running water for at least 10 minutes. This will reduce the pain and swelling.
Remove all clothing and jewellery from the affected area, unless it is attached to the burn. Do not try to remove clothes that are stuck to a burn.
Once the burn is cooled, cover with cling film (if available) – this will help stop infection. Place the cling film lengthways just to cover the area loosely - there is no need to wrap and seal the cling film round the area
A clean plastic bag can be used to cover a burn on the foot or hand
Call an ambulance if necessary. If you are not sure how severe the burn is seek advice. Burns to the face, hands or genitals require immediate medical advice.
Avoid using any creams or lotions.

More information can be found at:

https://www.redcross.org.uk/first-aid/learn-first-aid/burns

Question 19

Shock

Accepted Answer

Shock is a life-threatening condition and occurs when vital organs do not get enough oxygen due to reduced blood circulation.

The most common cause of shock is severe blood loss.

Signs of shock include pale, cold and clammy skin, a rapid and weak pulse, fast and shallow breathing, sweating, nausea and thirst.

If you suspect shock,

Call 999, and if you can’t, ask someone else to do so

Lie down with your legs raised higher than the rest of your body and supported

Wrap yourself in coats or blankets to keep warm

Avoid food and drinks in case there is a need for a general anaesthetic in hospital

Visit redcross.org.uk/firstaid/shock for further information

Question 20

Severe Bleeding

Accepted Answer

The main aim of first aid for severe bleeding is to stop blood coming out of the wound

Apply pressure to the wound - you can use your hand, or any clean material, such as a tea towel. If blood soaks through the item you’re using, do not remove it but add more items and maintain firm pressure.
Call 999 as soon as you can, and if you can’t, then get someone else to do so.
Keep pressure on the wound until help arrives
If something is embedded in the wound, DO NOT REMOVE IT and take care not to press on the object. Instead, you’ll need to press firmly on either side of the object and build up padding around it before bandaging to avoid putting pressure on the object itself.
Watch the person for signs of shock which include looking pale, feeling cold and feeling dizzy.

Please see the following links for further information:

https://www.redcross.org.uk/first-aid/learn-first-aid/bleeding-heavily

Question 21

Cuts

Accepted Answer

Adapted from Basic First Aid by the National Self Harm Network and British Red Cross – access the leaflet here

Apply pressure to the cut and hold the affected area above the heart (if possible) until the bleeding stops
If the bleeding does not stop after applying pressure for 10 minutes, seek medical attention
Rinse the cut(s) under running water or clean with alcohol-free wipes, and make sure there is no dirt in the cut(s) which could cause infection
Gently dry the affected area with a clean paper towel
Apply a plaster to close the wound, or if needed apply a sterile dressing
Seek medical attention if the cut was made with a non sterile object or if there is a risk of any dirt or foreign objects remaining in the wound

ALWAYS make sure your tetanus injections are up to date

Please seek medical attention if:

you think the cut may have become infected
it is not healing properly

Signs of infection include:

swelling
redness and increasing pain in the affected area
pus forming in or around the wound

More information can be found at:

https://www.nhs.uk/conditions/cuts-and-grazes/

Question 22

Distractions and Displacement Resources

Accepted Answer

Distractions from Self Harm

Distraction Techniques and Alternative Coping Strategies

Distractions and Distancing from Self Harm

Distractions that Can Help

Question 23

I need to find a displacement activity for the physical sensations of self-harm

Accepted Answer

There are a range of physical sensations associated with self-harm which will be different for different people. These are some of the sensations people have told us they needed to find displacement activities for:

Physical pain:

Some people find snapping an elastic band on their wrist or creating a short sharp pain in a non-damaging way helpful, as this brings physical pain which can be a grounding and reconnecting experience.

Sensation of blood or seeing an injury:

The sensation of blood or being able to see blood is important for some people, so trying to recreate that with food colouring and gelatine or drawing on yourself with red pen can be useful.

Taking care of wounds:

For some people taking care of wounds is a key area, so applying ointments and dressings can be another way to replace actual self-harm.

Question 24

How do I choose a useful distraction or displacement activity?

Accepted Answer

Distraction

The idea of distraction is what it says on the tin - aiming to move your focus to something different for long enough that your thoughts or urges to self-harm are not as strong, or have gone away.

The type of distraction that’s help will depend on both what you’re interested in, as well as what you need in that moment. There's no point picking something you hate doing just because someone else has recommended it.

You might feel able to make the choice to immerse yourself in an activity you enjoy, but you might need to specifically pick something which requires close concentration or focuses on reconnecting with your senses.

Displacement

Displacement focuses more on trying to recreate or replace what you need from self-harm, especially on a sensory level.

Thinking about your experience of self-harm and the feelings and sensations you associate with it can help you to consider what kind of displacement activities you might find helpful.

You might want to recreate a feeling of release or control, or you might want to focus on physical sensations or responses.

The list of potential distractions and displacement activities is huge and what works for each person will be different – probably at different times, but thinking in advance and creating a list of things to try as distraction or displacement activities can help you to be prepared if you are struggling with self-harm urges and want to focus on distraction or displacement as a way to manage.

Question 25

I need to feel reconnected with my body and my surroundings

Accepted Answer

Sensory distractions are where you focus on a specific sense to reconnect with your body and try to break the chain of urges to self-harm.

These distractions can focus on one or more of the five senses:

sight
sound
touch/sensation
taste
smell

Thinking carefully about what might help you in advance and which sense you would like to focus on can be helpful.

It's also important to remember that sights, smells, sounds, tastes and other sensations can also trigger specific memories and associations, so you might want to think about choosing a distraction that has a positive association for you and avoid things that bring up negative associations or memories.

Some suggestions of sensory distractions are things like:

immersing your face in very cold water
tapping your fingers on your face like gentle rain
snapping an elastic band on your wrist (yes, we know – not everyone, not all the time!)
sucking on ice
smelling or eating an orange or lemon
playing loud music
focusing on a bright picture or screen

Question 26

I need to change my focus and do something that needs a lot of concentration

Accepted Answer

Another type of distraction can be ones which require concentration and help you to bring your focus to something completely different such as:

colouring (swearing colouring books are available!)
cross-stitch(say you've always wanted to say but never could out loud!)
crosswords or other puzzles
online games or quizzes
jigsaws
any other task which requires your full attention

It can take some effort to get drawn into these type of distractions, but they can be very effective too.

It might be helpful to choose an activity in advance that you would like to try and have it ready for when you want to use it.

Question 27

I need to be totally immersed in something else to distract myself

Accepted Answer

Some distractions are also known as ‘hobbies’ and if you’re able to get totally immersed in something then that can be helpful in distracting you from how you are feeling and any urges to self-harm.

Having a specific place you go to and do this activity that you have decided is safe might also be helpful.

Hobbies people have told us they have used as distractions include:

reading
gaming
watching films or boxsets
doing sports
doing crafts

Question 28

Treatment Self Advocacy Resources

Accepted Answer

Self Injury Self Advocacy Sheet from Advocacy for You

Self_Injury Treatment Personal Checklist

Self Harm Report Card from National Self Harm Network

Question 29

How can I clearly give others information about what do and don't want to happen?

Accepted Answer

It can be hard to express what will help and what will make things worse when seeking treatment for self-harm, especially if you are hearing voices, having intrusive thoughts, are dissociated or feeling strong and distressing emotions.

It might be helpful to write down or note in your phone information you want to share about what you will find helpful and unhelpful.

This list may include some things you might want to mention:

How you are feeling now and how likely you are to self-harm again soon
Where would be a safe place for you to wait for assessment and treatment
Whether you want to talk to someone about your self-harm or not
Whether you have a preference about being treated by a man or a women
Whether you would like someone else to be contacted to support you

Question 30

How can I clearly give others information about what has happened?

Accepted Answer

It can be hard to put things into words when seeking treatment for self-harm, especially if you are hearing voices, having intrusive thoughts, are dissociated or feeling strong and distressing emotions.

It might be helpful to write down or note in your phone information you want to share or are likely to be asked about.

This list may include some things you might want to mention:

Type of Injury or Harm
Location of injury
Injury caused by
Medication or poisonous substance you have taken
Time of injury or of taking medication or other substances
Any medications you usually take
If you have had any alcohol or taken any other medications or street drugs

Question 31

Where Should I Go If I Need Treatment for Self-Harm?

Accepted Answer

Options for self-harm treatment are still available but they may have changed in the way you can access them.

Your GP surgery and 111:

If you don’t think you need to go to A&E you should contact your GP surgery or 111. All GP surgeries will have their own procedures about how to seek treatment, so you should call your own surgery for information on how to get a GP appointment or 111 if it is out of hours.

A&E and Minor Injury Units:

If you need to go to A&E the reception and triage may be different to normal.

Many A&E departments are triaging people at the main door so that people who do not have symptoms of coronavirus are sent to a different part of the hospital to avoid infection from those who do.

You may be sent to a different part of the hospital or a minor injuries unit.

You may be seen by staff wearing Personal Protective Equipment which can look quite strange.

This is for your protection and theirs, and they will still be able to give the same care and treatment.

Even if you are attending hospital for self-harm treatment you should report any other symptoms that might be related to coronavirus such as a persistent cough, temperature or shortness of breath to staff as soon as you arrive.

Question 32

Rosie Wild - Community History Worker

Accepted Answer

Rosie joined in 2020 to lead on our National Lottery Heritage Funded project Women Listening to Women. A trained historian, she has lots of experience working with marginalised communities to help them uncover their hidden histories and tell their stories in their own voice.

Question 33

Jess Puplett - Support Services Manager

Accepted Answer

Jess stepped into the role of Support Services Manager in 2020 after volunteering on the support services and working as Services Assistant. She has extensive experience in welfare benefits, as well as a background in Sociology and Social Policy.

Question 34

Florence Weston - Operations Manager and Business Development Officer

Accepted Answer

Florence has taken up a number of roles since joining Self injury Support in 2018, from book keeping from digital development. Currently she is responsible for organisational development focusing on internal systems and external networks.

Question 35

Clare Chubb - Administrator

Accepted Answer

Clare has a background in data analysis and joined the organisation in 2019. She has spent her time revitalising our financial and record keeping systems and making sure we actually know where all the stationery is!

Question 36

Louise Coleman

Accepted Answer

Louise first joined Self Injury Support as an intern and worked on training and communications development before becoming a trustee in 2018. She currently works in mental health support work and has previous experience in fundraising and community project management.