Breaking the Silence:
Young People, Parents, and the Crisis Period around Self-Harm
Young people are self-harming more than ever — and we’re not reaching them until the moment becomes critical.
This research set out to uncover what really happens in those critical moments, through the eyes of young people and another relatively unexplored population, their parents. It aimed to explore how we can stop crises from escalating in the first place.
Background
Self-harm is defined as “intentional self-poisoning or injury irrespective of the apparent purpose of the act” [1]. Rates have been increasing, with an estimated 26% of YP aged 16-24 having self-harmed worldwide [2].
For many young people who self-harm, the first time they receive mental health support is in the emergency department (ED) following a crisis. This means long periods of distress can go unnoticed and unsupported. Parents are often unaware of the extent of their child’s distress until crisis point, often feeling guilt, shock, confusion and uncertainty about where to turn for help.
Previous research has typically focused on either the perspective of the young person or parent, rarely using in-the-moment accounts. This study aimed to capture both perspectives close to the time of crisis, to see how distress builds and how families experience these moments.
What I hoped to achieve:
– Explore how young people and parents experience the crisis period
-Explore similarities and differences in accounts
-Identify where support could be offered earlier and more effectively
The Study
My study used data from the Supporting Adolescents with SelfHarm (SASH) study. We listened to conversations between participants and practitioners recorded during the study, when memories and feelings were still raw.
This included:
-Therapy sessions with young people exploring the events and emotions around their self-harm
-Parent therapy sessions exploring their understanding of their child’s selfharm
-Follow-up research interviews with parents for deeper reflection on their experiences of the crisis period.
Participant Demographics
| Participant group | Number | Gender |
|---|---|---|
| Young people | 4 | 4 females |
| Parents | 11 | 9 female (mothers), 1 male (father), 1 unknown |
Results:
Themes were analysed with a chronological lens, exploring how experiences unfolded before, during and after the crisis.
What Young People told us:
Sinking into Silence and Struggle
Many young people kept their pain hidden, compounding feelings of isolation: “I just feel really alone…just don’t have anyone there like no one really helps.“
Some expressed feelings of self-hatred and low self-esteem: “I just get the sense that people don’t want me around and that I just suck at like life.“
Chaos of Conflict and Coping
Arguments at home, friendship issues, and school stress often intensified existing struggles. Some tried to seek help but were left waiting or felt unheard. Self-harm, for some, became a way to cope: “To distract myself from the thoughts.“
Moments of Insight and Imagining Recovery
Even shortly after the crisis, some were able to explore and envisage future hopes, whether that be starting a new hobby, becoming more sociable or accepting help from services. For example, one young person showed openness to support, despite skepticism: “I guess I can always give them [services] a go”. These moments, though fragile, showed that ‘flickers of hope’ were emerging.
What Parents told us:
Shock of Discovery and Emotional Unravelling
Many parents were unaware of the true nature of their child’s struggles until crisispoint: “I didn’t realise the extent of how she was feeling…” describing how they were “shell shocked…everything was a bit of a blur”. Others had some instinct that something was going on but were unable to grasp how serious it was.
Struggling to Support Child Amidst Systems and Strains
After discovering self-harm, parents often became hyper-vigilant, trying to avoid triggering their child while managing their own emotions, “It’s kind of treading on eggshells… just to make sure I don’t put a foot out of place that will make her go back [to self-harming]”. Frustrations with slow or unhelpful services were common: “We were desperate to try and get help somewhere.”
Holding onto Hope and Rebuilding Connection
Parents found hope in small signs of connection — a conversation, a hug, or willingness to accept help: “It was good she gave me a hug and said thank you. You know it was a good day, and she went to school, so it was a very positive day.”
The Common Thread: Silence
Silence played a role for both groups, but in different ways:
-Young people used silence pre-crisis to protect against judgment and rejection.
-Parents used silence post-crisis to avoid triggering their child.
While well-intentioned, these silences often kept both young people and parents feeling alone. Breaking this silence is crucial in rebuilding trust and connection.
What this means:
1. We can’t wait for crisis
Distress is often there long before self-harm. Schools and community settings need specialist mental health support so difficulties can be detected early.
2. Parents need support too
Parents carry huge emotional and practical burdens after discovering self-harm. Offering them guidance, emotional space, and non-judgemental support can help them support their child more effectively.
3. Recovery starts small
Even tiny shifts — a willingness to talk, a shared moment — can be powerful starting points. Services should create safe spaces where these moments can be nurtured.
Strengths/limitations
✓ Capturing experiences close to the crisis, as well as using two types of data gave a raw, real insight into what families were feeling.
✘ All young people in the study were female, not capturing the experiences of other genders.
Take-Home Message
Self-harm is not a sudden event. It’s often the final step in a long period of hidden distress. Crisis points can open the door to change, but only if we respond with compassion, support, and an understanding of what led there.
If we can spot the signs earlier and involve families in a supportive way, we may be able to prevent crisis from being the first time help arrives
If you or someone you know is struggling: Samaritans – call 116 123 (free, 24/7)
References/further reading
- NICE. Overview | Self-harm: Assessment, Management and Preventing Recurrence | Guidance | NICE [Internet]. www.nice.org.uk. National Institute for Health and Care Excellence; 2022. Available from: https://www.nice.org.uk/guidance/NG225
- Mughal F, Troya MI, Dikomitis L, Tierney S, Corp N, Evans N, et al. The experiences and needs of supporting individuals of young people who self-harm: A systematic review and thematic synthesis. eClinicalMedicine. 2022 June;48:101437.