Background: This paper details the experiences of nine people with mild/moderate intellectual disability who self injure; looking beyond the clinical presentations in an attempt to capture the perceptions these people have of their care in a medium secure unit. Methods: A phenomenological approach was used, and during in-depth interviews, the participants gave rich descriptions of their experiences of self-injury. Results: The analysis of the interviews revealed four main themes; coping strategies, staff and the organizational response--therapeutic communication, close observation and looking to the future. As a coping strategy, self-injury was seen as an effective means of reducing distress--there were unique and common reasons for this distress. Common themes relating to the actions and reactions of health professionals and the organizational response were evident within all accounts. Conclusions: The theoretical and clinical implications for service users are discussed.