Space to be Understood - Self-Injury Support by Naomi Salisbury, Director of Self-Injury Support “The times when I would want to hurt myself I would be feeling panicky, small and unreal. I’d feel myself falling faster and faster into this scary place from the past.” Self injury Support (www.selfinjurysupport.org.uk) is a charity that has over 30 years’ experience in offering support around self-harm. Our vision is that anyone who uses self-injury knows they are not alone; that everyone understands that self-injury is a complex and important issue we should all care about; and that together we tackle both the causes and stigma of self-injury. We focus on improving support and knowledge around self-injury by offering safe spaces where we listen and never judge, and demonstrating the impact of this support; creating experience-led tools and information on topics clients tell us they want to know about; promoting better models of support through training health and social care workers of the future; working with researchers & policy makers to make sure what people tell us they want is put into practice Currently we offer a UK-wide multi-channel listening service to women and girls who self-harm, a regional peer-led support service for people over 18 who have attended Urgent Care or A&E for self-harm, training and education for health, social care, education and voluntary sector staff around supporting people who self-harm and extensive free online experience-led resources for anyone who uses self-harm or supports them through our website. Support around trauma and abuse has been a core part of our work since we were founded in 1986 as the Bristol Crisis Service for Women. The organisation started life as a feminist collective that offered peer support to women struggling to cope with mental ill health, trauma and distress. It started by opening a telephone helpline in January 1988, run from the back of a charity shop in Easton in central Bristol. Once the helpline had opened, it quickly became obvious that the majority of callers were using self injury as a way of coping with trauma they had experienced, often from childhood sexual abuse. The UK has one of the highest rates of self-harm in Europe with over 6% of UK adults self-harm and 10% of adolescents will have self-harmed before they leave school and this is highly concentrated in areas of severe socioeconomic deprivation[i]. Young women are at highest risk, being more than twice as likely as boys to self-harm. Along with People of Colour[ii], women in prison and people identifying as LGBTQUA+[iii]. Self-harm is highly stigmatised with research by The Lancet (2019) show only 50% of people who self-harm get support. According to research used to develop the NICE guidance for self-harm there is evidence from systematic reviews of cross-sectional studies and one prospective study that a history of childhood sexual abuse is a risk factor for self-harm.[iv] Research undertaken at London Metropolitan University also showed that “self-harming behaviour, without suicidal intent, was also very strongly associated with experience of violence and abuse. More than half (56%) of people in the ‘extensive physical and sexual violence and abuse’ group had self-harmed, compared with 10% of people with little experience of violence and abuse. The report noted that women were more likely to be in every group characterised by abuse and violence.”[v] On our listening services around 30% of callers talk about experiences of abuse, and often express high levels of guilt and shame around what has happened to them and also about using self-harm to cope. What is key for us is to offer compassionate, non-judgemental support to women who call us and be clear we know that they have nothing to be ashamed of and are doing their best to survive. We don’t ask people to stop using self-harm, although we will support someone to do that if they want to. We acknowledge that this is what is needed right now and we aim to provide a space where that is understood. Ideas for Supporting Someone Who Self-Harms: Short-term Show that you see and care about the person in pain behind the self-injury. Show concern for the injuries themselves. Whatever ‘front’ they may put on, a person who has injured themselves is usually deeply distressed, ashamed and vulnerable. You have an opportunity to offer compassion and respect – something different from what they are often used to receiving. Make it clear that self-injury is okay to talk about, and can be understood. If you feel upset by the injuries, it may be best to be honest about this, while being clear that you can deal with your own feelings and don’t blame them for them. Convey your respect for the person’s efforts to survive, even though this involves hurting themselves. They have done the best they could. Acknowledge how frightening it may be to think of living without self-injury. Reassure the person that you will not try to ‘steal’ their way of coping. (Also reassure yourself you are not responsible for what they do to themselves.) Longer-term Help the person make sense of their self-injury. eg ask when the self-injury started, and what was happening then. Explore how it has helped the person to survive, in the past and now. Retrace with them the steps leading up to self-injury – the events, thoughts and feelings which lead to it. Gently encourage the person to use the urge to self-injure as a signal: – of important but buried experiences, feelings, and needs. When they feel ready, help them learn to express these things in other ways, such as through talking, writing, drawing, shouting, hitting something, etc. Support the person in beginning to take steps to keep themselves safe and to reduce their self-injury – if they wish to. Examples of very valuable steps might be: taking fewer risks (e.g. washing implements used to cut, avoiding drinking alcohol if they think they are likely to self-injure); taking better care of injuries; reducing severity or frequency of injuries even a little. In all cases more choice and control are being exercised. Don’t see stopping self-injury as the only, or most important goal. A person may make great progress in many ways and still need self-injury as a coping method for some time. Self-injury may also worsen for a while when difficult issues or feelings are being explored, or when old patterns are being changed. It can take a long time for a person to be ready to give up self-injury. Encourage them and yourself by acknowledging each small step as a major achievement. Current information about all of Self-Injury Support services can be found here: https://www.selfinjurysupport.org.uk/our-support-services and our office can be contacted on [email protected] or 01179279600 References [i] https://www.childrenssociety.org.uk/good-childhood [ii] https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/ethnic-differences-in-selfharm-rates-characteristics-and-service-provision-threecity-cohort-study/CDBA53F0AC230909E892C263781A0A51 [iii] https://www.mentalhealth.org.uk/statistics/mental-health-statistics-lgbt-people [iv] National Institute for Health and Care Excellence (NICE). Self-harm (longer term management): Clinical guidelines CG133. London: NICE; 2012. http://guidance.nice.org.uk/CG133 [v] McManus S et al. Violence, abuse and mental health in England: Preliminary evidence briefing. NatCen Social Research, DMSS Research, and the Child and Women Abuse Studies Unit at London Metropolitan University; 2013.