Definitions of harm

Before going into further detail, it is important to understand what the different concepts related to this policy mean.

Self-harm

What is it?
Self-harm is intentional behavior that is considered harmful to oneself. This is most commonly regarded as direct injury of one's own skin tissues usually without a suicidal intention. Other terms such as cutting, self-injury, and self-mutilation have been used for any self-harming behavior regardless of suicidal intent. Although self-harm is by definition non-suicidal, it may still be life-threatening. People who do self-harm are more likely to die by suicide, and self-harm is found in 40–60% of suicides. Still, only a minority of those who self-harm are suicidal.

Why would it happen?

• The desire to self-harm is a common symptom of some personality disorders. People with other mental disorders may also self-harm, including those with depression, anxiety disorders, substance abuse, mood disorders, eating disorders, post-traumatic stress disorder, schizophrenia, dissociative disorders, and gender dysphoria.
• Studies also provide strong support for a self-punishment function, and modest evidence for anti-dissociation, interpersonal-influence, anti-suicide, sensation-seeking, and interpersonal boundaries functions. Self-harm can also occur in high-functioning individuals who have no underlying mental health diagnosis.
• The motivations for self-harm vary. Some use it as a coping mechanism to provide temporary relief of intense feelings such as anxiety, depression, stress, emotional numbness, or a sense of failure. Self-harm is often associated with a history of trauma, including emotional and sexual abuse.
• There are a number of different methods that can be used to treat self-harm, which concentrate on either treating the underlying causes or on treating the behavior itself. Other approaches involve avoidance techniques, which focus on keeping the individual occupied with other activities, or replacing the act of self-harm with safer methods that do not lead to permanent damage.

How to recognise symptoms?
If you know someone is self-harming, look out for signs, including:

• unexplained cuts, bruises or cigarette burns - usually on the wrists, arms, thighs and chest
• keeping themselves fully covered at all times, even in hot weather
• pulling out their hair
• misusing alcohol or drugs
• self-loathing and expressing a wish to punish themselves
• speaking about not wanting to go on and wishing to end it all
• becoming very withdrawn and not speaking to others
• changes in eating habits or being secretive about eating
• unusual weight loss or weight gain
• signs of low self-esteem, such as blaming themselves for any problems or thinking they're not good enough
• signs of depression, such as low mood, crying or a lack of motivation or interest in anything

Harm to others

What is it?
Mental illness can sometimes be associated with aggressive or violent behavior. But, when receiving effective treatment, people living with mental illness are no more violent or dangerous than the rest of population. Actually, they are more likely to harm themselves – or to be harmed – than they are to hurt other people.

Why would it happen?
Violence is not a symptom of psychotic illness. The relationship between mental illness and violence is complex. Research suggests there is little relationship between mental illness and violence when substance use is not involved. Psychotic illnesses such as schizophrenia can sometimes be associated with aggressive or violent behavior. People living with schizophrenia are no more violent or dangerous than the rest of the population, if they are:

• receiving effective treatment
• not misusing alcohol or drugs.

They are more likely to harm themselves than others. Other causes of violence/aggressive behaviors toward others can be behavioral disorders, such as antisocial personality disorder as well.

How to recognise symptoms?
There is a slightly increased possibility that someone living with a psychotic illness may be violent if they:

• are not receiving effective treatment
• have a previous history of violence
• misuse alcohol or other drugs
• are experiencing active psychotic symptoms (and are responding to hallucinations or delusions)
• are triggered by fear (for example, if they think they are in danger)
• are experiencing psychotic symptoms for the first time, or the experiences are unfamiliar.

People living with schizophrenia are more likely to express their aggression, agitation or frustration towards themselves, or to family and friends – rarely to strangers.

Suicide

What is it?
Suicide means ending your own life. It is sometimes a way for people to escape pain or suffering. When someone ends their own life, we say that they "died by suicide." A "suicide attempt" means that someone tried to end their life, but did not die.

Why would it happen?
Mental disorders (including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders), physical disorders (such as chronic fatigue syndrome), and substance abuse (including alcoholism and the use of and withdrawal from benzodiazepines) are risk factors. Some suicides are impulsive acts due to stress (such as from financial or academic difficulties), relationship problems (such as breakups or divorces), or harassment and bullying. Those who have previously attempted suicide are at a higher risk for future attempts. Also other challenges in life can be risk factors, such as prejudice or stigma, abuse, bereavement, housing problems, isolation, cultural pressure or other forms of trauma.

How to recognise symptoms?
Some people talk openly about thoughts of suicide, but many people keep their feelings secret. There are warning signs to show that someone needs help. You often see many warning signs happening at the same time. Here are some warning signs:

• The person talks about wanting to kill themselves.
• The person uses more drugs or alcohol than usual.
• The person says they have no reason to live.
• The person seems very scared or worried.
• The person says that they feel like there is no way out of a situation.
• The person cannot see hope for the future.
• The person does not want to spend time with others.
• The person has a hard time controlling their anger.
• The person does things that may be dangerous and does not think about what might happen.
• The person’s mood changes in a big way.

**Important: **Most people avoid questioning about suicidal ideation because of the false believe that it can increase the behavior, however, it’s just the opposite. It is good to ask, and research does not suggest it may increase the suicidal thoughts. More about how and when to ask can be read here.