This paper provides feedback from research with staff who work with people who self-harm in a medium secure learning disability service in the north-west of England. It outlines some of the experiences described by staff, as well as personal and organizational responses to incidents of self-harm; explanations that staff use to understand the behaviour; and recommendations for change to treatment models and the staff support system. The information was gained using in-depth interviews, within a participatory research framework. Staff reported experiencing powerful emotional responses to incidents of self-harm, ranging from feelings of anger to feelings of inadequacy and guilt. A number of explanatory models were used by participants to understand the behaviour, and these were generally carefully considered and related to the client's individual situation. The staff/client relationship was often reported as being very rewarding but sometimes staff felt the client was manipulating them. This raised issues about the balance between client autonomy and risk, which was a concern for all staff. When discussing support needs, participants commented that there should be more training that they are able to use in practice, and that more support is needed in the form of discussion groups with colleagues. The findings from this study may be relevant to similar residential facilities.