If you need immediate answers, please scroll down to the numbered list. If you're reading this for future reference, let's set you up with some background.
Self-harm can take on many forms. For people with mental illnesses (such as depression, anxiety, bipolar, etc.) it can start out with something as simple as self-self-depracating thoughts, which can transition into self-harm (like cutting), and/or transform into attempts at suicide. Whichever stage your friend is at, you're in the right place. It's important to note that just because someone self-harms, doesn't mean that they are necessarily attempting suicide. It's a case-by-case situation.
If you haven't been there yourself, I hope you never do. But it's pretty shocking looking at the statistics:
According to the American Foundation for Suicide Prevention, one out of every 25 suicide attempts ends in death.
Suicide is the second-leading cause of death among people aged 25 to 34 and the third-leading cause of death among people aged 15 to 24.
One in 10 college students has made a plan for suicide.
More males die by suicide than females (4.2 times more males than females), but more females attempt suicide than males.
Two-thirds of people that die by suicide are depressed at the time of their death.
Among those that have major depression, the risk of death by suicide is 20 times greater than those that are not depressed.
Treatment for depression is very effective; however, less than 25 percent of people with depression receive adequate care.
"But wait... these statistics are different from some other ones I've read."
There's another huge part of the problem: how can we get statistics on a silent disease? Oh how I wish depression was like a broken arm (it sounds weird but let me explain). When you have a broken arm, it's obvious. The problem is easily visible, the solutions are readily available and relatively standard, and nobody judges you for having an illness, because obviously you didn't mean to do it to yourself. That's one of the many problems with depression. Unless it's you, you have no way of knowing when a person has depression- and even when it is you, you still might not know. A lot of people don't recognize their depression for what it is until something life-altering happens to them; and by that time, we'd better hope it's not too late. This is also the common reasoning behind most self-inflicted wounds: it's a visible call for help to the world around you, and people can't say you aren't hurting because they can literally see it (which does not mean it's okay- I just want to help you understand instead of judge). Moreover, finding a solution once you recognize depression isn't easy, because it isn't "one-size-fits-all".
Even people who've recognized their depression for a while don't know this one: for some people the illness is psychological, but for others it's neurological- sometimes there wasn't some great trauma that caused it- it's just a natural chemical imbalance in your brain. Hence, why successful medication and/or therapy are unique combinations for every person. Lastly, when you finally do know you have a mental illness and make steps to alleviate the pain, a bunch of people judge you like you're completely insane and unstable 24/7 (fun fact: that's not true).
So, as you're hopefully starting to be able to tell, mental illness is a HUGE burden, that get's very difficult to carry. Instead of just dealing with life's bad days, you have to fight for your life every day- just to make it to those bad days. In case you can't tell, it SUCKS.
Thankfully, we have enough studies to know what helps alleviate this pain also. This is some awesome, life-changing stuff right here (literally):
Supportive family and social systems/networks
Solid problem-solving and conflict resolution skills
Ability to regulate emotions
Ability to cope
Positive view of the future
Access to mental health care
Cultural or religious beliefs that discourage suicide (which is true but I think the lamest reason- your religious beliefs damning you to hell shouldn't be the reason you don't commit suicide- it should be because you are in a better place mentally)
The Do's and Don'ts
Do be informed. This article is a good place to start learning- but continue doing research on your friend's specific illness- whether it be depression, suicidal thoughts, cutting, etc. This can first help you know what to look for in identifying it (like the consistent use of long-sleeve shirts in 90 degree weather- listen to your instincts. If a person constantly covers up their arms, legs, or torso at strange times to do so, pay attention). Knowing more helps you to be more empathetic- and allows you to pass on information to your friend that might be helpful in understanding their illness.
Do keep your emotions to yourself. It's okay to feel sad, disgusted, scared, maybe even a little mad when you find out a friend is or has been harming themselves. But those are feelings you need to talk about to a therapist or confidante. Telling your friend that their condition makes you feel a certain way might make them feel responsible for making you feel that way- adding more guilt to what they're already dealing with. Trust me, they have enough to deal with already. Don't judge. Don't shame. If anything, choose to be relieved that you finally might know, and if your friend has told you, be flattered. This is a huge stepping stone.
Do be ready to get shut down. Some people aren't ready to face the fact that this is a real problem: and while this shouldn't stop you from helping them, just anticipate that there might be denial or hostility involved. Keep in mind that it's not your friend talking- it's their illness. If they keep trying to change the subject, let them. But keep gently trying to get back to the main issue- if they just won't talk about it, give it some space (if possible). Just don't keep it a secret (and be honest about that if your friend asks you to). Tell another person you and/or that person trust- who can help with the situation further (like a therapist or counselor). It's a long process.
Don't put too much pressure on yourself. You cannot single-handedly fix the problem. Nobody can. It takes a team and a heck of a lot of work. But you can be the first person to do something and get that healing started.
Don't act like you know what they're going through- unless you have the same illness (and even then, everyone is different), so still don't. Saying things like "I know how you feel", "I feel like that too sometimes", "Things aren't that bad", "Don't be dramatic", etc. sound like you don't take your friend's pain seriously.
Don't join in. At young ages, self-harm can be something people use to become a part of a group. Trust me, it's not worth it. Don't let yourself or your friend buy into thinking that self-harm makes them cool, belong, strong, chic, rebellious, etc. Don't reinforce the behavior.
Don't deliver an ultimatum. Telling a friend something like "you have to choose this or me", or "if you don't stop, I'm leaving", only adds to their pain. Just be sure that your friend knows your love for them is unconditional- and you're there to help.
Don't threaten to take your friend to a therapist (psychologist, psychiatrist) or to the hospital. First of all, they'll lose trust in you. Second, it will make mental health professionals a punishment. It will make the person feel as though there is NO safe haven for them- bad idea. Unless your friend has already hurt themselves and is in grave danger, do not call 911. Even if the person just swallowed a bunch of pills, while they are still coherent, the ambulance cannot take them. This is due to the fact that some people will claim to have taken something in order to see what the response will be, or illicit a reaction without actually having done it. If you aren't sure, I'd probably recommend calling 911 just in case- the operator might be able to ask you questions to give them more insight.
"But what do I do when it's happening right now?"
If at all possible, get to your friend. Being physically present with them makes a huge difference in letting them know they aren't alone. If that's not possible, see if they'd be willing to video chat (i.e. Skype or FaceTime)- it's the next best thing. Here's the tricky part: a lot of people will say they don't want you there. It's a very complicated situation that I wouldn't trust to just anybody- but if you are aware, you've already made it to that point of closeness. I would always tell everyone NOT to come over. Sometimes it's because I wanted to be alone, sometimes it was because I wanted to see how much that person cared about me- a sick test to confirm how alone I was. Either way, be there. Even if it takes sitting outside their locked door talking to them, that person needs you- whether they know it or not. Depending on the person, they probably want you to come alone. That way it's more private and confidential, and it doesn't feel attacking or intervention-ey. Also, it lets them know that they are your priority at the moment- not someone else.
Ask questions to understand more about their situation. Are they just thinking about hurting themselves? Did they already hurt themselves? If so, how bad? Do they need medical attention? Right away, or can it wait? You need this information to be able to assess whether you need to call for help right away, or if it's something relatively minor that they wanted you to help with before it becomes worse. If the person has claimed they took pills, this is a good time to search the drug and find out what a harmful dosage would be. If they start acting exceptionally strange, call 911. Otherwise, if you aren't somewhere comfortable,
Take your friend to somewhere safe and comfortable. Try to get your friend to a private place where you can talk safely without the possibility of being overheard. Try to make the environment as friendly as possible.
Ask questions. See if you can find out what it was that brought this on. Was there some recent trauma that built upon an old problem? What's the full story? What was their childhood like? If they're having problems letting you in on the most private parts of their life, it might help to share some of your own to establish your genuine trustworthiness and let this person know that you trust them too. Don't compare your problems to theirs. Just share some of the intimate details of your life or trauma, to let that person know that you, too, are in a vulnerable place with them.
Listen to them actively. Sure, you know how to listen. But do you really? Listening actively means letting that person talk. Don't interrupt them. Let them take as long as they need to say what they need to say. Make eye contact, nod your head, use your body language to tell that person that you are truly interested in what they're saying. Keep all distractions to an absolute minimum. Use phrases like "So it sounds like what you're saying is..." and repeat back to that person what you understood, so they can clarify if you misunderstood
Set up solutions. Help your friend find ways to alleviate this pain both right now, and in the future. These should be based on all of the proven solutions we mentioned before:
Supportive family and social systems/networks. (Does this person have a supportive family? Is this a situation that might inspire them to become closer to their family? Are their friend groups stable? Do they have friends who genuinely care about them? If not, can they attend family counseling or can you introduce them to new people and/or new groups?)
Solid problem-solving and conflict resolution skills. (Do they have alternatives to self harm? What about exercise, DIY projects, meditation, yoga, art, music, reading, television, journaling, cooking, etc. What can they do to avoid this situation in the future?)
Ability to regulate emotions. (It's called DBT sometimes.... ride the wave below)
Ability to cope. (Find out what the triggers of this behavior are, so that they can be avoided in the future. Explore different options that can be used if this does occur again, such as exercise or meditation. Sometimes even setting up a codeword that your friend can text you can make it easier for them to let you know when they really need your presence. Everyone copes with things differently- maybe even luxurious bubble baths or a message might be an option!)
Positive view of the future. (Sit down with your friend and write out- on paper- their goals. Try thinking of life goals, ten year goals, five year goals, goals for this year, goals for each month, and how to work toward those goals every day. Keep your goals S.M.A.R.T. - specific, measurable, attainable, realistic, and timely. Then, is there something that person can look forward to? I.E. a trip, a reward for completing each goal, etc.).
Access to mental health care. (Have they ever considered seeing a psychologist and/or psychiatrist? Would medication help them manage the pain? What are the mental health services offered by their health plan? The research and finding someone is the hardest part- and they could probably use your help to get that started).
Cultural or religious beliefs that discourage suicide. (Do they have a religion to turn to? Have they ever been curious about exploring a religion? Or getting more involved with theirs? Would you be willing to explore or get involved with them?)
The Aftermath:
Take care of yourself.
It can be very emotionally exhausting to be in this situation. Take some time to relax, reevaluate your support systems and mental health, and maybe even see a therapist to detox.
Follow up.
Help your friend continue their journey toward self-help. Plan fun events with them, achieve your goals together, strengthen your friendships, and remind them often how loved they are by you and others.