R U OK? Day is for starting conversations about mental health, but what do you do if someone says "No"? Here are some tips to help you have those difficult conversations about depression or suicide.

Mental health: How to talk about it with someone who needs help

Warning: Sensitive content

Laila’s arms are beautiful.

They are covered in tattoos — flowers, cherry blossom branches, bees, birds, a realistic baby pig and a calf too. High on her left arm, written in cursive it says: Cruelty Free.

And in this moment, those words seem to have a double meaning.

Underneath the images on the 27-year-old’s skin lies something much darker. From the age of 12 until 19 Laila self-harmed. The intricate tattoos cover those scars.

“I was suffering so much emotionally with things that were going on at home, I just picked up an implement and … that’s kind of how it started”, she recalls.

“I was hurting inside and it’s just what came to my mind to do to feel better.”

“My parents were fighting a lot,” Laila continues, “it was mostly shouting, but a lot of things getting broken, doors slamming. Sometimes it would get so violent the police would come.

“Me and my siblings didn’t feel like we had any control over that. It was just happening around us and it was almost every night. It was very hard.”

At high school, things got worse for Laila. She was bullied by her classmates.

“And then I got depression and it (the self-harm) just sort of spiralled,” she says, “I did it for seven years consecutively. And it was almost every day. I couldn’t wait for the day to be over so I could go home and do it.

“Self-harm is an addiction. Because it felt so relieving, I was addicted to feeling that comfort and escaping my reality,” Laila reflects.

Research from Orygen, the National Centre of Excellence in Youth Mental Health, shows 24.4 per cent of young women and 18.1 per cent of young men aged 20-24 have self-injured in their lifetime. (And despite being a significant predictor of future suicide, it’s a highly stigmatised behaviour.)

For a year — between the ages of 18 and 19 — Laila stopped self-harming: “I was so proud of myself, but then something happened when I was 19 and I cut myself the worst that I ever had and I ended up in emergency.”

That “something” was a terrible breakup. She was full of hurt and guilt and explains that even though she’d been working on strategies to overcome the urge to self-harm, it was almost like “a reflex” when things went wrong. Her darkness was so profound that Laila recollects: “I wasn’t trying to kill myself, but I didn’t care either.”

Today — in 2019 — Laila’s life couldn’t be more different. She’s the smiling and happily-married mother of a gorgeous 17-month-old daughter; she hasn’t self-harmed for eight years.

One of the pivotal moments in her journey towards a better life was when she decided to get the scars on her right arm covered in tattoos in 2011.

“The cherry blossoms represent new life and new beginnings. So, to me, it’s like, ‘This is my new chapter’,” she says.

“I’ve never harmed myself again since I got this.”

Until recently Laila’s left arm — which was far more badly scarred — remained un-inked. In public, the way she was treated by others because of those marks could be especially confronting.

“I have seen parents staring, which obviously makes you uncomfortable because I just want to scream, ‘Hey, I’m a good parent!’” Laila tells me.

A few months ago Laila, who is passionate about animal rights, finally got her left arm covered in tattoos too. (Hence the “Cruelty Free” moniker.) It wasn’t a straightforward task, though. Deeper, rougher scars are harder to cover in ink — and some artists won’t work on that type of skin.

To undertake this tricky task, Laila turned to George and Jan Theodosiou, from Armani Artspace in Canberra. The husband and wife team are passionate about assisting clients who have previously self-harmed.

“We prefer disguising scars of all types with stippling or dot-style artwork (because) the dots take to the scar tissue more effectively than solid lines and shading do,” George explains. “With stippling, the dispersal of the ink over the two different skin surfaces isn’t as noticeable.”

George says with scar camouflage, tattooists aren’t trying to get rid of the damaged skin but rather draw the eye to the artwork. While he acknowledges that not everyone who has self-harmed will want their scars covered up, George wants people to be aware it’s an option. “(You) don’t have to live with this,” he says.

When it comes to tattooing, Jan’s speciality is dot work. Over a number of months, she tattooed the animals and flowers on Laila’s left arm.

“When you’ve got a visual of your pain, like a self-harm scar on your skin and you’re so afraid of being judged and you’ve suffered so much but you’ve moved past that and you want to have a fresh start, it’s very hard,” Jan says. “I felt exceptionally honoured that she trusted me to do this for her and to make this change.”

Jan says that in the process of tattooing Laila and the long hours they spent together, Laila explained she was anxious to go on play dates with her daughter because of the way she could be judged by the other parents. Once both her arms were covered in ink, the young mum was no longer afraid.

This is so profound that suddenly, all of three of us are crying — myself, Jan and Laila. (George is marginally holding it together.)

“People are so damn cliquey,” Jan says, “That just grabbed my heart when Laila told me that.”

For Laila, her metamorphosis was complete. Instead of judging her self-harm scars, strangers now see her tattoos and are curious about them.

“I can’t explain how life-changing it is to be able to wear a T-shirt on a hot day in front of people that you don’t know,” she says, “It is almost like armour because it’s protecting me from other people’s thoughts.”

Laila urges anyone struggling with self-harm to reach out for help.

“Finding somebody to open up to is difficult, and often when we’re battling self-harm and mental illness we either don’t think to ask for help or simply don’t want to,” she says. “But it’s a big step towards recovery, and a brighter future is possible.”

Laila is certainly proof of this.

If you or someone you love needs help or support for self-harm, use these numbers below. In an emergency, call triple-0.

Kids Helpline — (24 hours) for young people aged 5 to 25 years 1800 55 1800.

Headspace — (8am until 1am) 1800 650 890 or online chat.

SANE Helpline — mental illness information, support and referral 1800 18 SANE (7263)

Lifeline — 24 hours 13 11 14

Reach Out — Interactive website to help young people www.reachout.com.

Ginger Gorman is an award-winning journalist. Continue the conversation @GingerGorman