Who can I talk to?

Telling anyone about your self-harm is a massive and brave step, so confide in someone you feel comfortable with. Talking to a trained health professional such as your doctor (GP), a counsellor or support organisation is a safe move because they should listen calmly and offer you objective advice. It might also be easier to open up to someone you're not emotionally close to because you can relax and not worry about upsetting them.

There's no reason for you to deal with things all on your own; if you're really worried about talking to someone face-to-face, you can call, email, or even text a professional support group anonymously.

What does confidentiality actually mean?

Many professionals offer confidential help and advice to young people, but there isn't one set rule that covers confidentiality, so ask your doctor or health professional. All staff working for the NHS have a legal duty to follow the NHS Code of Practice on Confidentiality. This means they must ask for your consent before passing information to anyone else - this is part of their duty of care and applies whatever age you are.

Telling someone about self-harm is difficult. Whoever you tell should respect your right to privacy, but there are times when they may have to let other people know.

If you're aged 16 or 17, the law sees you as an adult when it comes to confidentiality and consent to treatment. Therefore, if you're 16 and you want a health professional to keep your treatment confidential then that should be respected. However, there are exceptions to this rule where they have to let your parents, guardian or GP know something you've passed on to them. This is normally when they feel you don't have 'mental capacity', i.e. when you may not be able to make certain decisions because they feel you won't understand the advice, or your physical or mental health is likely to suffer unless you receive treatment or support.

This also applies where there are issues around child protection; when they are worried you may harm yourself more seriously than you meant to; if you're expressing suicidal feelings; you're being sexually or physically abused; or your self-harm will lead to permanent damage. If they do decide to contact someone else, then they should let you know they are going to do that first.

Parental rights: Parents don't have an automatic right to know what is said during your treatment with a mental health professional, even if you're under 16 and if they've given permission for you to have the treatment in the first place. The only time this may happen is if the work with you takes place within your school and the notes form part of your school record. If you confide in a teacher, they should refer you to an experienced counsellor or health professional who knows how best to help and support you. Teachers have a legal duty not to keep certain things to themselves. "We can't keep anything confidential in terms of self-harming or abuse, and we do have to refer it," says Jo, a secondary school teacher. "But it won't necessarily be to your parents, but within the school, such as the school's designated Child Protection officer, the school nurse, or the head teacher."

Exceptional circumstances: There are some exceptional circumstances when a doctor can disclose information about you without your consent, even if you have mental capacity and are considered 'competent'. An example of this is if the doctor is concerned that you are going to kill yourself - it wouldn't necessarily be that they would tell your parents (if they do they must  tell you they will do this), but they may talk to another  professional such as psychiatrist or social worker. If you've been to an emergency department because you've self-harmed, a very brief letter will go to your GP which states why you came in and what investigations you had. There is a confidentiality policy, but this doesn't exclude doctors talking to each other where it's helpful they know about self-harm. If you really object to this then it's down to the health professional to decide if this should be respected.

Someone I know is self-harming, should I tell someone?

This is a tricky one as you don't want to betray your friend or partner's trust and right to privacy, but this might not be something you can handle alone, either. The ideal scenario is that they seek further help themselves, but this may not be something they want to do. You can talk to a GP or counsellor about someone, but they can only help them if the person you are worried about speaks to them directly. Even if you're a carer, rules of confidentiality still apply. This has led to a 'Partners in Care' campaign, which aims to get the laws changed so that carers can access information about patients.

If you're worried they may hurt themselves badly then it's best to tell someone. Karen Wright, psychiatric social worker, says: "If your partner's self-harm could seriously put their health at risk or they are suicidal you may need to be honest and clear that you feel you need to pass information onto their GP or A&E staff to help to keep them safe."

Updated: 07/02/2012

Written by Monica Perdoni and Julia Pearlman