Self harm strategy and action plan 2023 to 2027

Self-Harm Support and Services

We recognise that the complex nature of self-harm and the varied reasons someone might self-harm means that there should be a range of support and services available to meet diverse needs. The majority (77%) of people who self-harm in Scotland will seek support from healthcare services in connection with self-harm over their lifetime. This can include GPs, unscheduled care (for example A&E) or mental health services. However, only 1 in 4 people sought healthcare support following their most recent experience of self-harm, and for young people aged 18-24, the number seeking support from a healthcare professional was significantly lower than the adult average^[20].

It is therefore important that this programme of work also seeks to improve responses, by embedding both trauma- informed and Time, Space, Compassion approaches, across a varied range of supports and services. For example, healthcare services as well as community- based support and informal care and support provided by parents, carers, partners, and friends.

Informal Support

Many people with lived experience have told us that when they do seek help for self-harm, they want to be supported by someone they know and trust, who can listen to them, validate their feelings, and work alongside them to find ways to improve their wellbeing – all at their own pace. For many people this valuable support would be given by a family member, partner, friend, or other trusted person.

“Sometimes you don’t want a solution you just want someone to listen.” - Youth Advisor Group Member

We know that it can be incredibly difficult to support someone who is self-harming, it can be distressing and affect one’s own wellbeing. We have heard that people can be worried about not having the right knowledge or understanding about self-harm, not knowing how to help and fearing that an uninformed response could make the situation worse. We also recognise that many people in a supportive role may also have their own experience of self-harm and may find the topic area difficult to talk about, and potentially triggering.

We will work to increase knowledge and understanding of self-harm within these vital informal support networks so that they are able to respond more confidently and in a supportive, non-stigmatising way, whilst also ensuring that their own wellbeing is supported.

Community-Based Support

Community-based support is also important and can include responses and support given by staff in education, youth work, housing, criminal justice, social work or third sector organisations. Developing communities’, and services’ knowledge and confidence in responding to self-harm will be set within the broader context of the Time, Space, Compassion approach and supporting people experiencing poorer mental health, trauma or distress.

Our engagement in the development of this strategy, and ongoing learning from our pilot services have also shown that peer practitioner support can be incredibly beneficial in helping people to improve their wellbeing and take steps towards reducing or stopping self-harm. We will continue to learn from these projects and wider provision about the best ways to support peer workers and how peer support can be used.

“The fact that B (peer worker) was able to open up and share that she had been in a similar situation to me, and came out the other side, was huge! I actually looked forward to our sessions and felt like I wasn’t alone in what I was experiencing. The tools and techniques that B gave me, I still use to this day... I haven’t self-harmed in two and a half months and have seen a massive improvement with my moods and confidence.” - Supported Person, Self-Harm Network Scotland

Many people now turn to the internet and social media for support with self- harm. This includes accessing helpful, reliable information and tools from websites such as Self-Harm Network Scotland, NHS Inform and Aye Mind, as well as getting online support from peer practitioners, webchat services or finding informal community support in forums and chatrooms. Online support can be especially vital for those in rural communities, marginalised groups and young people. Current funding for pilot self-harm services, includes an online portal which gives access to an immediate webchat service and to support provided by peer practitioners. This service has been very popular and is already proving to be beneficial for people who self-harm, their friends and families and professionals.

“When I found out about the live chat launching, this filled me with confidence. I knew that the chat was there if I was ever struggling and needed to talk to someone quickly.” - Supported Person, Self-Harm Network Scotland

However, we also acknowledge that there can be unhelpful and even harmful self-harm content and bullying in online spaces. Scottish Government has taken action to make the internet safer for people who may be at risk of self-harm through the creation of a new offence in Scotland that will make it a crime to communicate encouragement or assistance to someone else to self-harm. This will act as a deterrent while we will also continue to explore ways people can safely access helpful advice and support online.

“It’s part and parcel of going online that you’re going to encounter trolls. You can take it on the chin, but it’s very difficult when you’re holding a device in your hand and there are strangers saying the most horrific things about you”^[21]

Healthcare Support

For those looking for healthcare support for self-harm, their GP should be the first point of contact. However, the principle of ‘no wrong door’ means that irrespective of the service, a person seeking support should be guided to the right place. When care is needed out of hours or in a medical emergency, support should be sought from NHS 24 by calling 111 or 999. People receiving self-harm treatment in emergency departments should receive a mental health assessment and support.

Our action plan aims to support compassionate responses, including within clinical settings, ensuring that people get access to the right ongoing support, which could range from social prescribing, psychological therapies (in line with the Psychological Therapies Matrix), referral to Distress Brief Intervention (DBI), local community based appointments or in-patient care. For people who self-harm frequently or have multiple hospital admissions appropriate support and follow-on care plans should be put in place. We will continue to work with services and health boards to strengthen cross-sector communication and collaboration between support organisations and healthcare professionals and to ensure that care for people who have self-harmed follows the principles of Time, Space, Compassion and is trauma-informed. We will continue to support workforce wellbeing by connecting to the Mental Health and Wellbeing Workforce Action Plan to ensure that people who may be affected by self- harm through the course of their work are supported.