Talking to children and young people about self-harm

• Explain confidentiality from the start and be clear about who you will need to share information with and when.
• Never make promises about confidentiality that you can’t keep, as this can damage trust and encourage secrecy.

• Be mindful of their privacy, e.g. find a quiet space to talk where they can’t be overheard.
• Take care not to minimise, belittle, make light of, or make assumptions about their feelings or experiences.
• Avoid language or responses that may cause guilt or shame, e.g. “attention-seeking” or “negative coping strategy.” This overlooks the fact that self-harm may be only strategy they have at this time.
• Focus on the person and don’t define or label the young person by their behaviour, e.g. “self-harmer” or “cutter.
• Don’t draw attention to scars/wounds or ask to see them, as this may make them feel self-conscious or ashamed.
• Don’t instruct them to stop the behaviour. This overlooks the lack of control and distress many children and young people feel around their self-harm.

• Listen carefully, ask thoughtful and open questions, and allow plenty of space for them to reflect on their answers.
• Give them your full attention. Multitasking, interrupting or talking over them can appear like you’re not listening or taking the issue seriously.
• Remember that everyone responds to difficult experiences or circumstances differently. Be open and honest if you don’t fully understand what they’re going through or why they self-harm.

• Approach the topic in a gentle, curious manner, as asking about self-harm too abruptly can feel scary and confrontational. For example:

“How are you finding things at the moment? Have you been having a difficult time?” 

• Respond to them in a calm, composed and supportive way – never with shock, judgement, disgust or hostility. For example:

“Thank you for sharing with me. I’m glad you reached out and I’m going to do my best to support you.” 

If they find it hard to share their feelings out loud, suggest alternatives like writing you a note.

Don’t insist that they communicate or express themselves in a certain way if it feels difficult for them. 

‘Why’ questions can feel overwhelming or difficult to answer. Instead, you can gently support them to explore their feelings, triggers and patterns with questions like:

“What was going on for you at the time?” or “How do you usually feel when that happens?”

• Recognise that talking about their experience takes courage and reassure them they’re taking a positive step.
• Don’t ask why they didn’t seek help sooner.
• Let them know that struggling to cope with difficult feelings is not something to be ashamed of.
• Remind them that they’re not alone and you are here to help.

• Let them share at their own pace, on their own terms. If you sense that they’re unwilling or uncomfortable sharing information, don’t rush or pressure them.
• Ask them how you can best continue to support them, rather than making decisions for them. They might not have an answer, but simply asking the question lets them know that their feelings and thoughts are important.
• Give them choices wherever possible, as this can help them feel in control. For example:

“These are some things we could do next – how do those sound to you?” 

• Don’t remove items they may use to harm themselves unless there is a clear and immediate risk to their safety, or they ask for your support to do so.

• Ask about their support network (family, friends, trusted adults).
• Don’t assume they’ll get support elsewhere.
• Talk about coping strategies and offer to help them create a safety plan.
• Encourage basic self-care and safety, including first aid and cleanliness, to reduce the risk of infection.