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Particularly if you and the self-injurer are both teenagers, you should encourage your friend to talk to his parents, a teacher, a school counsellor, or another trusted adult about their self-injury. Tell them that you will go with them if they are afraid to go by themselves.  Do not promise to keep this a secret. Keeping quiet enables your friend and gives him permission to keep injuring themselves.  Tell someone trustworthy yourself if necessary. Be honest with your friend and tell them whom you will be telling. Choose wisely and tell someone who will maintain confidentiality and act in a professional manner to get your friend the help they need.  Prepare for anger. Your friend might be ashamed or embarrassed and not want anyone to know. Let your friend know you care about them. You might be afraid of betraying your friend’s confidence and losing a friend, but your friend needs professional help and their health and safety is the most important factor. Most friends will understand your decision in time.  Do not give in to threats of further self-harm. Your friend may be angry and threaten to hurt themselves further if you say you want to tell someone about their behaviour. Remember that you are not to blame and the only person that has control over their injuries is the self-injurer themselves. While there is no specific diagnostic test for self-injury, you can encourage your friend to see a physician or mental health practitioner who can evaluate, diagnose, and create a treatment plan. Hospitalization may be required for severe, short-term crises. Some self-inflicted wounds may require medical treatment.  Extensive scarring may be able to be covered or reduced with cosmetic surgery. Counselling, or psychotherapy, can help your friend identify and manage underlying issues resulting in self-injuring behaviours. There are several types of therapy that can be helpful, such as:   Cognitive behavioural therapy. This helps identify negative beliefs and behaviours, and replace them with healthy, positive coping strategies. People create plans to better identify and react to their triggers, tolerate distress, and identify safe people and places to go to when they have the urge to self-injure   Psychodynamic psychotherapy. This focuses on identifying past experiences, traumatic memories, or interpersonal issues to get at the root of emotional problems  Mindfulness-based therapies.  These help individuals learn to live in the present and understand intentions, to reduce anxiety and depression, and improve general well-being  Family therapy. This is a group-based therapy which may be recommended in some cases, particularly for young individuals who self-injure Remember to treat your friend the same way that you did before you knew he was self-injuring.  Continue to spend time together doing things that you both like to do.  In addition to continuing to be a good friend, you may offer to:  Be an emergency contact if your friend has an urge to self-injure, or take them to medical appointments or clinics as necessary. Become an exercise buddy. Physical activity and relaxation techniques can help with anxiety, depression, and general wellness. Plus, you’ll have fun together. Encourage expansion of social networks. Many people who self-injure feel lonely, isolated, and disconnected. Anti-anxiety, anti-depressive, or anti-psychotic medication maybe prescribed by the physician or psychiatrist treating the person who self-injures.  Some people associate taking such medications with feelings of shame or failure.  This can be counteracted by your loving support; be sure to encourage your friend to stay on his medication and to embrace a more positive life after self-injury. You can spend a lot of energy on helping someone who self-harms. You may be worried, confused, shocked, conflicted, sad, and angered. These feelings are normal and can be draining.  Take time to be good to yourself and enjoy your hobbies. Get enough rest and exercise. See a counsellor to cope with your feelings, too. Remember you are not responsible for your friend’s actions. You cannot make your friend stop hurting themselves. You can only play a supporting role in their journey to healing.

Summary:
Don’t keep the secret. Get medical help for the self-injurer. Help your friend find emotional help. Be a source of support. Support your loved one in taking medications. Take care of yourself, too.