Urgent help · A path through, question by question
You Have Found a Self-Harm Injury
Look at the injury before you say anything about it. The conversation can wait a minute.
You have found a cut, a burn or a mark, or your child has shown you one. The injury comes first and the conversation second. Work through these questions in order; the first four are about tonight’s safety, and take about a minute. If they are away from home now, at school, a friend’s or their other parent’s, and have told you by phone or message, keep your child on the line and have someone with you ring the adult in charge there. If you are alone, tell your child you are ringing that adult and ringing straight back. Either way, stay on with them until an adult there is with them. If they have taken anything, are bleeding and it will not stop, have had anything round their neck, are slurring or drowsy, or you cannot reach an adult there, call 999 yourself and say where they are. This page is written for a parent in the same house.
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Question 1 Right now, are they awake, talking and breathing normally?
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Do this now
They have collapsed, cannot be roused, are drifting or slurring, are struggling to breathe, or are having a fit; or you are not sure
Call 999 now and do not drive them. Put the phone on speaker. If anything is round their neck, get it off while you talk: loosen it or cut it. Say what they have taken or done as soon as the handler answers. Look at their breathing and tell the handler what you see; they will say what to do next, including whether to turn them onto their side or start chest compressions. Stay with them.
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Awake, talking, breathing normally
Then question 2: Have they taken anything, or might they have?
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Question 2 Have they taken anything, or might they have?
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Do this now
Yes, you are not sure, or they have been drinking
Call 999 or go to A&E now, even if they seem completely well, and whatever they have taken, ordinary painkillers included. Some things do their harm hours or days later. Take the packet or the bottle, and if they are sick, keep some of it. Do not try to make them sick, and do not give them anything to eat or drink. Do not let them sleep it off.
If they become drowsy or hard to wake on the way, pull over and call 999. If you cannot get them there, or they will not go, call 999 and say so. Any injury will be looked at there too. Before you leave, ask for the mental-health assessment; they should offer it. If they keep your child in overnight for it, that is normal, not a sign it is worse.
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No
Then question 3: Is there anything round their neck, or any mark on it?
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Question 3 Is there anything round their neck, or any mark on it?
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Do this now
Something is round their neck now
Call 999 now, even if they are awake and talking and there is little to see. Put the phone on speaker, and loosen or cut away whatever is round their neck while you speak. Injury inside the neck can show hours later. Do not drive them. Stay with them.
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Do this now
A line or band of bruising, finger marks, or they say something was round their neck earlier; or their voice has changed, it hurts to swallow, or their breathing sounds different
Call 999, even if they seem completely well. Injury inside the neck can show hours later, and you cannot see it from the outside. Do not drive them. Stay with them.
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No
Then question 4: How bad is the injury? Ask to see it, or, if it is somewhere private, ask them: is it still bleeding, and how deep?
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Question 4 How bad is the injury? Ask to see it, or, if it is somewhere private, ask them: is it still bleeding, and how deep?
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Do this now
Blood that spurts, bleeding you cannot stop, a wound that is deep or very large, something still in it, numbness or loss of movement below it; or they are pale, cold or clammy, breathing fast and shallow, or feeling faint, sick or confused, whether or not the bleeding has slowed
Call 999 now and do not drive them. Put the phone on speaker and do exactly what the handler tells you. While you talk, press hard on the wound with a clean cloth or your hand, and keep pressing; do not lift it to look. If something is in the wound, do not pull it out; press either side of it. If they feel faint, lie them down and raise their legs. Do not give them anything to eat or drink. Stay with them.
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A cut that gapes open when they relax, is longer than about five centimetres, is on their face or palm or across a joint, shows anything pale or yellow under the skin, or is still bleeding after ten minutes of firm pressure
It needs closing tonight, not in the morning; a wound closes best within hours. Go to A&E. Press on it with a clean cloth on the way. If it starts to spurt, will not stop, or they go pale, clammy or faint, call 999. If they are 16 or over and will not go, you cannot make them: keep pressure on it and take them first thing. Anything taken, anything round the neck, or getting worse is 999 whatever they say.
Then question 5: Now the conversation. What is happening?
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A burn
Hold it under cool running water for twenty minutes, even if it happened a while ago. Take off anything tight or near it, unless it is stuck. Then lay cling film loosely over it. No plasters, creams or ice, and do not burst blisters. Go to A&E tonight if it is bigger than their palm, if the skin is white, waxy or charred, if it is on their face, hands, genitals or over a joint, or if it was not heat: a chemical, electricity or extreme cold. Otherwise leave the cling film on and ring the GP surgery in the morning.
Then question 5: Now the conversation. What is happening?
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A cut that looks infected: red, swollen, hot, weeping, or getting more painful
Ring the GP surgery in the morning. If the redness is spreading, there are red lines running from it, or they are feverish or unwell, go to A&E tonight.
Then question 5: Now the conversation. What is happening?
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Old marks, scabbed or healed, and nothing open
Nothing to do for the skin tonight.
Then question 5: Now the conversation. What is happening?
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A cut that has stopped bleeding and does not need closing; or they will not show you but say it has stopped
Clean it under running water, pat it dry, cover it, and leave the rest for now. If they will not let you see it or press on it, and they say it is still bleeding or gapes open, or will not answer, go to A&E as though it needs closing. Otherwise look again in the morning, and if it looks worse, or red, hot or weeping, ring the GP surgery.
Then question 5: Now the conversation. What is happening?
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Question 5 Now the conversation. What is happening?
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They are talking, or willing to be in the room with you
Say less than you want to. “I found this. You’re not in trouble. I’m glad I know.” Then stop. Do not ask why, not yet: the answer is usually “I don’t know”, and the question lands as an accusation. Do not ask for a promise never to do it again. It is a promise they cannot keep, and breaking it is what makes the next mark harder to show you. Sit down. Stay longer than feels natural. Before you leave the room, ask once, plainly: “Are you thinking about suicide?” Asking does not put the idea there. If the answer is yes, or a shrug, or you are frightened, go to the answer below, They have said they want to die.
Then question 6: Who is keeping them safe tonight?
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They are angry, silent, or have shut the door
Do not force the door or the conversation. Say, through it if you must, “I’m not going anywhere. I’ll be here when you want me.” Then be there. If you cannot get an answer from them, or you hear something that frightens you, go in. Look in every so often without making it a patrol. Anger is not a no, and silence is not an answer. When you do get in, ask one question, once: “Are you thinking about suicide?” If the answer is yes, or a shrug, or you cannot get in and you are frightened, go to the answer below, They have said they want to die.
Then question 6: Who is keeping them safe tonight?
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They have said they want to die, or to be with someone who has died; they have what they would use in front of them; or they answered yes, or with a shrug, when you asked about suicide
If they are in immediate danger, call 999 now. If you have not yet asked, ask plainly: “Are you thinking about suicide?” Asking does not put the idea there. Do not leave them alone tonight, and ring now. England, Scotland and Wales: call 111 and choose the mental-health option. Northern Ireland: call Lifeline on 0808 808 8000. Help is free, confidential and available at any hour. Whoever answers may share information to arrange care or keep someone safe. The page Asking Your Child About Suicide takes you through the rest of that conversation, question by question.
Then question 6: Who is keeping them safe tonight?
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Question 6 Who is keeping them safe tonight?
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I can, or another adult can share the night
Close enough to hear is enough; you do not have to stay awake watching them. If they have said they want to die, had what they would use in front of them, or you are worried about tonight, that means the same room, or their door open and you awake until they are asleep. Then the medicines, ordinary painkillers included, and whatever they used: out of the house, locked away, or handed to another adult, done while they are with you rather than as a search behind their back. Tell them what you are doing and why.
If you are at A&E, ask for the mental-health assessment before you leave; they should offer it. If you came home without one, ask the GP for it.
In the morning, ring the GP surgery, ask for an appointment this week, and say what you found. Tell any counsellor or CAMHS team they already see. Tell their school or college too, and ask for whoever leads on safeguarding; every school has one, whatever the title. Tell your child you are doing it. If they board, ring the school before they go back; there is someone on call tonight. The aim in the days after is not that it never happens again. It is that next time, they show you sooner.
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There is nobody else, or I cannot keep this safe on my own
Ring tonight. England, Scotland and Wales: call 111 and choose the mental-health option. Northern Ireland: call Lifeline on 0808 808 8000. Say that you are on your own with them and cannot keep them safe until morning. That is the sentence that gets you help. Help is free, confidential and available at any hour. Whoever answers may share information to arrange care or keep someone safe. If you cannot get through, ring the GP surgery and follow the out-of-hours message. Do not leave them alone overnight. If you cannot keep them safe while you wait, call 999. Needing help with this is not a failure. It is what these lines are for.
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If you rang tonight, you were right to. If you did not need to, then looking properly, saying less and staying near was the whole of what tonight asked. Tomorrow is the GP and the school.