Supporting someone who self-harms: what the latest research says

A 2014 review of 177 papers found that 16.3% of people who went to hospital after self-harm did it again within a year. Where researchers asked people directly, it was about one in five, probably because many repeats never reach hospital [1]. The longer view is more hopeful. An Australian study collected self-harm information from mid-adolescence to about age 29. Of 1,802 participants who responded during adolescence, 149 reported self-harm. Most adolescent self-harm was no longer reported in young adulthood [2]. This community study does not predict recovery for someone receiving hospital care, and its findings are not a reason to delay help. Still, a repeat doesn't mean nothing's working.

A study of 48,547 people aged 10 to 29 who attended hospital after self-harm in New South Wales, Australia, found that repeat hospital presentations were most frequent in the first year after the initial presentation [3]. It counted episodes reaching hospital, so it could not capture every episode. In England, a study of 35,938 people at hospitals in Derby, Manchester and Oxford found that those who had a psychosocial assessment, a proper conversation with a mental health professional, were about 40% less likely to self-harm again, in two of the three study centres over the following year [4]. That's a link and can't prove cause. NICE says people should have one as early as possible, and that staff shouldn't use scores or labels such as "low risk" to predict what happens next [5]. In the first few weeks, stay in touch a little more than usual, without checking up on them, know when the follow-up appointment is, and ask before they leave hospital what the plan is if things get bad again.

In a review of 129 studies, covering 329,001 initial hospital presentations, with some overlap between the groups studied, the clearest predictors of repeats were long-standing ones: self-harm before, hopelessness, past mental health treatment, a diagnosis of personality disorder or schizophrenia, alcohol or drug problems, and living alone. The review found that continuing vulnerabilities were more consistently associated with repetition than many features of a single episode [6]. These are group-level associations, not a checklist for deciding who will self-harm again. NICE advises against using risk scales or low, medium and high labels to predict this [5]. You can help with some of these, alongside their care team: keeping in touch so they're less on their own, noticing when they sound hopeless, and encouraging help with drinking or drugs.

For young people who self-harm often and find their emotions very hard to manage, NICE suggests considering dialectical behaviour therapy adapted for adolescents (DBT-A) [5]. In a 2021 Cochrane review of four trials with 270 young people, 30% repeated self-harm by the end of treatment after DBT-A, against 43% with usual care or another comparison treatment [7]. A 2025 review obtained data from 33 trials involving 4,146 young people. Its combined 12-month analysis used 22 trials and 3,117 participants, and found no clear overall difference between the therapies studied and comparison care. This does not prove that therapies are ineffective. A subgroup analysis suggested greater benefit among those with multiple previous episodes, but does not establish which therapy a particular person should receive [8]. For adults, NICE recommends a structured therapy informed by CBT and tailored to self-harm [5]. Cochrane found that CBT-based therapy may reduce repetition at longer follow-up, with low-certainty evidence [9]. If they're offered therapy, it's fair to ask what it's aiming to change and how everyone will know if it's working.

The UK SHIFT trial gave 832 young people aged 11 to 17, who had self-harmed at least twice, either family therapy or their usual care. Over 18 months, 28% of the family therapy group went back to hospital after self-harm, against 25% with usual care. The difference was not statistically clear, and the outcome counted hospital visits rather than all self-harm [10]. For adults, the 2021 Cochrane review found that remote contact interventions, such as postcards and phone calls, showed no clear difference in repetition. Much of the evidence was limited or uncertain [9]. Families and follow-up still matter for other reasons. If you're offered family sessions, ask what they're meant to help with.

NICE suggests a safety plan after self-harm: warning signs, ways of coping, people to contact and how to keep their surroundings safe. It's developed with family where appropriate, held by the person, and shared with whoever they decide [5]. A 2021 review of six studies involving 3,536 adults found that safety-planning interventions were associated with a 43% lower relative risk of suicidal behaviour. This was a relative reduction, not 43 percentage points. The studies included different designs and often other care alongside the plan; they did not establish the same benefit for non-suicidal self-harm or for children [11]. Ask whether there's a part you could help with, and wait to be shown it.

The family studies cited here mainly concern parents. They tell us less about friends and partners supporting an adult. In an Oxford study, 37 parents described how their parenting changed after they found out about self-harm. Early on, many were "walking on eggshells", and later felt able to take back some control. What helped included learning not to blame themselves or their child, and finding new ways to talk [12]. A review published in 2022 examined 17 studies, with eight contributing to its meta-analysis. It found no evidence that asking about suicide or self-harm increased those behaviours or distress, although the authors called for stronger studies [13]. NICE says families should get information and support, and be involved in the care plan where appropriate [5]. So in the weeks after an episode, it's reasonable to ask calmly and privately how they're doing, and whether they've hurt themselves again.

A 2024 review of 32 studies found that many parents of young people who self-harm had poor mental health themselves, and that guilt made them less likely to look after themselves. The authors called for peer support and for help beyond information leaflets [14]. A 2025 follow-up of families in the SHIFT trial tracked how critical parents were over time. In the small group where criticism increased, parents' distress also increased and young people's suicidal thoughts improved less than in some other groups. The study did not find a clear difference between groups in whether self-harm occurred [15]. That's a link, and it doesn't mean parents cause self-harm: stress and exhaustion wear anyone down. You deserve support for yourself, from someone you trust, a supporters' group or your GP. These studies do not prove that getting support for a parent reduces their child's self-harm.

A 2023 review brought together first-person accounts from 56 studies. People described immediate ways of interrupting self-harm and longer-term changes in relationships, work or living arrangements [16]. These accounts show why recovery can involve more than coping with an urge in the moment. They describe what people found helpful; they do not establish that any one approach will work for everyone.

A free app from the charity stem4 for people aged 13 and over, with activities based on DBT to help ride out the urge to self-harm. It needs no account [17]. The charity describes a pilot involving 14 young people who used the app alongside weekly psychological treatment. With no comparison group, it cannot show that the app caused the reported improvement. If they use it, leave it to them and don't ask to see what they've logged.

A free app made by UK doctors with young adults who have lived experience of self-harm. It has plain-English information about self-harm and suicidal feelings, help with safety planning, and emergency contacts [18][19]. The UK Apple App Store rates it 16+. The linked development report and app listing do not establish whether it reduces self-harm.

The Charlie Waller Trust's "Coping with self harm: a guide for parents and carers" is free to download and was developed from conversations with parents and carers [20]. The University of Oxford's "Self-harm: parents' experiences" website shares interviews with 39 people across the UK, mostly parents, covering finding out, getting help, family life and recovery. It was last updated in 2017 [21].