Do...

• Aim to be a good listener - allow the other person to speak without interruption or judgement. For them, self-harm may feel like the only way to express very strong and deep-rooted emotions. If someone feels able to open up to you this can be a huge breakthrough, so tread carefully.
• Read up on the subject - many organisations offer invaluable information and tips on techniques to break the cycle of self-harming.
• Look after yourself - it's hard to support someone if you're feeling overwhelmed or out of your depth. Setting boundaries to what you can offer and getting some support for yourself are important.

Don't...

• Panic if you're not sure how to react to news that a loved one is self-harming - often simply being there is enough. "Opening up to my friend and admitting I'd been burning and cutting my arms for two years brought overwhelming relief and shock," said Marcia, 17. "She told me afterwards that she felt at a loss as to what she should say or do, but it was OK - just having a hug and knowing I had told someone was enough for a start."
• Assume that people who self-harm are looking to commit suicide. Hurting yourself can be a way of dealing with pent-up emotions, such as anger or tension, and doesn't necessarily follow the same pattern as someone who is looking to end their life.
• Expect a 'quick fix'. For some people self-harm is a habitual way of responding to painful emotions they feel unable to control. Underlying causes, such as abuse or low self-esteem, are what need to be addressed.

Being honest

It's OK to feel upset if someone close to you tells you they've been harming themselves. If you feel unable to cope with the situation it's important to tell them you need extra help, and it's OK to let them know that you feel upset they are hurting because you care about them.

Respecting feelings

Very often, self-harm remains a secret which can add to the problem and make asking for help harder. Someone who is self-harming might feel very alone and worry about being labelled as attention-seeking, mad, or a freak. Although you might be shocked, self-harm is surprisingly common and rates of self-harm in the UK are among the highest in Europe. It can be helpful to reassure someone who self-harms that they're not the only one and that there are sources of help and support available.

Blame game

Seeing someone you care about hurting can be difficult to bear and will bring out the urge to protect them. So when that person is hurting themselves it can stir up complicated emotions. It can even make you feel angry towards them. As with all self-destructive behaviours, you may want to scream "Just stop it!" at the person, but try to remember that they're not to blame for the way they're feeling, and that the issue is more complicated than that.

Good intentions

Self-harm can become a ritual or habit used regularly as a coping mechanism. Try to avoid setting goals or pacts, such as: "If you promise not to hurt yourself between now and next week, you're doing really well," unless the person asks you to do this. It's impossible for someone in this situation to promise how they're going to feel at any given time as they come to terms with their problems. Making promises they can't keep could result in feelings of failure, shame and more secrets. "When I told my boyfriend about my self-harm, he freaked out and got really upset, accusing me of being selfish," said Marcia. "I ended up comforting him and agreeing never to hurt myself or mention it again. But it wasn't that simple - I carried on self-harming in secret until I felt able to tell a friend. I understand it was difficult for him, but if I'd just been able to talk to him it would've saved months of heartache."

Encouraging someone to get help

Take the initiative and find out about mental health and other support services in the area. It may also help if you support a loved one to make an appointment and offer to accompany them. As with all mental health issues, a neutral observer can prove easier to talk to than someone close, especially if there are underlying trust issues that make it difficult to open up. "It's important to go at the other person's pace and give them chance to set their own goals and find what works for them," says Tessa Gregson from young people's mental health service, 42^nd Street.

Updated: 14/02/2012

Written by Liz Nicholls