Self-Harm Awareness: How Care Staff and Foster Carers Can Respond Safely
Self-harm awareness helps care staff and foster carers notice when someone is struggling, respond calmly and without judgement, deal with any injuries safely and make sure the right support follows. The first response a person receives can shape whether they ask for help again.
Self-harm is usually a way of coping with feelings that seem overwhelming. It is a sign that someone needs support, not a behaviour to be punished.
This guide covers what self-harm is, the warning signs, how to respond in the moment and the support available in Wales.
Please note: This article provides general information, not clinical or case-specific advice. Follow the person's care, placement or safety plan, your organisation's procedures and advice from health professionals. If someone is seriously injured or has taken an overdose, call 999. The scenario is a fictional learning example.
What is self-harm?
The NICE guideline on self-harm defines it as intentional self-poisoning or self-injury, whatever the apparent purpose. That includes taking more medication than prescribed or swallowing harmful substances, not just injuries to the skin.
People self-harm for many reasons, including trauma, abuse, bullying, loss, relationship difficulties and the stress of being in care. NICE stresses that each person's reasons are their own and may change from one episode to the next.
Self-harm is not always linked to wanting to die, but people who self-harm are at higher risk of suicide. Every episode should be taken seriously.
Warning signs
Many people hide self-harm, so signs can be subtle. Look for changes and patterns:
- Unexplained cuts, burns, bruises or marks, often on arms, legs or the stomach
- Wearing long sleeves or covering up, even in warm weather
- Avoiding activities that involve changing clothes, such as swimming
- Medication, sharp items or other objects going missing
- Spending long periods alone in the bathroom or bedroom
- Withdrawal, low mood, changes in sleep or eating, or talk of feeling worthless
- Searching for or sharing self-harm content online
How to respond
1. Stay calm
Shock, anger or panic can increase shame and make the person less likely to talk. Take a breath and keep your voice steady.
2. Deal with injuries first
Give first aid in line with your training. Call 999 for serious injuries. Any suspected overdose or swallowed substance needs urgent medical advice, even if the person seems well, because some effects are delayed.
3. Listen without judgement
Let them talk at their own pace. Use their words, show you are not shocked and avoid asking for detail about how they hurt themselves. Do not demand that they stop or make them promise never to do it again.
4. Ask about suicide if you are worried
It is safe to ask directly whether someone is thinking about ending their life. Asking does not put the idea in their head, and it gives them permission to tell you. If they say yes, stay with them and get urgent help.
5. Be honest about confidentiality
Do not promise to keep it secret. Explain who you need to tell and why, and involve them in what happens next where you can.
6. Report and record
Follow your safeguarding procedure. In a children's home, tell the manager on duty and the child's social worker. Foster carers should tell their supervising social worker. Record what you saw, what was said and what you did.
7. Review the support plan
The person's safety plan, care plan and environment may need reviewing with professionals. Our guide to ligature risk management covers environmental safety in more detail.
8. Look after yourself
Supporting someone who self-harms can be distressing. Ask for a debrief, use supervision and talk to someone you trust.
What to avoid
Some well-meant responses can make things worse:
- Calling it “attention seeking” or treating it as bad behaviour
- Sanctions, lost privileges or consequences linked to self-harm
- Examining injuries in front of other people
- Blanket bans or room searches that are not part of an agreed, individual plan
- Leaving the person alone straight after a disclosure without a plan
Decisions to restrict items or search rooms should be individual, proportionate and reviewed. Our guides to room searches in children's homes and restrictive practices in Wales explain how to keep these decisions fair and lawful.
What Welsh guidance expects
NICE's guidance applies to staff in all sectors, including social care and education, and calls for compassionate, non-judgemental care with no place for punitive approaches.
In Wales, the Welsh Government's suicide and self-harm prevention strategy, Understanding, was published in April 2025. In March 2026, it published the Integrated Quality Statement for Self-Harm, which sets out the standard of care people who self-harm should expect wherever they seek help.
Example: a foster carer notices marks
The situation: A foster carer notices that a 14-year-old in her care has started wearing long sleeves all the time. While loading the washing machine, she sees fresh marks on the young person's forearm.
A useful response: Later, in a quiet moment, she says: “I noticed some marks on your arm. I'm not cross with you. I'm here to listen and I want to help you get the right support.”
She checks whether the injuries need medical attention, listens without pushing for detail and explains that she needs to tell her supervising social worker. She records the conversation and asks for a meeting to agree a safety plan with the young person and professionals.
Where to get support in Wales
- Emergency: call 999 if someone is seriously injured or in immediate danger
- NHS 111 press 2: urgent mental health support for all ages, 24 hours a day
- Meic: helpline for children and young people up to 25, 8am to midnight, on 080880 23456
- CALL Mental Health Helpline for Wales: 24-hour listening line on 0800 132 737
- Samaritans: free, 24 hours a day, on 116 123
Frequently asked questions
Is self-harm always a suicide attempt?
No. Many people self-harm to cope with distress, not to end their life. However, self-harm increases the risk of suicide, so it should always be taken seriously.
Should we take away anything someone could use to self-harm?
Not automatically. Restrictions should be based on an individual risk assessment, agreed with professionals and reviewed regularly. Blanket removal can increase distress and drive self-harm out of sight.
Who should I tell?
Follow your safeguarding procedure. For a looked-after child, that normally includes the manager or supervising social worker and the child's social worker.
What should self-harm awareness training cover?
Why people self-harm, the warning signs, how to talk about it, first response and first aid, safety planning, ligature risks and support for staff.
Help your team respond with compassion
A calm, informed response can make the difference between someone hiding their distress and someone accepting help. Training gives staff and carers the confidence to have these conversations.
SLC Training delivers Self-Harm & Ligature Awareness training for children's homes, foster care and adult care services across South Wales. Contact SLC Training to discuss training for your team.