history control tooltip
divider handle tooltip
Self-harm
Short Text
Introduction
This pathway covers the assessment and physical and psychological management of self-harm in primary and secondary care for children (8 years and older), young people and adults.
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. NICE clinical guideline 16 (2004)
Quality standards
Quality statements
Effective interventions library
Successful effective interventions library details
Implementation
Commissioning
These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.
Education and learning
NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.
Service improvement and audit
These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.
Pathway information
Information for the public
NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics
Patient-centred care
Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – 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, the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards. 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. If a young person is moving between paediatric and adult services their care should be planned and managed according to the best practice guidance described in the Department of Health's Transition: getting it right for young people.
Updates to this pathway
8 February 2013 Minor maintenance updates
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.
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
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeGeneral principles of care
View the 'General principles of care for people who self-harm' pathAssessment and initial management
View the 'Assessment and initial management of self-harm by ambulance personnel' pathTreatment and management
View the 'Treatment and management of self-harm in emergency departments' pathLonger-term management
View the 'Longer-term management of self-harm: assessment and treatment' pathPaths in this pathway
- General principles of care for people who self-harm
- Management of self-harm in primary care
- Assessment and initial management of self-harm by ambulance personnel
- Treatment and management of self-harm in emergency departments
- Medical and surgical management of self-harm
- Psychosocial assessment in self-harm by specialist mental health professionals
- Longer-term management of self-harm: assessment and treatment
Pathway created: November 2011 Last updated: February 2013
Copyright © 2013 National Institute for Health and Care Excellence. All Rights Reserved.