Self-harm strategy and action plan: mid-term report

Our Learning So Far

In the first 18 months of strategy implementation - from 28 November 2023 to 28 May 2025 - we have learned a lot about self-harm, including more about who is impacted by self-harm and how best to support them. This learning has supported us in our implementation so far, for example through the introduction of the Provider Network, and increased training and tailoring work provided by SHNS. We have consolidated this learning into the reflection points outlined below. We will also use these reflections to guide and focus our approach so we can maximise the impact over the next 18 months of this Action Plan (outlined in the next section).

Challenges Across All Outcomes

Data

As discussed throughout the report, efforts to increase the availability and use of self-harm data have taken place within the context of longstanding data limitations. Current data systems make it difficult to establish a clear and comprehensive baseline for understanding the prevalence and frequency of self-harm, particularly across diverse groups and settings.

Furthermore, the strategy’s focus on improving support and reducing stigma may lead to increased help-seeking and disclosure of self-harm. While this is a positive development, it may also result in an apparent rise in recorded incidents, reflecting greater reporting rather than an actual increase in self-harm behaviours. Careful and nuanced interpretation of emerging data is therefore essential to differentiate between real changes in self-harm trends and improvements in identification, reporting, or service access.

Capacity and resourcing

Significant capacity and funding pressures within existing services have been raised as challenges to implementation by our groups and stakeholders. In recognition of these challenges, steps have been taken to provide greater funding certainty, including SHNS receiving 2 year funding through the Fairer Funding pilot, and in turn, being able to offer free awareness raising training to practitioners. However, it is acknowledged that local budgets remain extremely constrained, and capacity concerns persist across all delivery partners, including within the NHS and Local Authorities. This has the potential to limit the extent to which new self-harm resources can be accessed and implemented.

Complexity of systems

Supporting individuals who self-harm requires a whole-system approach, and the strategy’s design and governance reflect this understanding. However, the inherent complexity of the system—combined with capacity constraints—remains a persistent challenge. Coordinating efforts across sectors and levels of government demands ongoing commitment, adaptability, and collaboration to ensure the strategy is effectively embedded and sustained.

Outcome 1:

There is increased provision and uptake of resources, support and learning opportunities about self-harm for people communities and settings to help develop greater knowledge, awareness, and compassionate understanding of self-harm.

In the first 18 months of implementation, activity across the strategy has supported increased provision and uptake of self-harm resources, training, and learning opportunities, helping to build knowledge, awareness, and compassionate understanding across a wide range of communities and settings. Evaluation data shows clear gains in knowledge and confidence, with participants reporting improved understanding of the types and functions of self-harm, the stigma associated with self-harm, and increased ability to respond compassionately. This early activity has reinforced the importance of free, and accessible resources, and has highlighted communities’ and professionals’ strong appetite for practical tools and guidance.

Further work is also needed to better understand the potential impact that increased awareness-raising is having on reducing stigma and discrimination. Evidence from people with lived experience, See Me, and the Scottish Government’s Mental Health Analytical team, consistently highlight that stigma and discrimination remain a significant – and often the biggest – barrier to people receiving care and support for self-harm. Feedback has shown us that dedicated action on stigma must provide targeted and measurable interventions at structural, institutional, and individual levels. It is important also to recognise that stigma is complex, evolving, and deeply rooted, which requires a sustained and adaptive efforts.

Outcome 2:

Resources, support and learning opportunities are targeted and tailored to meet the needs of key professional groups and sectors.

Activity has supported the development and delivery of resources, support and learning opportunities tailored to the needs of key professional groups and sectors. This has included targeted resources for unscheduled and primary care, colleges and universities, and wellbeing materials for those supporting people who self-harm. Evaluation of this work, including the Loved Ones support groups and the Provider Network, shows strong engagement and positive outcomes, with participants feeling better equipped to support others and manage their own wellbeing.

Feedback has also highlighted the need for flexible, accessible training options that can be integrated into already stretched workloads, examples of this can be found in Self-Harm Network Scotland’s work with Scottish Prison Service, and BDA, creating bespoke trainings that work for their professionals.

To support continuous improvement of these trainings, SHNS will introduce follow up activity which will enable us to explore the factors that enable and support people to implement their learning and use the tools and resources they have gained. This will also help explore what factors create barriers or challenges that prevent or make it more difficult for people to apply their learning (while also exploring the extent to which learning has been applied and changes to practice made). Efforts will also be made to increase response rates to training evaluations. This insight will inform how we can better support participants in effectively applying the learning, tools and resources provided through SHNS.

We recognise the ongoing capacity challenges in relation to funding and staffing for many services. This underscores the importance of building capacity and resource within services where possible if we are to embed self-harm support meaningfully and sustainably.

Outcome 3:

More resources, support and learning opportunities are co-designed with people with lived experience and key partners, to ensure they meet the needs of marginalised communities and groups at higher risk of self-harm.

In the first 18 months of implementation, activity has supported the co-design of resources, support and learning opportunities with people with lived experience and key partners, ensuring they meet the needs of marginalised communities and groups at higher risk of self-harm. This work has included tailored engagement with deaf communities, young carers, veterans, people in recovery, and those in prison. Evaluation and feedback highlight the importance of taking time to build trust and relationships, and of adapting content to reflect the realities of people’s lives and contexts. This early activity has reinforced the value of co-production in developing inclusive, relevant, and accessible resources. The recruitment of SHNS Practice Development Officers will enable further collaboration with people with lived experience and community partners to enable us to reach those most at risk and ensure support is meaningful and effective.

Outcome 4:

Increased availability and promotion of bespoke self-harm support, including online and peer support.

Activity to support this outcome has increased the availability and promotion of bespoke self-harm support, including online and peer-led services. SHNS’s one-to-one peer support and live chat services have provided flexible, person-centred support to people affected by self-harm, offering compassionate, recovery-focused help beyond traditional service hours and approaches. Feedback from those using the services highlights the value of lived experience in building trust, reducing distress, and supporting self-understanding. However, we are aware of the need to continue to extend, and broaden the reach of self-harm supports. Ongoing efforts will focus on continuing to raise awareness and tackling stigma throughout the remainder of the strategy.

This activity has also demonstrates the importance of accessible, non-judgemental support options and the significant role of peer support in reducing stigma and promoting recovery. However, it is also important to recognise that ‘recovery’ is deeply personal and can have different meanings for different people. Peer support must remain grounded in person-centred, trauma-informed practice, supporting people where they are, on their own terms, and in ways that align with their individual needs and goals. Continued promotion, tackling stigma and investment in diverse support options will be key to reaching more people in ways that work for them.

Outcome 5:

More existing services and settings will offer and deliver effective, compassionate, and non-stigmatising self-harm support.

In the first 18 months of implementation, activity has supported progress towards promoting effective, compassionate, and non-stigmatising self-harm support within services. Awareness-raising and training linked to national self-harm guidelines have supported the embedding of compassionate approaches across key professional groups. This early activity has highlighted the importance of cross-sector collaboration, lived experience input, and clear, practical guidance based on robust evidence, to support frontline teams in delivering timely, non-judgemental care. Ongoing support and leadership will be needed to continue to embed these changes in routine practice.

Outcome 6:

Increased collaboration, sharing of best practice and learning to support continuous improvement in existing and new services.

In the first 18 months of implementation, activity has supported increased collaboration and sharing of best practice to drive continuous improvement in self-harm support. National networks such as the Provider Network and joint work with Suicide Prevention Scotland have created spaces for professionals to share learning, evidence, and lived experience insights across sectors. Thematic learning sessions and the development of shared evidence resources have helped to deepen understanding of key issues, including stigma and intersectional inequalities. This early activity has demonstrated the value of sustained collaboration, peer learning, and cross-policy engagement in strengthening responses to self-harm. Continued partnership working and shared learning will be essential to embed improvements and promote system-wide change.

Outcome 7:

Currently available data, data gaps and limitations on self-harm are identified and reviewed across a broad range of settings, including those where risks of self-harm may be highest.

In the first 18 months of implementation, activity has focused on building a clearer understanding of self-harm through improved data and research, recognising the complexity and diversity of self-harm experiences. This includes how, why, and where self-harm occurs, and how it intersects with wider issues such as stigma, inequality, and access to support. Public Health Scotland’s review of existing data sources and the development of a pilot Evidence and Gap Map for children and young people have helped identify key limitations and opportunities. Alongside this, qualitative research has deepened insight into the lived experience of self-harm. This work is actively informing future strategy priorities, particularly in how we shape and tailor services to be more person-centred, inclusive, and effective. Strengthening the use of data and evidence will remain important in supporting meaningful, compassionate responses.

Outcome 8:

Increased availability and promotion of emerging self-harm research.

In the first 18 months of implementation, activity has supported increased availability and promotion of emerging research to inform understanding of self-harm and improve responses. This includes work led by NHS Greater Glasgow and Clyde, which explored the complex relationship between self-harm and social media, examined CAMHS patient journeys, and assessed the health needs of young people who self-harm. These studies provide new insights into when and how people access support, the diversity of their needs, and the role of social media as both a risk and a potential source of support. Alongside this, national evidence reviews, and practitioner surveys have highlighted common barriers to accessing services such as, stigma and restrictive criteria, and identified enablers like person-centred, compassionate approaches. This early activity reinforces the importance of having accurate data to draw on and lived experience evidence to improve service design and ensure responses reflect the real-life contexts of those affected by self-harm.