People who self-harm: rapid evidence review and survey of practitioner perspectives

Executive Summary

Background and Purpose

Self-harm is a complex behaviour affecting people across all ages and backgrounds. While not a mental health diagnosis itself, it often signals emotional distress and is particularly prevalent among young people, women, and marginalised groups. Many individuals do not seek support due to stigma, discrimination, and previous negative experiences with services. Understanding the barriers and facilitators for people who self-harm when accessing support is vital to improving service responses.

This report supports the Scottish Government and COSLA’s Self-Harm Strategy and Action Plan by investigating if self-harm acts as a barrier to accessing support and services, and what measures can be taken to overcome these barriers.

Methodology

This research included a rapid evidence review and a survey of practitioners who support people who self-harm. The rapid evidence review included UK- and Ireland-based studies between 2014 and 2024 to examine barriers and facilitators to accessing and engaging with self-harm support. The survey explored practitioner perspectives of the types of barriers faced by people who self-harm when seeking help across a range of services, the implications of these barriers, service-level factors contributing to access issues, and potential solutions to improve access and engagement. The full survey is available in the appendix.

Key Findings

Rapid evidence review

The rapid evidence review included 27 UK and Ireland-based studies published between 2014 and 2024. The studies included were predominantly qualitative, exploring lived experiences of accessing self-harm support. Most studies focused on adolescents and young adults, with women more frequently represented. Research settings mainly included primary care and emergency departments, with additional insights from schools, prisons, and community services.

Findings indicate that people who self-harm face multiple, intersecting barriers to accessing support through individual barriers relating to personal and social factors within or close to the individual that influence their willingness or ability to seek help, and services barriers relating to interactions with services:

• Individual barriers include fear of judgment from close relations and healthcare professionals, self-stigma, and confidentiality concerns, leading to reluctance to disclose self-harm.
• Service barriers include negative reactions and experiences of stigma from healthcare professionals, rigid eligibility criteria that leave individuals “between services,” long waiting times, and fragmented care pathways, and a lack of personalised, accessible services that further hinder engagement.

The review also identified key facilitators to accessing support. Support from peers and personal networks, such as encouragement from friends or involvement in organised peer groups, can help individuals take the first steps toward seeking professional help. Trusting relationships with professionals, characterised by empathy, active listening, and personalised care planning, enhance engagement, while system-level factors like reduced waiting times and longer appointments improve timely access to support.

While the rapid evidence review included studies from countries outside Scotland, with varying types and levels of service provision, and incorporated research conducted before the implementation of Scotland’s Self-Harm Strategy and Action Plan, the findings still offer valuable insights which can be applied to work to progress self-harm awareness, support and care across Scotland.

Survey of practitioner perspectives

The survey received 478 responses. The most common role among survey respondents was nurse, at just over one third of respondents, followed by clinical/NHS staff, support workers, doctors, social workers, service managers, and police officers. While the survey did not engage directly with service users or individuals with lived experience of self-harm, a broad range of practitioners completed the survey, from a variety of professional roles.

Almost three-quarters of respondents reported working with adults aged 18–64, while just over half supported children under 18. Other groups included care-experienced children and young people, older adults (65+), neurodiverse individuals, people with disabilities, and LGBTQ+ individuals.

Overall, almost three-quarters of practitioners agreed that the people they support who self-harm experience barriers when accessing support or services. Key findings include:

Services where practitioners reported access barriers: mental health services, out of hours care, physical healthcare services, addiction services, accessing education, emergency services, housing support, employment support, financial support, and educational support.

Practitioners reported the following as the most common individual, service, and structural barriers:

• Individual barriers: fear of stigma, discrimination, or judgement from service providers, self-stigma and family/cultural barriers.
• Service barriers: long waiting times, negative past experiences of accessing support, and an inadequate availability of specialised services.
• Structural barriers: Financial barriers (such as cost of accessing service or cost of transport), lack of transport to attend appointments and digital barriers (such as being unable to interact with online services due to lack of access to technology).

Nearly all respondents identified potential solutions in an open-ended survey question. Common suggestions included improving practitioner training, increasing awareness and understanding of self-harm, and providing more funding and resources for services.

Other themes included expanding access to specialist support (e.g. through GPs or schools), improving service accessibility (e.g. extended hours, flexible formats), and clearer signposting. Respondents also highlighted the need for person-centred, trauma-informed care; co-produced care plans; harm reduction approaches; and early intervention. Additional suggestions to overcome barriers to support and services included reducing stigma (both within services and in wider society); less restrictive eligibility criteria to access services; and clearer and faster referral process between services.

Conclusion

This research explored how self-harm may act as a barrier to accessing support and services and identified potential ways to address these challenges. Both the evidence review and practitioner survey revealed a range of barriers, including stigma, fear of judgment, restrictive service eligibility criteria, and long waits for support. Crucially, the findings show that these barriers extend beyond mental health care, affecting access to a wide range of services such as housing, education, and financial support.

Despite these challenges, the research also identified a number of facilitators that can improve access and engagement. These include person-centred, trauma-informed approaches, compassionate practitioner responses, and more flexible and inclusive service criteria. Taken together, these findings offer insight into self-harm support and service delivery in Scotland, and contribute to progressing the aims of the Self-Harm Strategy and Action Plan.