This section offers an overview of the project - highlighting that while everybody deserves access to safe and affirming care - both the broader literature and our work shows that when it comes to self-harm, this kind of care is almost always absent.

Offers an overview of the academic literature on experiences of and interventions for self-harm. Broadly, we found that there is complexity defining self-harm, and little conclusive evidence of the benefits of any one particular intervention.

Also outlines findings from our national consultation with various third sector groups - building the wider context in which the report sits. These groups highlighted gaps in service provision and training around self-harm, widespread misunderstandings, and structural barriers to the provision of good care for self-harm.

Outlines how we conducted the work - including who we spoke to and how. Overall, we spoke to 29 people over 3 months through a mixture of interviews, focus groups, and written testimony. Participants included people with experience of self-harm, carers, community leaders, third sector groups, commissioners, and teachers.

The majority of participants lived or worked in Torbay, but some were based in Devon more broadly. Once a first draft of the report was written, we held a workshop with participants who had experience of self-harm to help reflect on the findings and recommendations.

All participants were paid for their time and offered a debrief session with a therapist who had experience of self-harm, free of charge.

This section also notes the limitations of the work - particularly that we were unable to speak to people working in A&E and GPs. We also note that our work prioritises depth rather than breadth, and therefore the findings may not be widely generalisable.

Offers an overview of key findings.

First, we explore experiences of self-harm including who self-harms, the relationship to self-harm and suicide, and what “recovery “ meant to people. Overall, there was no ‘single’ experience of self-harm - it looked different to different people, definitions of ‘recovery’ varied, and the meanings people attributed to self-harm varied. Notably, the report troubles the linkage between self-harm and suicide - noting how for some self-harm can act as a helpful way of preventing thoughts or acts toward suicide.

We then explore people’s experiences of support - including from A&E, GPs, social prescribing, psychotherapy, third sector, and schools. Broadly, we found that almost all areas of care lacked training and support when caring for someone who had self-harmed, and that across the board services were stretched in terms of resources and staffing. There was no single service or intervention that people found most helpful. Instead, they focussed on the quality of care - namely, that which approached self-harm with curiosity, did not focus on cessation as the primary goal, and prioritised the needs and individual wants of an individual.

This section outlines the broader contexts and structures in which self-harm care arises, as described by our participants. Some of these were area specific, such as the geography of Torbay as a relatively isolated coastal location. Other factors were not location specific, including the impact of austerity on public service delivery, and the declining availability of broader community resources.

This section outlines seven key areas for change that may help public health teams, integrated care systems, and NHS services more broadly to improve their care around self-harm.

Each section includes an overview of the area, and options for what this may look like in practices. In some instances we also provide a case study.

Recommendations are offered with a broader understanding that while they may help to improve the lives of people who are self-harming, they are insufficient on their own to bring about widespread change that would interrupt systems creating distress in the first place.

The key areas for change are:

1. Widening peer support

2. Challenging attitudes and provision of training

3. Holistic and accessible support for young people

4. Joined up care

5. Community resources

6. A&E and aftercare

7. Community of practice

This section summarises the report - highlighting that self-harm care is impacted by systemic underfunding of mental health care more broadly, and widespread misunderstanding and misconception around self-harm.

We conclude by emphasising that what makes care “good” is not its form but instead its qualities - namely, non-stigmatising interactions focussed at supporting an individual’s whole experience (rather than just their self-harm), a sense of being listened to for their genuine needs, identity, values, and hopes for the future.

Supporters must have adequate training and resource to respond well to self-harm. This includes cultivating the ability of to see an individual who is self-harming as a person needing support rather than a ‘problem’ or as a ‘risk’.

We have found many gaps, absences, or failings in care. For those of us with experience of self-harm, little of this comes as new information. However, we have also found instances of care, tenderness, and possibility. We hope that by documenting the experiences of those we spoke to, we may help to bring about a world that those experiencing self-harm and their supporters deserve.