S3E8 – Understanding self harm, with Naomi Salisbury

W: Hi everybody, it’s Will here, just to give you a heads up that in this conversation we will be talking about self-harm and self-injury, although at no point will we go into any detail about any methods.

 

Just a reminder that the following conversation should not be considered any form of medical advice, and I’d also like to mention the UK charity selfinjuryupport.org.uk whose helpline can be reached on 0808 800 80 88. You’ll find those details and extra links to support in the episode show notes.

 

[music]

 

E: My name is Ellie.

 

W: And my name is Will.

 

E: Welcome to Lively Minds, the podcast about mental health challenges that go beyond the ebb and flow of the everyday.

 

W: The podcast that looks at how developing an understanding of our mental health influences how we address it.

 

E: In today’s episode, we will be discussing self-harm, what it is, how we can address it, and how we understand it in relation to our wider mental health.

 

[upbeat music]

 

W: Our guide in this conversation is Naomi Salisbury. Until recently, Naomi was the CEO of Self Injury Support, a UK-wide charity focusing on improving support and understanding around self-harm. Just to be clear, Naomi no longer works for self-injury support and therefore the views she expresses in this episode are hers and not those of the charity.  Now she is a consultant whose focus is on how lived experience can become integral to the development of policy and practice regarding self-harm. 

 

Welcome to the show Naomi.

 

N: Hi there, thank you so much for having me on. 

 

E: To start with, what is self-harm? How do you define it? 

 

N: So yeah it’s an interesting question I always find that I’ve obviously been asked a lot of times in my work and I tend to go with the hedging your bets answer in that there’s no one answer. I remember when I was first being interviewed to work at Self Injury Support and this was the first question in the interview and my answer then as it is now is that there’s, it’s many different things for many different people, and it can be different things for one person at different times. 

 

When it comes down to it, it is when somebody is doing something to themselves that is damaging, with the intention of damaging themselves and that can be for so many different reasons. What’s commonly talked about is in relation to emotion regulation and trying to kind of get back on an even keel with emotions, but in my experience that’s one of the reasons, and it is a common reason, it’s a reason for a lot of people, but people also talk about feeling really empty and numb, not having any emotions and wanting to feel almost real again. 

 

Also, spoken to a lot of people for whom they are dissociated, they feel really disconnected from reality. 

 

E: Yeah

 

N: It’s a way to sort of bring themselves back, people who are doing it in response to intrusive thoughts that might be related to obsessive compulsive disorder. It’s sometimes when people are hearing voices. So for, and it’s really tricky to pin down, I feel like this is a very vague answer. I know that at Self Injury Support and in all the work that I do, for me it’s about meeting the person where they are 

 

E: Yeah

 

N: and not having any preconceived ideas about what it might be about for them. There are lots of different things people do. There’s people causing direct harm to their bodies, but also I’ve spoken to people who’ve used alcohol and smoking because… 

 

E: That was going to be my next question.

 

N: Yeah. 

 

E: Because obviously the charity is called Self-Injury Support which is, to me, seems more about enduring bits of your body deliberately, but I was wondering whether within talking about self-harm you, you differentiate between that and self-harming behaviours. 

 

N: I think we do differ, differentiate in terms of talking about sort of direct harm to the body but that as part of a bigger umbrella of self-harm. 

 

E: Yeah

 

N: And like you said, it could be to do with alcohol, it can be to do with food, relationships. You know I’ve worked with people who, it was, just felt that they were self-sabotaging, very, very critical of themselves 

 

E: Yeah

 

N: and never gave themselves a chance and that, that was coming from a place of feeling like they didn’t deserve it. 

 

E: Yeah

 

N: so, and I think certainly for me it’s very much about where is it coming from, what’s it about for that person. And, you know for some people drinking a lot of alcohol is about having fun or not or that’s just what they do, but for some people it is about, you know I’ve spoken to people they didn’t care if they got into risky situations they felt that they deserved it, they felt this is damaging me and I want that damage to happen, so it’s very much about what’s it about for that person and I think I’m always really, I want to be really clear with people that you cannot make assumptions and you only know if you actually talk to somebody and sometimes people don’t know themselves and that’s where the talking and the time and space to help someone come to that understanding is really, really key. 

 

W: What insights do you think this phenomenon of self-harming can give us into understanding our mental health?

 

N: I think the way that I have approached this, and I think this is drawing on professional experience and my own personal experience, and the experience I’ve drawn from peers as well, is that helping somebody, or working out with somebody what feelings underpin self-harm and what function does it have for them is kind of how you, how you work out for somebody what it’s about for them and for some people it might be I’m feeling really intense unbearable emotions and when I do this everything calms down and I feel much better and I’m able to function. For some people it might be a sense of actually I feel like a bad person I need to punish myself and this is a necessary thing. For some people it might be, I feel really disconnected and that’s scary or I feel really emotionally detached and I feel like I’m not a real person and again it’s almost this grounding effect for some people. So I think it’s, again it’s very individual, but this is very much the approach which usually tries to take us to saying well you know what’s happening when you end up self-harming, what leads up to it, what are you feeling what other things happened before and almost try and backtrack as far as possible to where did this, where did the urge first start, what was going on and then, and then go from there, and you know for some people it, people say it just happens it feels very like it comes out of the blue and for some people it feels like there’s a very long buildup of very intensive feelings and they’re like I need to make this stop I can’t bear it I think what’s really key and this is where asking someone really comes in, is that for some people it is actually protective against suicide. It’s actually if I do this I can contain my feelings, I can go on, I can function and I think there’s a lot of even in policy and practice it’s often put it together with, in together with suicide and there’s definitely overlap and there’s definitely links, but it’s actually for a lot of people it’s really not about that it’s actually about surviving, and I think yeah if I was going to say it’s about one thing, it’s about survival in the broadest possible sense of, you know, people trying to contain things and go, “Okay, right, this has helped to ground me. This has helped to maybe not improve my emotional state but change it to one 

 

E: Yeah

 

N: that I can manage better and go from there. So I think, yeah, if I’d say one thing, it’s about surviving for many people.

 

E: Yeah

 

W: I’ve seen it described as a valid coping mechanism, which chimes in a big way with what you’ve just been talking about. And as somebody who doesn’t know very much about it, I kind of did a double take at that. Could you speak a little bit more to, to that?

 

N: Yeah, and I think that’s really important for a lot of people that it’s often seen, I think especially in some mental health services, often discussed as it’s behavioural. 

 

E: mmmm

 

N: And actually, thing we do as humans I would say is behavioral and people sometimes talk about things like “oh we’re doing it for attention” and I have, I don’t think I’ve ever met anybody or that was purely the aim. Sometimes there is a need to feel connected to yourself, to other people, a need to communicate but imagine if this is the if this is the best way that you’re able to come up with to communicate to people when you’re really distressed, you’re in a really difficult place and I would say that’s very much a person in need of and deserving attention and care. 

 

I think it’s, it’s a difficult one, it feels quite counterintuitive to say it’s a valid coping mechanism. I’m on the fence about the phrase “copying mechanism” because I think fundamentally actually, we all do things that are not great for ourselves in order to cope with life. You know, I’m from Scotland as one of my colleagues would say when we’re happy we have a drink, when we’re sad we have a drink, when we’re angry we have a drink, when we’re celebrating we have a drink and nobody you know is part of the culture, and actually it’s almost harder to be someone who doesn’t drink in some parts of Scotland because that’s questioned a lot more than someone who might drink to excess, and not everybody’s doing that to harm themselves, but there are socially acceptable ways that we all you know, do things that are not good for us. 

 

E: Yeah

 

N: I don’t know about you guys but I don’t exactly eat like a perfect diet or do my 30 minutes of exercise every day depending on how I feel, but I’m implying that I do it when I do feel good and that’s not actually true either.

 

[Laughter]

 

N: But we all do things that we knowingly know are not great for ourselves, but it’s really about the underlying – and you know,  there’s some things that are socially more acceptable, and some things are socially less acceptable, and with self-harm it’s about the fundamentally underlying intention. What are you trying to do there? But I think for me, what’s important to think about is that actually it’s not some out there coping mechanism that is completely unconnected to what everybody as human beings does to cope. It’s just, it’s that for some people what they need to cope with has pushed them further out in that kind of umbrella of coping mechanisms that we all have depending on people’s experiences. 

 

And I think it’s important to remember that often what we’re talking about is people dealing with really emotionally distressing experiences, people who’ve experienced trauma and abuse, 

 

E: Yeah

 

N: or people who have experienced something really intense, especially with young people, there’s a lot of talk about interpersonal relationships, bullying, pressure at school. So there’s a lot of things going on in people’s lives that actually, there’s a really clear connection if, if we’re willing to sit down and listen and give someone the time and space to understand why they might have ended up in this place rather than making assumptions about it.

 

E: Yeah, I think the most I ever learnt about self-harm was from when I was a youth worker working with some young people who, who really used it as a coping mechanism and yeah, I’ve always remembered like that experience is teaching me quite a lot about, yeah, the different ways in their minds like, helps, and things like that. 

 

W: And I guess as well it’s possible to hold two things at once isn’t it? It’s possible on the one hand to be able to build and develop one’s understanding about the nuances of self-harm and how it can be framed as a, as a valid behaviour amongst other behaviours that we may do as human beings, as a, as a means to cope whilst at the same time recognising that that doesn’t make it a good thing, right? I mean, necessarily, that’s, that’s still something that you want to support people with in stopping when they are able to stop. Would that be fair to to say? 

 

E: Is it? I dont know.

 

N: I think it very much depends on the person and I know that the approach that always taken itself injury support and this is very much when I would support is, also actually the NICE guidance say this as well, as that long term, your aim should be to support somebody with the distress and what they say is bothering them. It shouldn’t, the focus should not be on trying to get someone to stop because if that’s the fundamental focus, then that actually will miss potentially a lot of things that are going on for people.

 

W: Mmm

 

N: And my experience is if you can help somebody sort out and reduce the distress that they’re experiencing, then that can have quite an impact on their self-harm. And I know that the evaluation that we did of services at Self Injury Support, we never asked somebody to try and stop. 

 

E: Yeah

 

N: That’s what some people wanted to do. 

 

W: Yeah

 

N: But around 70% of people said that our support helped them to reduce or stop their self-harm, even though that wasn’t something that we ever put on the table. 

 

E: Yeah

 

N: And I think it’s really, really tricky, but I would say that if somebody is harming themselves, but not, but it’s allowing them to function 

 

E: Yeah

 

N and keeping them from suicide, 

 

E: Yeah

 

N: is that the worst thing?

 

W: yeah sorry, yeah

 

N: no, it’s okay, and I think we get very focused, I was going to say we just get very focused on this makes us as a society uncomfortable, therefore I don’t want you to do it. And I’m much more focused on what is somebody’s quality of life. 

 

E: Yeah

 

W: Yeah

 

N: And to me that is the fundamentally important thing. If I’m trying to keep someone in a space where they’re miserable and distressed and I’m saying you must not do the one thing that helps you cope with that, I’m not sure how helpful that actually is. 

 

W: Yeah, I guess I did mean we wanted to stop but one might want to stop maybe because we feel uncomfortable about it as a site etc, but the idea being that that would be about getting to that root reason why somebody was doing it in the first place, rather than just sort of stopping it at that kind of surface level, I guess is what I was getting at. I guess, I guess, another question would be, I guess what I’m trying to get at is there’s never going to be, or is there, there’s never going to be a situation where somebody is self-harming and it doesn’t have some root back to some kind of distress? Is that, is that the case? 

 

N: I really like to make a blanket statement. I think, I think for the vast majority of people that I’ve ever spoken to, yes, it definitely started like that. But like I said before, it can also be that people are having intrusive thoughts or hearing voices that are telling them to do that. Or I feel like, there,  I’ve also known people who have had manic episodes released into bipolar disorder where they always felt invincible, 

 

E: Yeah

 

N: and it didn’t matter that they could survive anything that they did to their body. So I think there it’s again it comes back to it’s really important to, to talk to somebody and find out why and what might have started as something that was really distressing might have just gone into well this is how I cope now and this is how I stay on and even keel so and I think it can really evolve for people and one thing that we saw at self-injury support was during the pandemic especially the first lockdown we had quite a lot of people contacting us who had not self-harmed for, like, a couple of decades who were now feeling really trapped 

 

E: Wow

 

N: and anxious about the situation and had kind of gone back to it. So I think it’s, as with everything in mental health, people talk about the recovery journey and things. It’s like nothing’s linear and I think people go backwards and forwards. Certainly, I’ve seen people be supported quite often, you know for a few months through a crisis situation, then they will disappear from a service and then they’ll come back again if something else is happening. So I think it’s, you know, it’s a really, it is almost counterintuitively a difficult space to sit in. One of the things that we talk about quite a lot is harm minimisation. 

 

E: Yeah

 

N: And actually if somebody is harming themselves to quite a severe degree, helping them do something that is a little bit less damaging is a massive success. 

 

E: Or less dangerous in the long run. Like I remember learning about being in a, there, there’s some amazing training about you know making sure…Yeah, like the cleanliness, you know, like hygiene stuff to avoid serious infection and sepsis. And it’s difficult to have those conversations with people and it feels like, you’re right, it feels like a very weird space to sit in, sort of professionally to be having that conversation with someone at first,  I think. I imagine a lot of people, it’s strange to imagine that they’re saying to someone like that’s why you do it, I get it, you need to do something, could you harm yourself in a different way? Like that I think is what makes, is what Will’s picking up on that probably feels quite uncomfortable to a lot of people, and it is tricky isn’t it?

 

N: Definitely and I think in virtually every job role where people are supporting people who self-harm, you’ve gone into it to be helpful and you know, especially in kind of health kind of spaces almost to fix things and this is something that perhaps it is not if there’s a fix there’s not a quick fix and you know there’s a lot of discussion in this area about sitting with uncertainty and sitting in that space of distress with somebody 

 

E: Yeah

 

N: and I came across a really amazing blog somebody had written and saying we always talk about holding hope for somebody but what if we also sometimes need to hold their despair and just sit in it with them and witness it and I think that is really hard. It’s quite brave and it’s quite counterintuitive when you’re there to help somebody, to feel that perhaps all you’ve done is be in it with them but I think that that is a very, very valuable thing to do that’s quite often overlooked but yeah it doesn’t mean it’s not difficult for sure to see someone in distress.

 

E: I think it really is, especially because you said there’s so many different like reasons for self,  I’m just thinking about specifically physical injury now, but within all of, you know, like, is it punishment or is it to combat feelings of disassociation or, you know, all of those different reasons why it’s something that some people do. But at the core of it, doing it is an, is an isolating experience, isn’t it right? It’s just you, your nerves, body, it’s very… and actually having someone to get as close to being able to share that place of despair with you is absolutely huge. And also because of all the ways in which self-harm is viewed by society in general, like very unlikely for a lot of people to ever be able to share that space with someone.

 

N: Yeah.

 

W: It feels as though there’s work there around obviously supporting people who self-harm, but also there’s a lot of work to do around educating society more broadly about the best way to support somebody and trying to get over that hump of, of discomfort in having these conversations.

 

N: Yeah, absolutely. And I think what I find is that the vast majority of people who, you know are looking to provide that support do want to do it right but they’re just worried about saying the wrong thing. And I think that that is, I think it’s tricky in a lot of situations, but I think for me on a personal and professional level, I think that showing that empathy and thinking about if I feel, you know, that it’s okay to feel what you feel and if you feel scared or you feel cross with somebody or if you feel panicked, it’s okay to feel those things but remember that they’re your feelings and what, what would you do if somebody had come by this injury accidentally? How would you be treating them? And I think thinking about actually show care for do they need medical attention, do they need first aid and also show social care on a physical level but also show care on an emotional level. And I think it’s okay to say to somebody, you know, I find it really upsetting that this is the space that you’re in, 

 

W: mmmm

 

N: but also I understand that you’re in this space and what can I do to help you in this space? And it may be that someone says, “Actually, I want you to help me not to do this,” and then you can make a plan together. But it may be that somebody’s saying, “Well, actually, I kind of need to do this right now and I need you to understand that.” And that is obviously, you know especially if that is your partner, your child, your friend, there’s no denying that that’s distressing and I’m not pretending that it’s not, but I’m also not saying that that is the fault of someone who is harming themselves, I’m just saying that, you know, as human beings we come across situations which are upsetting that are no one’s fault and how do we best, how do we best deal with them and show empathy without, I guess, panicking or thinking I want this person to stop because that feels like the most comfortable thing for me. 

 

W: Okay, let’s go to a short break and we’ll be back in a moment.

 

[music] 

 

E: We are on social media. Come over and tell us what you thought of a show, suggest a topic for future episodes or just say hello. Our handle is the same across all platforms, Lively Minds Pod, that’s all one word. You’ll find us on X, Instagram, Facebook and LinkedIn and you’ll find all links to our social media pages at livelymindspod.com. You can also get in touch by emailing hello@livelymindspod.com.

 

E: In your work around in this area, what are the most common myths or stereotypes that you come across around self-harm that you find yourself tackling? 

 

N: I think one of the most common is, this is a problem of white teenage girls. 

 

E: Arr

 

N: This comes a lot and then you and I would say that on the helpline service at Self Entry Support, the average age of people using that service is in their 30s and 40s. You know, a young person who harms themselves, if they you know, if they don’t get the support they need or don’t feel able to stop, they’re going to become someone who’s slightly older and slightly older who harms themselves, its not, there’s a lot of focus on youth services which is absolutely right but you don’t magically become a different person at the age of 25 when you age out of those services. So I think statistically all, all the data shows that there are higher rates of self-harm than young people for sure and that’s where there should be support and attention especially, I guess as with everything else, that early intervention, there’s quite an amazing project that was run by an organisation called Mind and Body where they tried to identify within school students who were potentially at risk of self-harm and do intervention work with them and it did reduce the rates of self-harm overall in the school, which you know is an amazing example of early intervention but I think it’s really important also to address the idea that this is only about young people, that it’s only about women, that it’s only about white people, because actually some of the other groups where self-harm is most likely are black women. There’s higher rates there compared to other groups. Anyone really who’s experienced oppression, discrimination, marginalisation. So we’re talking about people from LGBTQ+ communities, we’re talking about people who’ve experienced you know, racialised violence or racialised oppression. We’re talking about people who have been in prison as well, it’s really high rates of self-harm there. So actually, it’s not that helpful because it can give people the sense of, “Oh, well, you’re not a young white woman, therefore, what are you doing?” 

 

E: Yeah

 

N: As opposed to exploring what’s the valid reason around that or assuming that because somebody is not in that category, there’s no concern to be had there.  And I think other ones are often around, kind of, people are doing this for attention. I’ve virtually never come across somebody where that was their intent. I think when you talk about it with people sometimes there is a need to communicate or a need to be cared for and not knowing how to formulate that and bring that forward. Perhaps having come from an environment where you only got care from your parents or other people if you had fallen down and you know, hurt yourself, and therefore the message is if there’s not something to show for it, you know, then your emotional state is not of interest. 

 

E: Yep

 

N: And it’s hard to move away from anyone from these really formative experiences. And I think some people try to reframe this as “oh” is in, “people are in need of attention”. And I would say as human beings, we all are in need of attention and connection, and we do not thrive without social interaction. So it’s not unreasonable to want that on a lot of levels.

 

E: and how sad if someone’s situation is that they’ve felt that this is the best way for them to

receive that attention. That’s what I always think when someone says, “Oh, it’s for attention.” I’m like, “That’s awful, if so, that’s awful and they need attention.” 

 

N: if it is, then shouldn’t we be working on that? 

 

E: Giving them attention, Yeah.

 

N: Exactly. And I think, again, like I said, what you feel and what the other person intended are not necessarily the same thing. And you might feel, “Oh, this person is looking for attention. They’re trying to manipulate me.” That doesn’t mean that that was their intention, 

 

E: No

 

N: and I think it’s really important to separate how you feel from what that person’s potential intentions were. To manipulate someone is quite sophisticated. One, it’s something that all humans do. My cats do it. So it is, I think, inherent in nature that we all kind of try to set things up so that they work in the right way for all of us. And also it implies a lot of almost bad intent. 

 

E: Yeah, it implies a lot of cruelty and actually there’s not that many people who are that cruel probably.

 

N: Yeah. And I think, you know, actually, if somebody is doing something because they’re really distressed or they really need a shift in emotional state or they’re struggling with intrusive thoughts or voices, I don’t think manipulating or manoeuvring other people is high on the agenda, even if that’s what it feels like, even if that’s what it looks like, again it comes back to you’ve got to talk to the person and find out what was going on. And even if that was the reason, well why? How are the, how is the need not being met somewhere else that means people feel they are forced into that situation?

 

E: I wondered if you could tell us some of the common techniques or approaches for addressing self-harm. We’ve touched on them already, a few of them like harm minimisation.

 

N: So again, it’s probably going to depend on who you are and what the person is looking for, but, you know I think about things in the short term and the long term. In the short term, showing care and compassion to somebody, showing curiosity for what’s happened. Do they need medical attention for injuries and what do they need right now in this moment? And it might actually be to do something calming together, it might be just to talk, it might just be upset with someone else who’s willing to witness that and not be afraid of it. In the long term, helping someone perhaps to understand and unpick the patterns around their self-harm and do things in a less risky way if that’s what they would like to do. So a lot of people do find some sort of counselling really beneficial. I know that my personal experience and from other people that I’ve spoken to in those spaces like that peer support has been really valuable. I think people panic a bit about the idea of a peer support group for people who self-harm 

 

E: Yeah

 

N: everyone will just get together and share methods. I have to say that any peer space I’ve been involved with, it’s been really clear that that is not something that we discuss and it’s not something you bring into that space. Because they valued the space so much, they’ve been extremely careful not to do that, urm, and the only times I’ve seen it happen is when somebody is just in a really uncontained emotional state and it wasn’t intentional. 

 

E: Yeah

 

N: it was like, you know… 

 

E: Yeah, they were just in a really, really bad place. 

 

N: In a really bad place. And that’s, I mean, I’m talking about like maybe once or twice I’ve seen that happen. So I think there’s different things for different people, but I think being heard, being validated, and having the space and time to understand what’s behind it for some people. I think you mentioned before about being isolated. Definitely, there’s people who feel like I’m the only person that does this. I’m the only person that’s…

 

E: There’s a secondary thing isn’t there, that you can end up thinking like “I’m a weirdo” like, “no one else does this to themselves”, “why am I”, like it becomes its own thing almost. Yeah, 

 

N: Yeah, absolutely, and I think still when I was at Self Injury Support we would occasionally get people getting in touch who would say “oh, I didn’t know other people did this” and so I think it can’t be underestimated how isolating it can be and how actually just reducing that isolation and making it okay to talk about it can be really fundamental. I think one of the things that we talked about a lot at Self Injury Support was thinking if you can understand the feelings and functions then potentially you can look at things that might replace those functions. So, if your need is to get out anger or rage is there something else that you can do to get that? You know one of my colleagues who was a peer support worker, I’ll never forget them coming back and saying to me “oh I saw this person who’d been to A&E for self-harm and they’re just really angry and so I suggested that maybe they could go to a rage room”. I don’t know if you guys have come across the idea of a rage room 

 

E: Yeah

 

N: where you can just smash things up and I was like that’s brilliant.

 

E: My auntie told me once for a breakup she said you just need to get some old plates, a tea cloth and a hammer and just smash them up and I was like is that all I need? but it was.

 

[Laughter]

 

N:And I’m not saying that that’s a long-term solution. But it’s a really…

 

E: But it’s a release for the unmanageable emotion, isn’t it?

 

N: Exactly, exactly.

 

N: And I’m not saying also that this is a sort of linear process. It can take time for people to find things. They may not be able to find something that matches that function. But I think acknowledging the need is really important and acknowledging that perhaps, you know, let’s look for something else that matches that function. And that alongside counselling, peer support can make an enormous difference to, to people. Like I said, for me it’s about somebody’s quality of life, are they less distressed? Are they more able to function in the ways that they want to? And that to me is what’s really important.

 

W: How much awareness do you think there is within primary health services and within A&E departments, how much knowledge and understanding do you think there is about self-harm amongst those professionals? And how can somebody best equip themselves for going into those environments? Let’s say as somebody who self harms and is going into those spaces for help.

 

N: I think there’s a lot of good intent in my experience but there is a very much a lack of training and a definite feeling of my job is to fix this and to get this person to stop and to find out right now 

 

W: Yeah

 

N: while they’re in my presence what it’s about, what’s going on. You hear varying things from people having very compassionate responses, from people feeling actually I’m really distressed or I’m really dissociated and I can’t talk about it and I’m being expected to talk about it which is tricky and then occasionally unfortunately you get things like people being told “oh that was a bit silly” you know what would you, “won’t your mother be upset when she sees that”, “you won’t get a boyfriend with those things”, and occasionally…

 

E: I wish that surprised me more than it does unfortunately.

 

N: Yeah and people being given you know, things like stitches without anesthetic and I would just like to say that that is negligent, that is against NICE guidance, that is completely unacceptable and if somebody does that to you, you should absolutely make a complaint if you feel able to. 

 

To people working in those environments, I guess I would say that your compassion and your time and not judging someone.

 

E: Yeah

 

N: is the biggest thing that you can give them. In the five minutes, ten minutes you have with them, if something has taken a long time to become a problem for someone, you’re probably not going to fix it in five minutes, but that’s okay. I think, you know, if you can be kind to somebody it won’t make them come back, it won’t make them do it again. I think there’s a bit of a myth that if you’re really nice and kind and supportive that just encourages people to come back and I would say that that is definitely a myth. There’s no evidence or research to back that up at all. I think if somebody’s going, someone who might be seeking help going to A&E or a GP, I think there’s a couple of actual tools that I would recommend. 

 

W: If somebody is self-harming and they go to a GP, for example, for help, some tools for them?

 

N: Yes, so I can give you guys the link. There is on the Self Injury Support website, there are a couple of sheets that you can download where you can actually just write on it what’s happened. There’s a body map. You can say, “I’d rather talk to a women”, “I do not want to talk about what’s happened. I just want physical treatment.” There is also an app, and I’m incredibly sorry, I can’t remember the name of it, but I will find it afterwards.

 

W: We’ll put the things in the show notes.

 

N: But it’s basically an app for preparing to go and talk to your GP. And it could be about anything, but it was developed for young people to talk to GPs about mental health. So, and that is also, it takes you through steps of what you might want to say so that you’ve got a bit of a prompt there. And you know, those are the things I would say is actually, if you can think about that and advocate for yourself about what you might need in a potentially quite intense environment that can be really useful if somebody’s willing to go with you, that can be really helpful as well. But I would also say that don’t feel that you shouldn’t be there because you are deserving of care and treatment and help, and it’s as valid for you to be there as anyone else. 

 

W: I’m just wondering what words of guidance you would give to someone who’s listening who self harms and somebody who’s listening who knows somebody who self harms. 

 

N: For someone who self harms I would just say I would say you’re not alone, you’re not doing something weird, it’s actually, it’s much more common than you think and I hear your distress, I hear your shame, and shame can be such a big driving factor but there are places and spaces out there where people will listen to you and they will understand. Self Injury Support runs a helpline service and that is a listening service that’s got no judgment, they won’t tell you what to do and there are other various other help lines and spaces like that and it’s okay, you’re still a valid person, this is not all of who you are and that that’s really important to hold on to that. Other people’s judgment, it’s easy to say it doesn’t matter, because it does matter and we all feel people’s judgment but actually there are places and spaces where people will understand and they will support you whatever you want to do and however you want to go forward, so hang in there, I would say.

 

E: That’s so lovely.

 

N: I think it’s what I would have wanted to hear, I think, when I was younger. And I think a lot of my colleagues at Self Injury Support, it’s the space of actually what would I have wanted, what would I have liked to have when I was in a really bad place. And I always feel like I’ve always missed something, because I won’t say something that will be comforting to everyone. But hopefully, if one person finds that beneficial, then…

 

E: I think I’d like to hear that as well when I was younger.

 

N: Yeah.

 

E: And then what about…

 

N: Friends and family.

 

E: Yeah.

 

N: I think I would say don’t panic. Don’t feel like you have got to make somebody stop. Don’t feel like it’s your fault. Obviously, their relationships have an impact. But if you can offer someone kindness and compassion, that is a massive thing in a world where we’re directed to apps and chatbots to deal with our mental health. Your time and space and compassion is really important but also it’s okay to support someone to seek help outside of that because, as with anything that is, if you’re supporting somebody with something that feels very big, that can be very big for you as well and that is again, no judgment or anyone’s fault but it’s okay for you to seek support for that person outside of your relationship, it’s okay to seek support for you outside of that relationship, it’s okay to make your village, to try and deal with something that’s difficult for all of you.

 

W: I think that’s a really, really valuable point to end on actually.

 

N: Yeah.

 

W: And please do send us all of the links that you mentioned and we’ll make sure that all

the put in the show notes. Thank you so much Naomi.

 

E: Yeah, thank you so much. That was such an amazing conversation. And yeah, I would really love to speak to you again because there’s like already so many other conversations coming up from that in my head.

 

N: Yeah, absolutely.

 

W: Check out the show notes for links to further support regarding self-harm and once again the UK charity Self Injury Support can be found at selfinjurysupport.org.uk and their helpline which is 0808 800 80 88. 

 

Links to other mental health support across the UK and internationally can, can be found on our website, livelymindspod.com.

 

[upbeat music]

 

E: Thank you for listening. As always, you can find us on social media at livelymindspod.

 

W: Make sure that you subscribe to Lively Minds, wherever you get your podcasts and tune in again next month for another episode.

 

E: Please note that this show does not constitute medical advice and is not a replacement for seeking professional help. You can find signposting to support on our website, livelymindspod.com.

 

W: Take care and bye for now.

 

E: Bye bye.

 

[Music]