These acts can stem from increasing self-hatred and depression, unresolved anger, aggression and powerlessness, causing tension and loss of control. Mutilation relieves the tension and allows some control to be regained over the emotions. Feelings of guilt and worthlessness follow, further lowering self-esteem. Working with these young people requires the establishment of trust, the recognition of feelings which are present, and the identification of alternative methods for coping with these feelings and thus achieving positive release. Intentional and unintentional overdose is common.
Harm minimisation works through advice on safer drug and needle use, and needle exchange.
Support and encourage, but be realistic. Work with the young person's goals and expectations, recognising that unfortunately these may not be your own preferred goals for this person.