Pushed into secrecy: stigma and self-harm

5 May 2023 Nick Garbutt    Last updated: 5 May 2023

Pic: Isai Ramos, Unsplash

A troubling new report published by the Samaritans shows the terrible effects of stigma on those who self-harm.

An Open Secret: Self-harm and Stigma in Ireland and Northern Ireland demonstrates the extent to which stigma silences, shames and pushes those who self-harm into secrecy.

This is no wonder given that the same research also finds that the stigma can impact peoples’ ability to rent property, find jobs and even enter relationships.

The report is based on input from 769 adults from both jurisdictions in Ireland including people with lived experience, their loved ones or caregivers, healthcare professionals, and members of the public with no connection to the issue. These included  208 from Northern Ireland.

Ellen Finlay, the Samaritan’s Policy and Development Manager, said: “Our findings are staggering and reveal that society in general frequently inflicts stigma and its effect on those who self-harm is profound. Nobody should have to bear the stigma and discrimination outlined in this report.

Self-harm is complex and ill-defined. The Samaritans define it as: “any deliberate act of self-poisoning or self-injury carried out without suicidal intent.”

It can also be a way of releasing or coping with difficult emotions..

Many argue the definition should be broader still. One participant in the survey which underpins the Samaritans’ report describes it as “…entering knowingly dangerous scenarios with a disregard for your own safety…”

It is also not confined to particular age groups. An Open Secret shows people can start to self-harm as young as four-years-old, with others self-harming for over 50 years, showing that supports and coping mechanisms need to be aimed towards all age groups.

One professional reported: “People associate self-harm mostly with teenage girls cutting themselves. Anyone can be impacted by self-harm at any time. This stereotype and the stigma that people only self-harm for attention prevents people from recognising they need and deserve help.”

There’s also a wide variety in how long self-harm lasts. Some reported self-harming for a year or less, while others struggled with it for a lifetime. The majority of those who self-harmed reported their self-harming behaviours lasted an average of 13 years.

Compiling statistics on self-harm is difficult too. The National Self-Harm Registry (NSRF) suggest 1 in 500 people self-harm, while for specific demographics of individuals it may be up to 1 in 118. But it is difficult to be accurate. Statistics are based on those presenting to mental health service and Emergency Departments. Sadly, because of the stigma, many do not seek help.

The Samaritans report that callers who disclosed self-harm to them were often reluctant to talk to family or friends out of fear of judgement or negative reactions.

Yet regardless of how it is precisely defined self-harm is recognised as a significant public health concern and a leading risk factor for suicidal ideation and completion of suicide. However, it is important to understand that not everyone who self-harms wants to end their life.

Latest figures, which run to March 2020 for Northern Ireland, show 8,945 presentations to emergency departments for self-harm, involving 6,176 individuals.


Although what precisely constitutes self-harm might be unclear, the resulting stigma is there for all to see.

An especially troubling aspect of this is what appears to be a clear disconnect between participants’ willingness to help someone who self-harms and their actual behaviour, and the fact that so many people who self-harm believe others have a lower opinion of them.

As a result almost 85% of those who self-harm think others will have a lower opinion of them and whilst 76% of participants would be willing to ‘help’ someone who self-harmed, 63% would not carpool and 49% would not rent an apartment to them.

Good intentions need to be followed by supportive actions – when they are not the individuals affected will be aware of this which exacerbates the stigma

More troubling still is that whilst professionals believe they provide warm and understanding care to patients,  some individuals expressed the opposite view.

The survey shows around 40% of respondents felt unsure or knew they would be judged or stigmatised by their GP or other healthcare service and less than 50% of people believed they could talk to their partner, close family member, or friend.

One who had lived experience said: “I was sent to hospital after all overdoses… I wasn’t treated very well by some nurses. They were bi***** to me.”

Another summed up the experience as follows: “…I feel huge shame because of the stigma associated with self-harm.”

And another reported teasing, bullying and harassment because of her self-harm, which has at times impacted her recovery. The report added “She has sometimes avoided situations where she thinks she may be stigmatised, such as seeking mental health support.”

The stigmatisation of self-harm is clearly a matter of concern: it affects employers and potential employers, colleagues and friends even health professionals, the result is under-reporting of the issue, putting those who self-harm even further at risk.

The Samaritans have built excellent relations with the media and provide very useful guidance on how suicide and self-harm should be covered. The organisation can also answer specific questions about coverage at [email protected]

It has also has developed a list of actions it would like authorities to address. These include:

The Department of Health and the Public Health Agency should undertake a public education campaign to raise awareness to reduce the associated stigma of self-harm by promoting positive messages about mental health and providing accurate information about the causes and effects of self-harm as well as encouraging help-seeking behaviours.

Services for those who self-harm including, counselling and  therapy need to be available/enhanced;

Schools and universities should be equipped with the resources and knowledge to identify and address self-harm;

Mandatory training should be developed and delivered to all healthcare professionals, teaching staff and community workers. Including specific policies on how to respond to self-harm, and empower staff to engage in supportive, non-judgemental conversations;

Also important is for the authorities to prioritise the voices and experiences of those with lived experience of self-harm, so that a mental health system can be created which is more supportive, empathetic and effective for all.

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