If your teen is in immediate danger, has a serious injury, or talks about wanting to die, call or text 988 (988 Suicide & Crisis Lifeline), call 911, or go to the nearest ER. Stay with them if you can. 988 is free, confidential and open 24/7, and it says people do not have to be suicidal to call. It also has guidance on helping someone else.
Part of our guide: A Parent’s Guide to Child and Teen Mental Health
If there is no immediate danger, the next steps are to stay calm, talk with your teen without judgment, and arrange an evaluation with a mental health professional soon. Self-harm is a sign of real distress, and it deserves a real response even if your teen says it is nothing. Help is available, and this is no verdict on your parenting.
What self-harm usually means
Self-harm usually points to feelings that have become too much to carry. The American Academy of Child and Adolescent Psychiatry (AACAP) describes it as a complex behavior with several contributing factors, and says adolescents who have difficulty talking about their feelings may show emotional tension, physical discomfort, pain and low self-esteem this way. Peer influence can also play a part.
Teens do this for different reasons, and AACAP notes that some have suicidal thoughts. You cannot tell from the outside, so ask, and let a professional assess it.
Self-harm and suicide risk
Self-harm without intent to die is different from a suicide attempt, but the two are linked. A published review describes strong associations between them and cites research in which it predicted future attempts among adolescents with depression. This is why every instance deserves an evaluation, even if your teen says they were never trying to die. Most important, it is no reason to panic, and a calm response keeps the door open.
The first conversation
You may feel fear, anger, guilt or disbelief. Those reactions are understandable. If you need a few minutes to steady yourself first, take them, as long as your teen is safe.
What tends to help
- Pick a private, calm moment. Side-by-side settings, like a walk, can feel easier than a face-to-face talk.
- Lead with care. "I love you. I noticed this, and I'm not angry. I want to understand what's been so hard."
- Listen more than you speak. NIMH says listening without judgment is key to learning what a person is thinking and feeling.
- Ask directly about suicide. "Are you thinking about suicide?" NIMH reports that studies show asking does not increase suicidal thoughts or behavior.
- Tell them what happens next. "We're going to get someone who knows how to help, and you'll have a say in it."
What tends to backfire
- Calling it attention-seeking or dramatic.
- Asking them to describe in detail what they did. A clinician can assess that privately.
- Punishing them, or demanding a promise that it will never happen again. A promise can make it harder to tell you if it does.
- Telling them how much this is hurting you. Your feelings are real. Take them to another adult or your own support.
- Spreading the news. Decide together who really needs to know.
When it is an emergency, and when it is urgent
| What you see | What to do |
|---|---|
| Talk of wanting to die, a plan, an attempt, or an injury that may need medical care | Call or text 988, call 911, or go to the nearest ER. Do not leave your teen alone if you can avoid it. |
| Warning signs of suicide such as hopelessness, feeling like a burden, saying goodbye, or giving away important items | Treat this as urgent. Call or text 988 for guidance and contact a clinician right away. |
| Self-harm you have just learned about, no suicidal thoughts reported, and no injury needing care | Call your pediatrician or a mental health professional promptly and ask for an evaluation soon. |
AACAP says a young person with suicidal thoughts should be evaluated immediately by a trained mental health professional. Mind Body Seven is not an emergency service, so please use 988, 911 or an ER in a crisis.
Making home safer
NIMH says reducing access to highly lethal items or places can help prevent suicide, and AACAP lists access to firearms among suicide risk factors. Ask a clinician or a 988 counselor what to lock up or remove in your home, including firearms and medications. They can help you make a plan that fits your family. Present it to your teen as care, and keep it as low-key as you can.
Some families also write a short safety plan with a clinician. It may name early warning signs, things that help, people to contact, and crisis numbers. NIMH also suggests that teens save emergency numbers in their phones, along with a trusted friend or relative.
Getting an evaluation
AACAP says evaluation by a mental health professional may help identify and treat the underlying causes of self-injury. Depression, anxiety, trauma, substance use or bullying may be part of the picture, and treatment depends on what is found. You can begin with your pediatrician or go directly to a child and adolescent mental health clinician.
A clinician will usually want to talk with your teen alone for part of the visit. That privacy has limits around safety, which should be explained at the start. See what parents are told in teen therapy.
What treatment can look like
The clearest research finding so far is for dialectical behavior therapy for adolescents (DBT-A). A 2021 Cochrane review found a lower rate of repeated self-harm with DBT-A (30%) than with comparison care (43%) across four trials with 270 participants, and noted the trials were generally small and that further evaluation is warranted. It found no clear evidence that other approaches studied, such as family interventions or individual CBT-based therapy, prevent repeat self-harm, while saying the evidence for them is limited in quality and quantity. That is different from showing they do not help a particular teen, and other conditions may need their own treatment.
Those results come from DBT-A programs with more than one part. One major trial, for example, combined weekly individual therapy, a weekly multifamily skills group, 24/7 phone coaching and a therapist consultation team, and a 2025 review says DBT typically involves both individual therapy and group skills training. So the figures above cannot be assumed to apply to individual DBT alone. DBT programs differ, so ask any provider which parts they offer. At Mind Body Seven, DBT is individual only, with no DBT group or full DBT team. A clinician can talk through whether that fits your teen or whether a fuller program elsewhere makes more sense. For more on fit, read Is DBT right for my teen? If weekly therapy is not enough, see when a teen needs more than weekly therapy.
Medication is a separate decision that depends on the diagnosis. Antidepressants carry an FDA boxed warning for young people, explained in psychiatric medication for children.
Living with this over time
- Expect setbacks to be possible. A setback is a reason to call the clinician and is no proof that treatment has failed.
- Keep ordinary life going. Meals, routines and time together that has nothing to do with this all count. Your teen is more than this problem.
- Stay curious about feelings. A plain "how's today been, 1 to 10?" can work better than a heavy conversation.
- Follow up. NIMH says staying in touch after a crisis can make a difference.
- Get support for yourself. Your own therapist, a partner or a trusted friend gives you somewhere to put the fear. A family therapist can also help everyone talk more easily.
Other children at home may notice something is wrong. Offer a short, honest, age-appropriate explanation without details, and let them know they can come to you.
When you are ready, the child and adolescent psychiatry and therapy page explains how care for teens works here. You can request a consultation, and the intake team confirms fit, scheduling and costs.
FAQs
Does self-harm mean my teen wants to die?
Not always, but you cannot assume. AACAP notes that some teens who self-injure have suicidal thoughts. Ask directly and arrange a professional evaluation. If there is any suicidal talk or danger, call or text 988, call 911, or go to the nearest ER.
Is it my fault?
Self-harm has many contributing factors, and blame does not help you or your teen. Many caring parents find themselves in this position. What you do from here is what matters.
Should I tell the school?
That depends on what your teen needs in order to be safe and supported at school. Talk it through with your teen and clinician, and share only what school staff need to know.
Should I check my teen's phone or room?
There is no single right answer, and it depends on the level of risk. Ask the clinician to help you balance safety and trust, and be open with your teen about any checks you decide on.
