Self-harm

Short Text

This pathway covers the assessment, and the short- and longer-term management of self-harm.

Introduction

This pathway covers the assessment and physical and psychological management of self-harm in primary and secondary care.
The term self-harm is used in this pathway to refer to any act of self-poisoning or self-injury carried out by an individual irrespective of motivation. It does not include harm to the self arising from excessive consumption of alcohol or recreational drugs, or from starvation arising from anorexia nervosa, or accidental harm to oneself.
Self-harm is common, especially among younger people, and is associated with a wide range of psychiatric problems. For all age groups, annual prevalence is approximately 0.5%. Self-harm increases the likelihood that the person will eventually die by suicide by between 50- and 100-fold above the rest of the population in a 12-month period.
Self-harm is often managed in secondary care – this includes hospital medical care and mental health services. About half of the people who present to an emergency department after an incident of self-harm are assessed by a mental health professional.
People who self-harm also have contact with primary care. About half of the people who attend an emergency department after an incident of self-harm will have visited their GP in the previous month. A similar proportion will visit their GP within 2 months of attending an emergency department after an incident of self-harm.
The pathway is relevant to all people aged 8 years and older who self-harm.

Source guidance

The NICE guidance that was used to create the pathway.
Self-harm: longer-term management. NICE clinical guideline 133 (2011)
Self-harm: the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. NICE clinical guideline 16 (2004)

Quality standards

Quality statements

Effective interventions library

Successful effective interventions library details

Implementation

Assessment tools

The baseline and self-assessment tools are Excel spreadsheets that can be used by organisations to identify if they are in line with practice recommended in NICE guidance and to help them plan activity that will help them meet the recommendations.
Self-harm: longer-term management: baseline assessment tool

Costing support

Costing support includes national cost impact reports that summarise the national costs and savings and discuss the assumptions used; costing templates to assess the impact on local budgets; and costing statements when the impact is not significant or impossible to quantify at a national level.
Self-harm: longer-term management: costing report
Self-harm: longer-term management: costing template

Learning resources

Learning resources are designed to support people to run workshops and for individual learning. They include clinical case scenarios, presentations for trainers and tests for participants.
Self-harm: longer-term management: clinical case scenarios

Podcasts

Interviews that focus on practical actions to overcome specific implementation challenges. They are recorded by NICE with experts in the area, who were usually involved in guidance development.
Self-harm: longer-term management (service user's perspective, access to services and harm reduction): podcast
Self-harm: longer-term management (risk assessment): podcast

Pathway information

Information for patients and the public

NICE produces booklets for patients and the public, called 'Understanding NICE guidance'. They summarise, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written a booklet for patients and the public explaining its guidance on each of the following topics.
Self-harm: longer-term management
Self-harm: the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If someone does not have the capacity to make decisions, healthcare professionals should follow the Department of Health's advice on consent and the code of practice that accompanies the Mental Capacity Act. In Wales, healthcare professionals should follow advice on consent from the Welsh Government. If the person is under 16, healthcare professionals should follow the guidelines in Seeking consent: working with children.

Updates to this pathway

2 March 2012 Clinical case scenarios added.

Supporting information

Glossary

Child and adolescent mental health services
National Poisons Information Service
'Significant other' refers not just to a partner but also to friends and any person the service user considers to be important to them.

Self-harm

Self-harm

Planning of services

Planning of services

Planning of services

All relevant health, social care and other organisations should ensure that people who self-harm are involved in the commissioning, planning and evaluation of services for people who self-harm.
Emergency departments, local healthcare commissioners and local mental health services, in conjunction with local service users and carers wherever possible, should jointly plan the configuration and delivery of integrated physical and mental healthcare services within emergency departments for people who self-harm.
Emergency departments catering for children and young people under 16 years of age, local healthcare commissioners and local children's mental health services, in conjunction with local carers and service users, should jointly plan the configuration and delivery of integrated physical and mental healthcare services within emergency departments for children and young people who self-harm.
In jointly planning an integrated emergency department service for people who self-harm, service managers should consider integrating mental health professionals into the emergency department, both to improve the psychosocial assessment and initial treatment for people who self-harm, and to provide routine and regular training to non-mental-health professionals working in the emergency department.
Emergency department and local mental health services should jointly plan effective liaison psychiatric services available 24 hours a day.

Source guidance

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CG16

General principles of care

View the 'General principles of care for people who self-harm' path

Assessment and initial management

View the 'Assessment and initial management of self-harm by ambulance personnel' path

Treatment and management

View the 'Treatment and management of self-harm in emergency departments' path

Primary care

View the 'Management of self-harm in primary care' path

Secondary mental health services

Secondary mental health services

Longer-term management

View the 'Longer-term management of self-harm: assessment and treatment' path

Paths in this pathway

Pathway created: November 2011 Last updated: March 2012

Copyright © 2012 National Institute for Health and Clinical Excellence. All Rights Reserved.

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