Self-harm: why people do it, how common it is and what helps

If you are having thoughts of harming yourself or of suicide right now, please do not carry them alone: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you live outside Korea, your family doctor or local mental health services are another place to start. If you are badly hurt or in immediate danger, contact your local emergency services. Self-harm means hurting yourself on purpose. The UK NICE guideline defines it as “intentional self-poisoning or self-injury irrespective of the apparent purpose of the act” (NICE, 2022). The word therefore covers both self-harm without any wish to die and acts with suicidal intent (Witt et al., 2021b). Research also uses the narrower term “non-suicidal self-injury” (Taylor et al., 2018; Swannell et al., 2014) for deliberate, direct harm to the body without suicidal intent (Nock, 2010; Klonsky, 2007). The Royal College of Psychiatrists says that people who self-harm are not usually trying to die, but that anyone who self-harms should be taken seriously and offered help (RCPsych, 2020).

Self-harm is often written off as “attention-seeking”, but the NHS lists insulting someone, “for example by saying they’re attention-seeking”, among the things not to do, and asks you to consider that any amount of self-harm might be a sign that the person is feeling extremely distressed (NHS, 2023b). The Royal College of Psychiatrists explains that it no longer uses the word “deliberate” self-harm, because it makes it sound as though the person is to blame and the act was calmly planned rather than the result of emotional anguish. “Attempted suicide” is also going out of use, because it assumes that harming yourself is the same as wanting to die, which is often not the case (RCPsych, 2020). This guide puts no label on anyone and speaks of people who self-harm or have self-harmed.

mind.io does not offer a self-harm test. Question 9 of the depression check-in (PHQ-9) asks about thoughts that you would be better off dead or of hurting yourself, and any answer other than “Not at all” brings up crisis lines first, right under the question and at the top of the result. Even so, the PHQ-9 is a self-check of depressive symptoms over the past 2 weeks, not a tool that judges the risk of self-harm or suicide. The UK guideline also recommends not using risk assessment tools to predict future suicide or repeat self-harm (NICE, 2022). This guide follows Korea’s Suicide Prevention Reporting Code 4.0, which says not to report “specific suicide methods, tools or places” (MOHW, 2024c), and Samaritans’ guidance that explicitly describing a method can lead to imitation among vulnerable people while stories of coming through a crisis encourage people to seek help (Samaritans, n.d.), so it does not cover methods, tools or places. It covers what self-harm is and why it happens, how common it is, how it relates to suicide, what helps, what to do when the urge comes, what the people around someone can do, and when to go to the emergency department.

There is no single reason. The NHS lists expressing or coping with emotional distress, trying to feel in control, a way of punishing oneself, relieving unbearable emotional distress, a cry for help and a response to intrusive thoughts. Sometimes the reason is unknown, and the reasons can change over time and will not be the same for everybody (NHS, 2023c). The NICE guideline likewise says that each person who self-harms does so for their own reasons, and that a person’s reasons may vary from episode to episode (NICE, 2022).

Research draws a similar picture. A review of 18 studies found converging evidence for an affect-regulation function, with intense negative feelings before self-harm and decreased negative feelings and relief after it, strong support for a self-punishment function, and modest evidence for the other functions, such as influencing other people (Klonsky, 2007). In a meta-analysis of the functions of self-harm, intrapersonal functions were reported by 66% to 81%, with emotion regulation the most common at 63% to 78%, while interpersonal functions such as expressing distress were less common at 33% to 56% (Taylor et al., 2018). A meta-analysis of community studies of adolescents also found that the most frequent reason was relief from thoughts or feelings (Gillies et al., 2018). In other words, the most common reason is to manage feelings inside oneself rather than to act on other people; interpersonal functions are reported by a substantial share, and their typical example is expressing distress. The brief easing of tension and distress can, however, turn self-harm into a way of dealing with feelings, and for some people who do it regularly it can become hard to stop (RCPsych, 2020). The NHS says it is important to find the right support or treatment to deal with the underlying cause in a less harmful way (NHS, 2023c).

The NHS says self-harm is most often described as a way to express or cope with emotional distress, which is often a build-up of many smaller things. Its examples include being bullied, pressure at school or work, family arguments or relationship problems, money worries, low self-esteem, stress, anxiety or depression, confusion about sexuality, grief after bereavement or loss, physical or sexual abuse, complex mental health difficulties that sometimes cause impulsive behaviour or difficulty controlling emotions, often due to past trauma, and conditions such as ADHD or autism (NHS, 2023c). The Royal College of Psychiatrists adds that people are more likely to harm themselves when they feel that others do not understand or listen to them, hopeless, isolated and alone, or without power over their lives, and that it seems to happen more often in young people, in gay, lesbian, bisexual and transgender people (which may be due to the stress of prejudice and discrimination) and in people neglected or abused in childhood (RCPsych, 2020). Difficulties that can come with it are covered in the depression guide, the anxiety symptoms guide, the trauma and PTSD guide, the borderline personality disorder guide and the eating disorders guide.

Self-harm among adolescents is not rare. A meta-analysis of community studies from 1990 to 2015 estimated lifetime self-harm at 16.9% among 597,548 people aged 12 to 18 in 41 countries (172 datasets). Girls were more likely to self-harm (risk ratio 1.72), the mean age of starting was 13, and 47% reported only 1 or 2 episodes. Of those who had self-harmed, slightly more than half sought help, but for most this was from a friend (Gillies et al., 2018). Another meta-analysis of non-clinical samples put non-suicidal self-injury at 17.2% among adolescents, 13.4% among young adults and 5.5% among adults (Swannell et al., 2014). The NICE guideline notes that prevalence statistics are unreliable because self-harm is sometimes hidden, and cites a national study in England in which 7.3% of girls and 3.6% of boys aged 11 to 16, and 21.5% of young women and 9.7% of young men aged 17 to 19, had self-harmed or attempted suicide at some point (NICE, 2022).

The figures depend heavily on how the question is asked. In one meta-analysis, methodological factors explained over half (51.6%) of the differences between studies’ estimates, and after adjusting for them there was no evidence of an increase over time (Swannell et al., 2014). A review of 52 adolescent studies found no statistically significant difference between studies of “non-suicidal self-injury” (18.0%) and studies of “deliberate self-harm” (the studies’ own term; 16.1%), and single-item questions gave lower rates than checklists of specific behaviours (Muehlenkamp et al., 2012). Another meta-analysis, however, found rates increasing up to 2015 (Gillies et al., 2018), so studies disagree on whether self-harm has become more common.

The Korean child and adolescent survey reports much lower figures for non-suicidal self-injury. In the National Center for Mental Health’s 2022 survey of children and adolescents (ages 6 to 17, face-to-face interviews in visited households, a reported sample of 6,275), non-suicidal self-injury, defined as harming oneself without any intention to die, was 2.2% over the lifetime among adolescents and 1.7% on the survey’s “current” measure, and 1.0% on both among children (NCMH, n.d.a; Kukinews, 2024). The adult survey has no separate self-harm item: the 2021 adult survey (5,511 people aged 18 to 79, household interviews) divides suicide-related behaviour only into suicidal thoughts, plans and attempts, at 10.7%, 2.5% and 1.7% over the lifetime; an attempt is defined there as “harming oneself with an intention to end life” (NCMH, n.d.b). In the 2023 National Suicide Survey (2,807 people aged 19 to 75), 14.7% had ever thought of suicide (MOHW, 2024b). Because definitions and methods change the numbers so much (Muehlenkamp et al., 2012; Swannell et al., 2014), these figures cannot be compared directly with the international meta-analyses.

Only some people come to hospital: NICE says only a minority of people who have self-harmed present to hospital services (NICE, 2022). Emergency figures still show the trend. A report on the National Emergency Department Information System found 206,409 emergency patients for self-harm or suicide attempts in 2018 to 2022 (including people triaged for suicidal ideation), 61.2% of them women, and the age- and sex-standardised incidence among women was about 31.0% higher in 2022 than in 2018 (Jung et al., 2023). In the 2023 National Suicide Survey, of 30,665 people who came to the emergency departments of the 85 hospitals in the emergency department-based aftercare programme after a suicide attempt, 29.4% were aged 19 to 29 and 14.0% were 18 or younger (MOHW, 2024b). According to a news report, regional emergency centres recorded 35,170 visits for self-harm or suicide attempts in 2024, 39.9% of them by people in their teens or twenties (Kyunghyang Shinmun, 2025). According to a news report on data that a National Assembly member obtained from the Korea Disease Control and Prevention Agency, the share of teenagers among emergency patients after self-harm or suicide attempts rose from 8.5% in 2015 to 18.7% “last year” (2025, by the article’s date) (Korean Education Newspaper, 2026). If these numbers describe what you are going through now, please do not carry it alone: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere; outside Korea, your family doctor is another place to start; in an emergency, contact your local emergency services.

Not everyone who self-harms wants to die. The NHS notes that some people describe their self-harm as a way of staying alive by responding to or coping with severe emotional distress (NHS, 2023c). Self-harm is nonetheless clearly linked with later suicide, and the Royal College of Psychiatrists says that although people who self-harm are not usually trying to die, they are more likely than other people to die by suicide, so anyone who self-harms should be taken seriously and offered help (RCPsych, 2020). According to NICE, 20% of people who self-harm do so again within a year, and the risk of suicide rises 30- to 50-fold in the year after a hospital presentation (NICE, 2022). A meta-analysis of 177 papers on hospital-presenting self-harm found that 1.6% died by suicide within 12 months and 3.9% within 5 years, and that 16.3% repeated self-harm within a year (10.0% in Asian countries) (Carroll et al., 2014). Seen the other way round, 24 in 25 people who came to hospital did not die by suicide within 5 years (Carroll et al., 2014). In the Multicentre Study in England, 40,346 people who came to hospital in 2000 to 2010 were followed to 2012: 1.6% died by suicide (2.6% of men, 0.9% of women), 0.5% in the first year, and over the period the risk was 49 times that of the general population (Hawton et al., 2015). Most did not die by suicide, and a higher risk means that help is needed. If you are having thoughts of suicide right now, please call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere; outside Korea, your family doctor is another place to start. If you are in immediate danger, contact your local emergency services.

The same holds for young people. A study in England that followed 9,173 people aged 10 to 18 who came to an emergency department after self-harm in 2000 to 2013 to the end of 2015 found that 55 (0.6%) died by suicide; in the first 12 months, suicide was more than 30 times more frequent than expected for that age group in the general population (standardised mortality ratio 31.0). Of the 55, 76% died after the age of 18, and the risk was higher in males and in those who repeated self-harm (Hawton et al., 2020). In community studies, adolescents who self-harmed also had more suicidal thoughts (risk ratio 4.97) and suicide attempts (risk ratio 9.14), and more so when they self-harmed more often (Gillies et al., 2018). In Korea, a 2013 national suicide survey finding that the suicide death rate of people who have attempted suicide is about 25 times that of the general population is often cited (MOHW, 2023). As in the studies above, most did not die by suicide (Carroll et al., 2014; Hawton et al., 2020), but a higher risk does not mean a fixed fate: it means that help is needed. As shown below, some therapies reduced repeat self-harm, and a cohort study found less suicidal behaviour among people who received a safety plan. If you are having thoughts of suicide right now, please call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere; outside Korea, your family doctor is another place to start. If you are in immediate danger, contact your local emergency services.

No score can pick out who is at risk, though. A meta-analysis of 172 longitudinal studies found that earlier self-injurious thoughts and behaviours were linked with later suicidal thoughts (odds ratio 2.07), attempts (2.14) and death (1.54), but prediction was weak: sensitivity was only 10% to 26%, and overall accuracy was barely above chance (Ribeiro et al., 2016). A systematic review of scales for predicting suicide after self-harm found positive predictive values of 1.3% to 16.7%, concluded that no scale has sufficient evidence to support its use, and warned that relying on such scales may provide false reassurance and is therefore potentially dangerous (Chan et al., 2016). So the NICE guideline says not to use risk assessment tools and scales, or a global low, medium or high risk rating, to predict future suicide or repeat self-harm, or to decide who is offered treatment or discharged, and to focus instead on the person’s needs and their immediate and long-term safety (NICE, 2022). Because risk cannot be picked out, everyone who has self-harmed deserves serious attention and help.

After self-harm, physical care needs to go together with an assessment of how the person is. The NICE guideline recommends that, at the earliest opportunity after an episode, a mental health professional carries out a psychosocial assessment to build a collaborative therapeutic relationship, begin to develop a shared understanding of why the person has self-harmed and make sure they receive the care they need, and it says not to delay this assessment until medical treatment is completed. It rules out punitive approaches for frequent self-harm and says staff should be trained to understand the stigma and discrimination around self-harm, avoid judgemental attitudes and communicate compassionately. Diagnosis, age, substance misuse or coexisting conditions must not be used as reasons to withhold psychological interventions, and coexisting difficulties are treated alongside, following their own guidelines (NICE, 2022). The NHS says that if you talk to a GP about self-harm, they will listen and discuss the best options with you, and can give advice and treatment for minor injuries (NHS, 2023a).

For adults, NICE recommends a structured, person-centred psychological intervention informed by cognitive behavioural therapy (CBT), such as CBT or problem-solving therapy, tailored to adults who self-harm, starting as soon as possible and typically lasting 4 to 10 sessions (NICE, 2022). In a Cochrane review of 76 randomised trials (21,414 participants) in adults who had recently (within six months) self-harmed and come to hospital or clinical services, compared with usual care and other comparators, individual CBT-based psychotherapy may have reduced repeat self-harm by the end of treatment (odds ratio 0.35, 95% CI 0.12 to 1.02, 4 trials, 238 people, low certainty), but the interval included no effect, and there was some evidence that it may reduce repetition at longer follow-up such as 6 and 12 months. For dialectical behaviour therapy (DBT), repetition was slightly lower (66.0% against 68.2% in the comparison groups), but whether it reduced repetition remained uncertain. Mentalisation-based therapy (MBT) reduced repetition in a single trial (odds ratio 0.35, 0.17 to 0.73, 134 people, high certainty), and a group-based emotion-regulation therapy may also have reduced it in two trials by the same group (odds ratio 0.34, 0.13 to 0.88, 83 people, moderate certainty). The authors concluded that, given significant methodological limitations, the evidence for several interventions remains uncertain (Witt et al., 2021b).

There is less evidence for young people. In a Cochrane review of 17 trials (2,280 participants, 87.6% female, mean age 14.7) in young people up to 18 who had recently (within six months) self-harmed and come to hospital or clinical services, repeat self-harm by the end of treatment was 30% with dialectical behaviour therapy adapted for adolescents (DBT-A), against 43% with usual care, enhanced usual care or another psychotherapy (odds ratio 0.46, 0.26 to 0.82, 4 trials, 270 people, high certainty). Individual CBT-based therapy may have made no difference compared with usual care (low certainty), family therapy probably made no difference (moderate certainty), and the evidence for mentalisation-based therapy for adolescents was of very low certainty. None of the trials tested a medicine (Witt et al., 2021a). NICE likewise says to consider DBT-A for children and young people with significant emotional dysregulation difficulties who self-harm frequently (NICE, 2022).

NICE says not to offer drug treatment as a specific intervention to reduce self-harm (NICE, 2022). If a condition such as depression has been diagnosed, medicine may be offered alongside talking therapy (NHS, 2023a). Medicines are used only on prescription; if you already take one, do not stop it suddenly on your own: talk to the prescriber first. On so-called harm minimisation, NICE states that it makes no recommendations about the use of safer self-harm, and says harm-minimisation strategies should only be considered for someone already in ongoing care, as part of recovery-focused care rather than as a standalone intervention, and after collaborative discussion and agreement with the person, their family or carers and the wider team (NICE, 2022). That is why this guide gives no such instructions: those conversations belong with a clinician who knows you.

NICE also says to consider developing a safety plan together with the person. It covers recognising the triggers and warning signs of increasing distress, further self-harm or a suicidal crisis; individual coping strategies and solving problems that get in their way; people and places that can help as a distraction; family members or friends who can help resolve a crisis; contact details for mental health services, including out-of-hours and emergency contacts; and keeping the surroundings safe by working together to remove or restrict lethal means of suicide. The person holds the plan, shares it with family and professionals as they decide, and should be able to reach it at times of crisis (NICE, 2022). A cohort study at 9 US veterans’ hospital emergency departments (5 intervention and 4 comparison sites) found that among adults seen for suicide-related concerns, 3.03% of 1,186 who received a safety planning intervention with telephone follow-up showed suicidal behaviour over 6 months, against 5.29% of 454 in usual care (odds ratio 0.56, 0.33 to 0.95). It was not a randomised trial, and about 88% of participants were men (Stanley et al., 2018). Korea runs an emergency department-based aftercare programme that offers treatment and counselling to people who come to an emergency department after a suicide attempt and connects them with local mental health welfare centres. In 2022, among 11,321 people who completed case management, the share with a high overall suicide risk was reported to have fallen from 15.6% to 6.5% (MOHW, 2023), but this was a before-and-after comparison without a comparison group, so the change cannot all be credited to the programme. Even without a safety plan yet, if you are thinking of suicide or the urge to self-harm feels too hard to bear, call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere; outside Korea, your family doctor is another place to start; in an emergency, contact your local emergency services.

First, who to contact in a crisis. If you are thinking of suicide or the urge to self-harm feels too hard to bear, please call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you live outside Korea, your family doctor or local mental health services are another place to start. If you have swallowed something harmful, even if you feel all right, or are badly hurt, do not wait at home to see how it goes: contact your local emergency services now, as you should whenever you are in immediate danger.

Urges do not last forever. The Royal College of Psychiatrists asks you to remember that the feelings of self-harm will go away after a while, and says that if you can cope with your distress without self-harming for a time, it may get easier over the next few hours. Things it suggests for that time include talking to someone (if you are on your own, phoning a friend or using a helpline), finding a way to distance yourself from an environment that is making you feel worse, distracting yourself by going out, listening to music or doing something that interests you, being kind to yourself by doing something you enjoy, and writing a diary or a letter, which no one else needs to see, about what is happening to you (RCPsych, 2020). Practising kindness towards yourself is covered in the self-compassion guide.

When the urge has gone and you feel safe, the Royal College of Psychiatrists suggests thinking back to the last time you wanted to self-harm, where you were, who you were with and what you were feeling, and what (if anything) helped, and making a “crisis plan” with someone so that you can get in touch with someone quickly when the urge comes; while you talk, the wish to harm yourself may start to go away. If you think you may harm yourself, the same leaflet says not to suffer in silence but to tell someone, and that the best place to start might be a health professional such as your GP (RCPsych, 2020). This points the same way as the NICE safety plan above. In Korea, people can start with a psychiatric clinic or a mental health welfare centre, and calling 1577-0199 connects a mobile phone to a nearby centre, or to a regional centre at night and on public holidays (MOHW, 2025).

If you think someone has started to self-harm, the NHS says to approach the subject with care and understanding: just being there and letting them know they are not alone can help a lot, but you may not be able to help them on your own. It suggests encouraging them to speak to a GP or a free listening service, asking how they would like to be supported, letting them know you are there for them, telling them about their positive qualities, trying to understand their emotions and experiences without judging them rather than focusing on the self-harm, considering that any amount of self-harm might be a sign of extreme distress, and letting them be in control of their decisions while getting them medical attention if needed. It says not to try to force them to change, not to threaten to take away their control, and not to insult them, for example by saying they are attention-seeking (NHS, 2023b). The Royal College of Psychiatrists also says the most important thing is to listen without judgement or criticism, and advises against trying to be their therapist, expecting them to stop overnight, reacting strongly with anger, making them promise not to do it again, or saying you will not see them unless they stop. It suggests offering to go with them to see someone, and helping them see self-harm as an ordinary problem that needs support and understanding rather than something secret and shameful (RCPsych, 2020).

Emotional signs listed by the NHS include becoming very withdrawn and not speaking to others, signs of depression such as low mood, tearfulness or a lack of motivation, signs of low self-esteem such as thinking they are not good enough, and talking about ending things or not wanting to go on (NHS, 2023b). In Korea, among people who came after a suicide attempt to the 80 hospitals in the 2022 emergency department aftercare programme, more than half (56.0%) were reported to have hinted at the attempt or asked people around them for help (MOHW, 2023). If someone talks about ending things, do not let it pass: contact a crisis line together right away, by calling or texting 988 in the US and Canada, calling Samaritans on 116 123 in the UK and Ireland, or finding a line at findahelpline.com elsewhere; outside Korea, their family doctor is another route. If they have swallowed something harmful, even if they seem all right, or are badly hurt, do not wait at home to see how it goes: contact your local emergency services now, as you should whenever they are in immediate danger. When a life may be at risk, safety comes before a promise to keep it secret.

Family members can ask the care team for the information NICE says families and carers should receive: the emotional impact on the person and the family, how to cope when supporting someone who self-harms, what to do if it happens again, how to get help for physical injuries, steps to reduce the likelihood of self-harm in the future, and the impact of stigma (NICE, 2022). The NICE guideline recommends that schools have policies and procedures for supporting students who self-harm and a designated lead, develop a support plan with the student and family on the advice of mental health professionals, and take into account how it affects close friends and peers (NICE, 2022). Most adolescents who seek help turn to a friend (Gillies et al., 2018), so friends who hear about it need support too. In Korea, students can get counselling in a Wee class, which many schools have, or a Wee centre at the local education office, and Korea Policy Briefing describes the project’s student counselling as confidential and free (Korea Policy Briefing, 2022); the Youth Counselling 1388 line is free, around the clock, for young people aged 9 to 24 and their parents, by phone, text or KakaoTalk (Korea Policy Briefing, 2024). Supporting someone can be draining, so the NHS and the Royal College of Psychiatrists advise looking after yourself and having someone to talk to as well (NHS, 2023b; RCPsych, 2020). WHO notes that because of stigma many people who are thinking of suicide or have attempted it do not seek help, and that breaking down the taboo matters (WHO, 2026).

Q. Is there a self-harm test? A. mind.io does not offer a self-harm test. Answering anything other than “Not at all” to question 9 of the depression check-in (PHQ-9) brings up crisis lines first, but the check-in looks at depressive symptoms over the past 2 weeks and does not judge the risk of self-harm or suicide. Risk scales predict future suicide poorly, which is why the NICE guideline says not to use such tools for prediction (NICE, 2022; Chan et al., 2016). Whatever your score, if you have thoughts of harming yourself, call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere; outside Korea, your family doctor is another place to start. If you are badly hurt or in immediate danger, contact your local emergency services.

Q. Isn’t it just attention-seeking? A. For most people it is not. In a meta-analysis, the most common functions were intrapersonal ones such as emotion regulation (66% to 81%), while interpersonal functions such as expressing distress were reported by 33% to 56% (Taylor et al., 2018). In studies of adolescents, the most frequent reason was relief from thoughts or feelings (Gillies et al., 2018). The NHS lists calling it attention-seeking as an insult to avoid, and asks you to consider that any amount of self-harm might be a sign of extreme distress (NHS, 2023b). If someone did want others to know, take it as a call for help.

Q. Does self-harm mean someone wants to die? A. Not necessarily. People who self-harm are not usually trying to die (RCPsych, 2020). The risk of suicide does rise after self-harm, though: among people who came to hospital, 1.6% died by suicide within 12 months and 3.9% within 5 years. Seen the other way round, 24 in 25 did not die by suicide within 5 years (Carroll et al., 2014). Because no score can pick out who is at risk, everyone who has self-harmed deserves serious attention and help (NICE, 2022). If thoughts of suicide come too, please call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere; outside Korea, your family doctor is another place to start. If you are in immediate danger, contact your local emergency services.

Q. Once someone starts, do they keep going? A. Not necessarily. In community studies of adolescents, 47% of those who had self-harmed reported only 1 or 2 episodes (Gillies et al., 2018). For some people who do it regularly it becomes hard to stop (RCPsych, 2020), and among people who came to hospital, 16.3% self-harmed again within a year (Carroll et al., 2014). The more it repeats, the more getting help matters: for adults there is low-certainty evidence for CBT-based psychotherapy (Witt et al., 2021b), and for adolescents high-certainty evidence for DBT-A (Witt et al., 2021a). If you have started to want to stop, you can say exactly that to a doctor or counsellor.

Q. A friend told me they self-harm and asked me to keep it secret. A. First, listen without judging or criticising. Do not make them promise not to do it again (RCPsych, 2020); ask how you can help. You may not be able to help them on your own, though (NHS, 2023b). Suggest talking together to an adult you both trust, a school counsellor or a helpline, and offer to go with them (RCPsych, 2020). If your friend says they want to die or is badly hurt, safety comes before the secret: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere; outside Korea, a family doctor is another route; and if they are badly hurt or in immediate danger, contact your local emergency services. You will need someone to talk to as well.

Q. I have found out that my child self-harms. What should I do as a parent? A. Shock and anger are natural, but reacting strongly with anger is likely to make your child feel worse, which can make it harder to change (RCPsych, 2020). Rather than forcing them to stop or threatening to take away their control, try to understand their feelings and experiences without judging, and ask how they would like to be supported (NHS, 2023b). Get any injury treated, and start with a doctor or mental health service; in Korea, a school Wee class, a Wee centre at the local education office, or the 1388 youth line, which parents can also use (Korea Policy Briefing, 2022, 2024). Among treatments for adolescents, DBT-A is the one with high-certainty evidence (Witt et al., 2021a). If your child says they want to die, call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere; outside Korea, your family doctor is another route. If they have swallowed something harmful, even if they seem all right, or are badly hurt, do not wait at home to see how it goes: contact your local emergency services now, as you should whenever they are in immediate danger.

Q. I have the urge to self-harm right now. A. Please do not carry it alone. Call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere; outside Korea, your family doctor or local mental health services are another place to start. If you have swallowed something harmful, even if you feel all right, or are badly hurt, do not wait at home to see how it goes: contact your local emergency services now, as you should whenever you are in immediate danger. The feelings of self-harm will go away after a while, and it may get easier over the next few hours (RCPsych, 2020). For now, phone someone you trust, or if the place you are in is making you feel worse, find a way to put some distance between you and it (RCPsych, 2020).

References: National Institute for Health and Care Excellence (2022), Self-harm: assessment, management and preventing recurrence, NICE guideline NG225, https://www.nice.org.uk/guidance/ng225; Nock, M. K. (2010), Self-injury, Annual Review of Clinical Psychology 6, 339-363, https://doi.org/10.1146/annurev.clinpsy.121208.131258; Klonsky, E. D. (2007), The functions of deliberate self-injury: a review of the evidence, Clinical Psychology Review 27(2), 226-239, https://doi.org/10.1016/j.cpr.2006.08.002; Taylor, P. J., Jomar, K., Dhingra, K., Forrester, R., Shahmalak, U., & Dickson, J. M. (2018), A meta-analysis of the prevalence of different functions of non-suicidal self-injury, Journal of Affective Disorders 227, 759-769, https://doi.org/10.1016/j.jad.2017.11.073; Gillies, D., Christou, M. A., Dixon, A. C., Featherston, O. J., Rapti, I., Garcia-Anguita, A., Villasis-Keever, M., Reebye, P., Christou, E., Al Kabir, N., & Christou, P. A. (2018), Prevalence and characteristics of self-harm in adolescents: meta-analyses of community-based studies 1990-2015, Journal of the American Academy of Child and Adolescent Psychiatry 57(10), 733-741, https://doi.org/10.1016/j.jaac.2018.06.018; Swannell, S. V., Martin, G. E., Page, A., Hasking, P., & St John, N. J. (2014), Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression, Suicide and Life-Threatening Behavior 44(3), 273-303, https://doi.org/10.1111/sltb.12070; Muehlenkamp, J. J., Claes, L., Havertape, L., & Plener, P. L. (2012), International prevalence of adolescent non-suicidal self-injury and deliberate self-harm, Child and Adolescent Psychiatry and Mental Health 6, 10, https://doi.org/10.1186/1753-2000-6-10; Carroll, R., Metcalfe, C., & Gunnell, D. (2014), Hospital presenting self-harm and risk of fatal and non-fatal repetition: systematic review and meta-analysis, PLoS One 9(2), e89944, https://doi.org/10.1371/journal.pone.0089944; Hawton, K., Bergen, H., Cooper, J., Turnbull, P., Waters, K., Ness, J., & Kapur, N. (2015), Suicide following self-harm: findings from the Multicentre Study of self-harm in England, 2000-2012, Journal of Affective Disorders 175, 147-151, https://doi.org/10.1016/j.jad.2014.12.062; Hawton, K., Bale, L., Brand, F., Townsend, E., Ness, J., Waters, K., Clements, C., Kapur, N., & Geulayov, G. (2020), Mortality in children and adolescents following presentation to hospital after non-fatal self-harm in the Multicentre Study of Self-harm: a prospective observational cohort study, The Lancet Child & Adolescent Health 4(2), 111-120, https://doi.org/10.1016/s2352-4642(19)30373-6; Ribeiro, J. D., Franklin, J. C., Fox, K. R., Bentley, K. H., Kleiman, E. M., Chang, B. P., & Nock, M. K. (2016), Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: a meta-analysis of longitudinal studies, Psychological Medicine 46(2), 225-236, https://doi.org/10.1017/s0033291715001804; Chan, M. K., Bhatti, H., Meader, N., Stockton, S., Evans, J., O’Connor, R. C., Kapur, N., & Kendall, T. (2016), Predicting suicide following self-harm: systematic review of risk factors and risk scales, British Journal of Psychiatry 209(4), 277-283, https://doi.org/10.1192/bjp.bp.115.170050; Witt, K. G., Hetrick, S. E., Rajaram, G., Hazell, P., Taylor Salisbury, T. L., Townsend, E., & Hawton, K. (2021a), Interventions for self-harm in children and adolescents, Cochrane Database of Systematic Reviews 3, CD013667, https://doi.org/10.1002/14651858.cd013667.pub2; Witt, K. G., Hetrick, S. E., Rajaram, G., Hazell, P., Taylor Salisbury, T. L., Townsend, E., & Hawton, K. (2021b), Psychosocial interventions for self-harm in adults, Cochrane Database of Systematic Reviews 4, CD013668, https://doi.org/10.1002/14651858.cd013668.pub2; Stanley, B., Brown, G. K., Brenner, L. A., Galfalvy, H. C., Currier, G. W., Knox, K. L., Chaudhury, S. R., Bush, A. L., & Green, K. L. (2018), Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency department, JAMA Psychiatry 75(9), 894-900, https://doi.org/10.1001/jamapsychiatry.2018.1776; World Health Organization (2026), Suicide [fact sheet, 28 August 2026], https://www.who.int/news-room/fact-sheets/detail/suicide; NHS (2023a), Self-harm: assessment and treatments, https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/self-harm/assessment-and-treatments/; NHS (2023b), Self-harm: how to help someone else, https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/self-harm/how-to-help-someone-else/; NHS (2023c), Why people self-harm, https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/self-harm/why-people-self-harm/; Royal College of Psychiatrists (2020), Self-harm [patient information], https://www.rcpsych.ac.uk/mental-health/mental-illnesses-and-mental-health-problems/self-harm; Samaritans (n.d.), Samaritans’ media guidelines for reporting suicide, https://www.samaritans.org/about-samaritans/media-guidelines/media-guidelines-reporting-suicide/; Ministry of Health and Welfare (2023), Suicide attempters: suicide risk down about 60% after case management, results of the 2022 emergency department-based aftercare programme [press release, in Korean], https://www.mohw.go.kr/board.es?mid=a10503010100&bid=0027&act=view&list_no=378043; Ministry of Health and Welfare (2024a), Suicide prevention lines unified as 109 from 1 January [press release, in Korean], https://www.mohw.go.kr/board.es?mid=a10503010100&bid=0027&act=view&list_no=1479607; Ministry of Health and Welfare (2024b), Results of the 2023 National Suicide Survey [press release, in Korean], https://www.mohw.go.kr/board.es?mid=a10503010100&bid=0027&act=view&list_no=1480826; Ministry of Health and Welfare (2024c), Suicide prevention reporting code 4.0 announced [press release, in Korean], https://www.mohw.go.kr/board.es?mid=a10503010100&bid=0027&act=view&list_no=1483567; Ministry of Health and Welfare (2025), Community mental health welfare centres and the mental health crisis line [in Korean], https://www.mohw.go.kr/menu.es?mid=a10706040100; National Center for Mental Health (n.d.a), 2022 National Mental Health Survey of Korea (children and adolescents): suicide-related behaviour, and survey overview [in Korean], https://mhs.ncmh.go.kr/menu.es?mid=a10503090000 and https://mhs.ncmh.go.kr/menu.es?mid=a10202000000; National Center for Mental Health (n.d.b), 2021 National Mental Health Survey of Korea (adults): suicide-related behaviour, and survey overview [in Korean], https://mhs.ncmh.go.kr/menu.es?mid=a10501060000 and https://mhs.ncmh.go.kr/menu.es?mid=a10206000000; Kukinews (2024), 16.1% of children and adolescents have had a mental disorder, only 6.6% got professional help [news report on the 2022 survey, 2 May 2024, in Korean], https://www.kukinews.com/article/view/kuk202405020088; Jung, K. Y., Kim, T., & Ro, Y. S. (2023), Epidemiology of suicide attempts and self-harm in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022, Clinical and Experimental Emergency Medicine 10(Suppl), S69-S74, https://doi.org/10.15441/ceem.23.141; Kyunghyang Shinmun (2025), Four in ten emergency patients after self-harm or suicide attempts last year were in their teens or twenties [news report on the 2024 severe emergency disease indicators, 9 November 2025, in Korean], https://www.khan.co.kr/article/202511091455001; Korean Education Newspaper (2026), Youth self-harm and suicide attempts: Korea Disease Control and Prevention Agency data released by a National Assembly member [news report, 6 October 2026, in Korean], http://www.hangyo.com/news/article.html?no=109565; Korea Policy Briefing (2022), Strength to stand up again for students in crisis: the Wee project [in Korean], https://www.korea.kr/news/policyNewsView.do?newsId=148909192; Korea Policy Briefing (2024), Youth Counselling 1388, open 365 days a year, 24 hours a day [in Korean], https://www.korea.kr/news/policyNewsView.do?newsId=148937356