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Self-harm

About

What is covered

This interactive flowchart covers the assessment and physical and psychological management of self-harm in primary and secondary care for people aged 8 and over.

Updates

Updates to this interactive flowchart

9 September 2019 Suicide prevention (NICE quality standard 189) added.
13 April 2017 Structure revised and summarised recommendations replaced with full recommendations.
28 June 2013 Self-harm (NICE quality standard 34) added.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on assessing and managing self-harm in an interactive flowchart

What is covered

This interactive flowchart covers the assessment and physical and psychological management of self-harm in primary and secondary care for people aged 8 and over.

Updates

Updates to this interactive flowchart

9 September 2019 Suicide prevention (NICE quality standard 189) added.
13 April 2017 Structure revised and summarised recommendations replaced with full recommendations.
28 June 2013 Self-harm (NICE quality standard 34) added.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Self-harm in over 8s: long-term management (2011) NICE guideline CG133
Suicide prevention (2019) NICE quality standard 189
Self-harm (2013) NICE quality standard 34

Quality standards

Suicide prevention

These quality statements are taken from the suicide prevention quality standard. The quality standard defines best practice for reducing suicide and helping people bereaved or affected by suicide and should be read in full

Self-harm

These quality statements are taken from the self-harm quality standard. The quality standard defines clinical best practice for self-harm and should be read in full.

Quality statements

Multi-agency suicide prevention partnerships

This quality statement is taken from the suicide prevention quality standard. The quality standard defines best practice for reducing suicide and helping people bereaved or affected by suicide and should be read in full.

Quality statement

Multi-agency suicide prevention partnerships have a strategic suicide prevention group and clear governance and accountability structures.

Rationale

By working together, local organisations can combine their expertise and resources to implement a range of interventions to prevent suicide including addressing risk factors such as self-harm.
Partnerships should have a strategic suicide prevention group to identify priorities and manage the overall strategic direction. Organisations that have a key role in suicide prevention should have senior level representation on the strategic suicide prevention group. Although local structures are likely to vary, the group may coordinate the work of a wider network of representatives from specific services and organisations to implement the local suicide prevention strategy.
To promote understanding, partnerships should involve people with personal experience of a suicide attempt, suicidal thoughts and feelings, or a suicide bereavement. Clear terms of reference and governance and accountability structures will improve effectiveness and sustainability.

Quality measures

Structure
a) Evidence that multi-agency suicide prevention partnerships have a strategic suicide prevention group attended by senior level representatives.
Data source: Local data collection, for example, membership list including job titles and responsibilities and attendance registers.
b) Evidence that multi-agency suicide prevention partnerships have clear governance and accountability structures.
Data source: Local data collection, for example, terms of reference.
c) Evidence that multi-agency suicide prevention partnerships support people with personal experience of a suicide attempt, suicidal thoughts and feelings, or a suicide bereavement, to be involved in the partnership.
Data source: Local data collection, for example, programme of induction and support for people with personal experience who are involved in the partnership.
Outcome
a) Rate of emergency hospital attendance or admission for intentional self-harm.
Data source: Public Health England’s Suicide Prevention Profile includes data on the age-standardised rate of emergency hospital admissions for intentional self-harm in local authority areas. NHS Digital’s Hospital Episode Statistics includes data on A&E attendances for self-harm.
b) Rate of self-harm in the community.
Data source: Local data collection, for example, community or school surveys. NHS Digital’s survey of the mental health of children and young people in England includes questions on self-harm and attempted suicide. Data on episodes of self-harm in primary care are likely to be available from primary care electronic health care record systems.
c) Suicide rate.
Data source: Public Health England’s Suicide Prevention Profile includes data on the rate of suicide in local authority areas for different population groups (based on Office for National Statistics source data).

What the quality statement means for different audiences

Lead organisations such as local authorities and residential custodial or detention providers set up a multi-agency suicide prevention partnership with a strategic suicide prevention group that includes senior representatives from key organisations. Lead organisations ensure that representatives on the group can make decisions and commit resources on behalf of their organisation, and have skills and knowledge in line with Health Education England’s Self-harm and suicide prevention competence frameworks.
Lead organisations ensure that people with personal experience of a suicide attempt, suicidal thoughts and feelings, or a suicide bereavement who are involved in the partnership can access a programme of induction and support. They identify clear leadership for the partnership and ensure it has clear terms of reference, based on a shared understanding that suicide can be prevented. The terms of reference should:
  • clarify local partnership structures, including working arrangements between the strategic suicide prevention group and any wider network or partnership subgroups
  • identify clear governance and accountability structures, including oversight from local health and care planning groups such as the health and wellbeing board
  • clarify links between suicide prevention partnerships in the local community and those in custodial settings, particularly in relation to managing prisoners and detainees in the community.

Source guidance

Preventing suicide in community and custodial settings (2018) NICE guideline NG105, recommendations 1.1.1, 1.1.2 and 1.1.4

Definitions of terms used in this quality statement

Multi-agency suicide prevention partnership
Suicide prevention requires work across a range of settings targeting a wide variety of audiences. Given this complexity, the combined knowledge, expertise and resources of organisations across the public, private and voluntary sectors is essential. A wide range of representatives working with adults, children and young people may be brought together to contribute to a multi-agency suicide prevention partnership.
Strategic suicide prevention group
A strategic suicide prevention group in the community could include representatives from the following:
  • clinical commissioning groups
  • local public health services
  • healthcare providers
  • social care services
  • voluntary and other third-sector organisations, including those used by people in high-risk groups
  • emergency services
  • criminal justice services
  • police and custody suites
  • employers
  • education providers
  • people with personal experience of a suicide attempt, suicidal thoughts and feelings, or a suicide bereavement.
A strategic suicide prevention group in a residential custodial or detention setting could include representatives from the following:
  • governors or directors
  • healthcare staff (including physical and mental health)
  • other staff
  • pastoral support services
  • voluntary and other third-sector organisations
  • escort custody services
  • liaison and diversion services
  • emergency services
  • offender management and resettlement services
  • people with personal experience of a suicide attempt, suicidal thoughts and feelings, or a suicide bereavement, to be selected according to local protocols.
[NICE’s guideline on preventing suicide in community and custodial settings, recommendations 1.1.3 and 1.1.5 and expert opinion]

Equality and diversity considerations

Multi-agency suicide prevention partnerships should make reasonable adjustments to ensure that people with additional needs such as physical, sensory or learning disabilities, and people who do not speak or read English, or who have reduced communication skills, can participate in the strategic suicide prevention group. People should have access to an interpreter (including British Sign Language) or advocate if needed.

Reducing access to methods of suicide

This quality statement is taken from the suicide prevention quality standard. The quality standard defines best practice for reducing suicide and helping people bereaved or affected by suicide and should be read in full.

Quality statement

Multi-agency suicide prevention partnerships reduce access to methods of suicide based on local information.

Rationale

Reducing access to common methods of suicide and to places where suicide may be more likely to occur can be an effective way of preventing suicide. A range of measures can be used to interrupt people’s plans, giving them time to stop and think, or making it more difficult for them to put themselves in danger. An understanding of local information will help suicide prevention partnerships prioritise the methods and places to focus on locally.

Quality measures

Structure
a) Evidence that multi-agency suicide prevention partnerships collect and analyse local information on methods of suicide and locations.
Data source: Local data collection, for example, data sharing protocols and a rapid intelligence gathering process.
b) Evidence that multi-agency suicide prevention partnerships identify how they will reduce access to methods of suicide.
Data source: Local data collection, for example, local suicide prevention action plan.
c) Evidence that multi-agency suicide prevention partnerships review progress in reducing access to methods of suicide at least annually.
Data source: Local data collection, for example, local suicide prevention action plan progress reports.
Outcome
a) Number of suicides by methods identified in the local suicide prevention action plan.
Data source: Local data collection, for example, rapid intelligence gathering. Detailed information on methods should not be included in the published suicide prevention action plan.
b) Number of suicides in high-frequency locations.
Data source: Local data collection, for example, rapid intelligence gathering. Detailed information on locations should not be included in the published suicide prevention action plan.
c) Suicide rate.
Data source: Public Health England’s Suicide Prevention Profile includes data on the rate of suicide in local authority areas for different population groups (based on Office for National Statistics source data).

What the quality statement means for different audiences

Multi-agency suicide prevention partnerships gather and analyse information from a range of sources to understand local patterns in suicide method and location. The partnership uses this information to prioritise the methods and locations to focus on. It includes these priorities in the suicide prevention action plan, identifies actions and regularly reviews progress.
The partnership supports partner organisations to ensure that they comply with national guidance on issues such as providing and maintaining safer cells in residential custodial or detention settings and restricting access to painkillers. The partnership also facilitates data sharing protocols between organisations to support timely analysis of data and actions to reduce access to methods of suicide for people in high-risk groups.
People in the community and in custody know that organisations are working together to prevent suicide.

Source guidance

Preventing suicide in community and custodial settings (2018) NICE guideline NG105, recommendations 1.6.1, 1.6.2 and 1.6.3

Definitions of terms used in this quality statement

Reducing access to methods of suicide
Suicide prevention partnerships should ensure local compliance with national guidance:
Reduce the opportunity for suicide in locations where suicide is more likely, for example by erecting physical barriers (see Public Health England's Preventing suicide in public places: a practice resource). Also consider other measures such as:
  • providing information about how and where people can get help when they feel unable to cope
  • using CCTV or other surveillance to allow staff to monitor when someone may need help
  • increasing the number and visibility of staff, or times when staff are available
  • working with planners who have responsibility for designing bridges, multi-storey car parks and other structures that could potentially pose a suicide risk.
[NICE’s guideline on preventing suicide in community and custodial settings recommendations 1.3.2, 1.6.2, 1.6.3 and 1.6.4]
Local information
Suicide prevention partnerships should use local data including audit, Office for National Statistics and NHS data, as well as rapid intelligence gathering, to:
  • identify emerging trends in suicide methods and locations
  • understand local characteristics that may influence the methods used
  • determine when to take action to reduce access to the methods of suicide.
[NICE’s guideline on preventing suicide in community and custodial settings recommendation 1.6.1]

Media reporting

This quality statement is taken from the suicide prevention quality standard. The quality standard defines best practice for reducing suicide and helping people bereaved or affected by suicide and should be read in full.

Quality statement

Multi-agency suicide prevention partnerships have a local media plan that identifies how they will encourage journalists and editors to follow best practice when reporting on suicide and suicidal behaviour.

Rationale

Irresponsible reporting of suicide and suicidal behaviour may have harmful effects, including potentially increasing the risk of suicide. By promoting best practice, partnerships can encourage responsible reporting, which can help prevent suicide clusters and avoid further distress being caused to those bereaved or affected by suicide.

Quality measures

Structure
a) Evidence that multi-agency suicide prevention partnerships have a local media plan that identifies how they will encourage best practice in reporting on suicide and suicidal behaviour.
Data source: Local data collection, for example, a partnership media plan.
b) Evidence that multi-agency suicide prevention partnerships have a named lead for the local media plan.
Data source: Local data collection, for example, description of partnership roles and responsibilities.
c) Evidence that multi-agency suicide prevention partnerships work with other organisations such as the Samaritans to give feedback to local media journalists and editors about reporting on suicide and suicidal behaviour.
Data source: Local data collection, for example, a feedback log. This may include information on feedback given by other organisations such as the Samaritans.
Outcome
a) Number of local media reports of suicide or suicidal behaviour that do not meet best practice criteria.
Data source: Local data collection, for example, monitoring records.
b) Suicide rate.
Data source: Public Health England’s Suicide Prevention Profile includes data on the rate of suicide in local authority areas for different population groups (based on Office for National Statistics source data).

What the quality statement means for different audiences

Multi-agency suicide prevention partnerships in the community develop a plan for liaising with local media organisations that encourages a positive relationship and promotes best practice when reporting on suicide and suicidal behaviour. Partnerships identify a lead to coordinate the local media plan. Partnerships work with organisations such as the Samaritans to provide feedback to editors and journalists if a report is not consistent with best practice guidelines.
Multi-agency suicide prevention partnerships in residential custodial and detention settings liaise with local media through the Ministry of Justice, if relevant, and encourage Ministry of Justice press officers to follow best practice when reporting on suicide and suicidal behaviour.
Local media journalists and editors work with the local suicide prevention partnership and other organisations such as the Samaritans to increase awareness of best practice and improve reporting standards.

Source guidance

Preventing suicide in community and custodial settings (2018) NICE guideline NG105, recommendations 1.10.1, 1.10.2 and 1.10.4

Definitions of terms used in this quality statement

Best practice when reporting on suicide and suicidal behaviour
This includes:
  • using sensitive language that is not stigmatising or in any other way distressing to people who have been affected
  • reducing speculative reporting
  • avoiding presenting detail on methods
  • providing stories of hope and recovery including signposting to support.
[NICE’s guideline on preventing suicide in community and custodial settings recommendations 1.10.2 and expert opinion]

Involving family, carers or friends

This quality statement is taken from the suicide prevention quality standard. The quality standard defines best practice for reducing suicide and helping people bereaved or affected by suicide and should be read in full.

Quality statement

Adults presenting with suicidal thoughts or plans discuss whether they would like their family, carers or friends to be involved in their care and are made aware of the limits of confidentiality.

Rationale

Families, carers and friends can help to support a person who has suicidal thoughts or plans. They can also provide valuable input to an assessment of the person’s needs to help keep them safe. Involving families, carers or friends can be complex so, providing the person has mental capacity, it is important for them to discuss who they would or would not like to be involved if there is a concern over suicide risk. The person should have the opportunity to discuss information sharing and their right to confidentiality so that they are aware of the circumstances in which confidential information may need to be disclosed to family, carers or friends.

Quality measures

Structure
a) Evidence of local arrangements to provide training on information sharing and confidentiality based on the Department of Health and Social Care's consensus statement on information sharing and suicide prevention to practitioners in contact with adults presenting to health or care services with suicidal thoughts or plans.
Data source: Local data collection, for example, staff training records.
b) Evidence of local processes to ensure that adults presenting with suicidal thoughts or plans discuss whether they would like their family, carers or friends to be involved in their care.
Data source: Local data collection, for example, local service protocol.
c) Evidence of local processes to ensure that adults with suicidal thoughts or plans are made aware of the limits of confidentiality.
Data source: Local data collection, for example, local service protocol.
Process
a) Proportion of adults presenting with suicidal thoughts or plans who discuss whether they would like their family, carers or friends to be involved in their care.
Numerator – the number in the denominator who discuss whether they would like their family, carers or friends to be involved in their care.
Denominator – the number of adults presenting with suicidal thoughts or plans.
Data source: Local data collection, for example, audit of patient records.
b) Proportion of adults presenting with suicidal thoughts or plans who are made aware of the limits of confidentiality.
Numerator – the number in the denominator who are made aware of the limits of confidentiality.
Denominator – the number of adults presenting with suicidal thoughts or plans.
Data source: Local data collection, for example, audit of patient records.
Outcome
a) Proportion of assessments for adults who presented with suicidal thoughts or plans who wanted their family, carers or friends involved, that involved family, carers or friends.
Numerator – the number in the denominator that involved family, carers or friends.
Denominator – the number of assessments for adults who presented with suicidal thoughts or plans who wanted their family, carers or friends involved.
Data source: Local data collection, for example, audit of patient records.
b) Proportion of family members, carers or friends of adults who presented with suicidal thoughts or plans who are satisfied with information sharing about suicide risk.
Numerator – the number in the denominator who are satisfied with information sharing about suicide risk.
Denominator – the number of family members, carers or friends of adults who presented with suicidal thoughts or plans.
Data source: Local data collection, for example, survey of family members, carers or friends of adults who presented with suicidal thoughts or plans.
c) Suicide rate.
Data source: Public Health England’s Suicide Prevention Profile includes data on the rate of suicide in local authority areas for different population groups (based on Office for National Statistics source data).

What the quality statement means for different audiences

Service providers (such as general practices, hospitals, ambulance services, mental health trusts, prisons and social care providers) ensure that processes are in place for adults presenting with suicidal thoughts or plans to discuss whether they would like their family, carers or friends to be involved in their care, and to make them aware of the limits of confidentiality.
Providers ensure that if the person wants their family, carers or friends involved in their care, the nature of their involvement, including how and when information is shared with them, is agreed. Providers ensure that staff are trained and aware of the Department of Health and Social Care’s consensus statement on information sharing and suicide prevention.
Health and social care practitioners (such as A&E practitioners, paramedics, first responders, GPs, nurses, social workers, mental health professionals and allied health professionals) discuss with adults presenting with suicidal thoughts or plans whether they would like their family, carers or friends to be involved in their care. They also make them aware of the limits of confidentiality. If the person wants their family, carers or friends involved, health and social care practitioners ensure they agree how they will be involved and when information will be shared with them.
Commissioners (such as local authorities, clinical commissioning groups and NHS England) commission services that discuss with adults presenting with suicidal thoughts or plans whether they would like their family, carers or friends to be involved in their care. They also make them aware of the limits of confidentiality.
Adults who contact a health or care service and feel suicidal discuss whether they would like their family, carers or friends to be involved in their care. If they want their family, carers or friends to be involved, they agree how they will be involved and when information will be shared with them. They are also told about confidentiality and when it may be necessary to share information with their family, carers or friends.

Source guidance

Definitions of terms used in this quality statement

Adults with suicidal thoughts or plans
Adults who disclose suicidal thoughts or plans when asked about suicide ideation and intent.
[Expert opinion]
Limits of confidentiality
If a person is at imminent risk of suicide, there may be sufficient doubts about their mental capacity to consent to information about their risk of suicide being shared. In these circumstances, a professional judgement will need to be made, based on an understanding of the person and what would be in their best interest. This should take into account the person’s previously expressed wishes and views in relation to sharing information with their family, carers or friends.
The judgement may be that it is right to share critical information. If the purpose of the disclosure is to prevent a person who lacks capacity from serious harm, there is an expectation that practitioners will disclose relevant confidential information, if it is in the person’s best interest to do so. Disclosure may also be in the public interest because of the far-reaching impact that a suicide can have on others.

Equality and diversity considerations

Services that support adults with suicidal thoughts or plans should make reasonable adjustments to ensure that people with additional needs such as physical, sensory or learning disabilities, and people who do not speak or read English, or who have reduced communication skills, can use the service. People should have access to an interpreter (including British Sign Language) or advocate if needed.
Health and social care practitioners should ensure that adults who temporarily lack mental capacity to consent to information sharing are asked if they want their family, carers or friends to be involved in their care as soon as they are able to give consent.

Supporting people bereaved or affected by a suspected suicide

This quality statement is taken from the suicide prevention quality standard. The quality standard defines best practice for reducing suicide and helping people bereaved or affected by suicide and should be read in full.

Quality statement

People bereaved or affected by a suspected suicide are given information and offered tailored support.

Rationale

Children, young people and adults who are bereaved or affected by a suspected suicide are themselves at increased risk of suicide. Providing support after a suspected suicide can reduce this risk, especially when tailored to the person’s needs. It is important to identify people who may need support as soon as possible so that they can be given practical information and access support if, and when, they need to.

Quality measures

Structure
a) Evidence of local arrangements to use rapid intelligence gathering to identify people who may be bereaved or affected by a suspected suicide.
Data source: Local data collection, for example, data sharing agreements and reporting arrangements.
b) Evidence of local processes to give information to people bereaved or affected by a suspected suicide and to ask if they need help.
Data source: Local data collection, for example, a local protocol.
c) Evidence of local services that can provide support to people bereaved or affected by a suspected suicide.
Data source: Local data collection, for example, service specifications and a local directory of information on the services available.
Process
a) Proportion of people bereaved or affected by a suspected suicide who are given information.
Numerator – the number in the denominator who are given information.
Denominator – the number of people bereaved or affected by a suspected suicide.
Data source: Local data collection, for example, audit of case records.
b) Proportion of people bereaved or affected by a suspected suicide who are asked if they need help.
Numerator – the number in the denominator who are asked if they need help.
Denominator – the number of people bereaved or affected by a suspected suicide.
Data source: Local data collection, for example, audit of case records.
c) Proportion of people bereaved or affected by a suspected suicide who access tailored support.
Numerator – the number in the denominator who access tailored support.
Denominator – the number of people bereaved or affected by a suspected suicide.
Data source: Local data collection, for example, monitoring information from local support services.
Outcome
a) Proportion of people bereaved or affected by a suicide who are satisfied with information and support.
Numerator – the number in the denominator who are satisfied with information and support.
Denominator – the number of people bereaved or affected by a suicide.
Data source: Local data collection, for example, survey of people bereaved or affected by a suicide.
b) Number of suicides among people bereaved or affected by a suicide.
Data source: Local data collection, for example, rapid intelligence gathering.

What the quality statement means for different audiences

Multi-agency suicide prevention partnerships carry out rapid intelligence gathering to identify children, young people and adults who may be bereaved or affected by a suspected suicide. Partnerships ensure that coordinated processes are in place across partner organisations to provide information to people who are bereaved or affected by a suspected suicide, to ask them if they need additional help and to signpost them to support if needed.
Partnerships ensure that information and signposting to support is offered to people who are bereaved or affected by a suspected suicide as soon as possible and then at subsequent opportunities to ensure that people can access support when they need it.
Service providers (such as police, hospitals, ambulance services, prisons, general practices, funeral directors, coroners’ offices, employers and education providers) ensure that processes are in place to provide information to people who are bereaved or affected by a suspected suicide (including health and care practitioners and first responders), to ask them if they need additional help and to signpost them to support if needed.
Providers ensure that information and signposting to support is offered to people who are bereaved or affected by a suspected suicide as soon as possible and then at other opportunities to ensure that people can access support when they need it.
Practitioners (such as police officers, GPs, nurses, paramedics, mental health practitioners, prison staff, funeral directors, coroner’s office staff and human resource managers) provide information to people who are bereaved or affected by a suspected suicide, ask them if they need additional help and signpost them to support if needed. Practitioners who respond to a suspected suicide or provide support to people bereaved or affected by a suspected suicide, are aware of how they can access support to help them cope, if they need it.
Commissioners (such as local authorities, clinical commissioning groups and NHS England) commission services that provide support after a suspected suicide with the capacity and skills to meet the needs of the local population, including children and young people. They also commission services that provide information to people who are bereaved or affected by a suspected suicide, ask them if they need additional help and signpost them to support if needed.
Children, young people and adults who are bereaved or affected by a suspected suicide are given practical information, such as an information booklet, and asked if they want any other help. If they do, they are put in touch with a support service.

Source guidance

Preventing suicide in community and custodial settings (2018) NICE guideline NG105, recommendation 1.8.2

Definitions of terms used in this quality statement

People bereaved or affected by a suspected suicide
Children, young people and adults who are bereaved or affected by a suspected suicide may include relatives, friends, classmates, colleagues, other prisoners or detainees, as well as first responders and other professionals who provided support.
[NICE’s guideline on preventing suicide in community and custodial settings, recommendation 1.8.1]
Information
Practical information expressed in a sensitive way that helps people to cope and signposts to other services, such as Public Health England’s Help is at hand guide.
[Expert opinion and NICE’s guideline on preventing suicide in community and custodial settings, recommendation 1.8.2]
Tailored support
Support that is focused on the person’s individual needs. As well as professional support, it could include:
[NICE’s guideline on preventing suicide in community and custodial settings, recommendation 1.8.3]

Equality and diversity considerations

Information for people bereaved or affected by a suspected suicide should be in a format that suits the person’s needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate. For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard.
Services that provide support after a suspected suicide should ensure that staff have the skills and knowledge to support children and young people who are bereaved or affected. Services should also ensure that they provide support for people from black, Asian, other minority ethnic groups and people with religious beliefs in a culturally sensitive way.
Services that provide support after a suspected suicide should make reasonable adjustments to ensure that people with additional needs such as physical, sensory or learning disabilities, and people who do not speak or read English, or who have reduced communication skills, can use the service. People should have access to an interpreter (including British Sign Language) or advocate if needed.

Compassion, respect and dignity

This quality statement is taken from the self-harm quality standard. The quality standard defines clinical best practice for self-harm and should be read in full.

Quality statement

People who have self-harmed are cared for with compassion and the same respect and dignity as any service user.

Rationale

Everyone who uses healthcare services should be treated with compassion, respect and dignity. For people who have self-harmed, however, staff attitudes are often reported as contributing to poor experiences of care. Punitive or judgemental staff attitudes can be distressing for people who have self-harmed and may lead to further self-harm or avoidance of medical attention.

Quality measure

Structure
Evidence of local arrangements to provide staff training on treating people with compassion, respect and dignity that includes specific reference to people who self-harm.
Process
Proportion of staff in contact with people who have self-harmed who have received training on treating people with compassion, respect and dignity that includes specific reference to people who self-harm.
Numerator: the number of staff in the denominator who have received training on treating people with compassion, respect and dignity that includes specific reference to people who self-harm.
Denominator: the number of staff in contact with people who have self-harmed.
Outcome
Evidence from feedback that people who have self-harmed feel treated with compassion and the same respect and dignity as any service user.

Description of what the quality statement means for each audience

Service providers ensure that training is provided on treating people with compassion, respect and dignity that includes specific reference to people who self-harm.
All staff ensure that they treat people who have self-harmed with compassion and the same respect and dignity as any service user.
Commissioners ensure that they commission services in which all staff who come into contact with people who have self-harmed are trained in treating people with compassion, respect and dignity that includes specific reference to people who self-harm.
People who have self-harmed are cared for with compassion and the same respect and dignity as any service user.

Source guidance

NICE clinical guideline 16 recommendations 1.1.1.1 and 1.1.2.1
NICE clinical guideline 133 recommendations 1.1.1, 1.1.9 and 1.1.10

Data source

Structure
Local data collection.
Process
Local data collection.
Outcome
Local data collection. NHS surveys ask questions about dignity when using services; however, data on diagnosis are not collected.

Definitions

People who have self-harmed
Children or young people (aged 8 years and older) and adults who have carried out an act of self-poisoning or self-injury, irrespective of motivation.
Staff
Everyone employed by or working in a service that provides care and support for people who have self-harmed. It is not restricted to qualified healthcare professionals, and could include reception staff, administrative staff and others. It applies to primary care, ambulance services, emergency departments, community services and inpatient settings.

Initial assessments

This quality statement is taken from the self-harm quality standard. The quality standard defines clinical best practice for self-harm and should be read in full.

Quality statement

People who have self-harmed have an initial assessment of physical health, mental state, safeguarding concerns, social circumstances and risks of repetition or suicide.

Rationale

An initial assessment can identify whether a person who has self-harmed is at immediate physical risk so that steps can be taken to reduce this risk, including referral for more urgent care if indicated.

Quality measure

Structure
Evidence of local arrangements to ensure that initial assessments of people who have self-harmed include physical health, mental state, safeguarding concerns, social circumstances and risks of repetition or suicide.
Process
Proportion of people who have self-harmed who have an initial assessment of physical health, mental state, safeguarding concerns, social circumstances and risks of repetition or suicide.
Numerator: the number of people in the denominator with an initial assessment of physical health, mental state, safeguarding concerns, social circumstances and risks of repetition or suicide.
Denominator: the number of people with a new episode of self-harm.

Description of what the quality statement means for each audience

Service providers ensure that people who have self-harmed have an initial assessment after an episode of self-harm that includes physical health, mental state, safeguarding concerns, social circumstances and risk of further self-harm or suicide.
Healthcare professionals ensure that people who have self-harmed have an initial assessment after an episode of self-harm that includes physical health, mental state, safeguarding concerns, social circumstances and risk of further self-harm or suicide.
Commissioners ensure that they commission services that undertake an initial assessment of physical health, mental state, safeguarding concerns, social circumstances and risk of further self-harm or suicide for people after an episode of self-harm.
People who have self-harmed have their physical health, mental state, social circumstances and risks of repetition or suicide assessed after an episode of self-harm.

Source guidance

Data source

Structure
Local data collection.
Process
Local data collection.

Definitions

People who have self-harmed
Children or young people (aged 8 years and older) and adults who have carried out an act of self-poisoning or self-injury, irrespective of motivation.
Initial assessment
The first assessment by a healthcare professional after an episode of self-harm. It applies to people first seen in primary care, ambulance services or emergency departments. It also applies to the first assessment of episodes of self-harm in inpatient settings. An initial assessment should be undertaken each time a person presents with an episode of self-harm.
Physical health
Factors that should be recorded in an initial assessment of physical health include, but are not limited to:
  • level of consciousness
  • physical injuries
  • level of pain
  • details of the nature and quantity of any overdose.
Mental state
Factors that should be recorded in an initial assessment of mental state include, but are not limited to:
  • mental capacity
  • level of distress
  • presence of mental health problems
  • willingness to remain for further psychosocial assessment.
Safeguarding
The protection of vulnerable people from harm. It can apply to people of all ages, including adults, older people, children and young people. It includes consideration of risks to the person who has self-harmed, any children or adults in the person's care and to other family members or significant others.
Social circumstances
Factors that should be recorded in an initial assessment of social circumstances include, but are not limited to:
  • family members, significant others or carers who can provide support
  • dependants
  • housing
  • personal or financial problems.

Equality and diversity considerations

NICE clinical guideline 16 recommendation 1.9.1.1 states that children and young people under 16 years who have self-harmed and present at the emergency department should be triaged, assessed and treated by appropriately trained children's nurses and doctors in a separate children's area of the emergency department.

Comprehensive psychosocial assessments

This quality statement is taken from the self-harm quality standard. The quality standard defines clinical best practice for self-harm and should be read in full.

Quality statement

People who have self-harmed receive a comprehensive psychosocial assessment.

Rationale

A comprehensive psychosocial assessment is aimed at identifying personal factors that might explain an act of self-harm. It should be carried out each time a person presents with an episode of self-harm. It can start a therapeutic relationship with the healthcare professional and be used to form an effective management plan.

Quality measure

Structure
Evidence of local arrangements to ensure healthcare professionals either undertake comprehensive psychosocial assessments with people who have self-harmed or refer them to a specialist mental health professional for the assessment.
Process
a) Proportion of people who have self-harmed who either receive a comprehensive psychosocial assessment or are referred to a specialist mental health professional for the assessment.
Numerator: the number of people in the denominator receiving a comprehensive psychosocial assessment or referred to a specialist mental health professional for the assessment.
Denominator: the number of people with a new episode of self-harm.
b) Proportion of people who have self-harmed and are referred to a specialist mental health professional for a comprehensive psychosocial assessment who receive a comprehensive psychosocial assessment.
Numerator: the number of people in the denominator receiving a comprehensive psychosocial assessment.
Denominator: the number of people who have self-harmed and are referred to a specialist mental health professional for a comprehensive psychosocial assessment.

Description of what the quality statement means for each audience

Service providers ensure that systems are in place for healthcare professionals to undertake comprehensive psychosocial assessments for people who have self-harmed or refer them to a specialist mental health professional for the assessment.
Healthcare professionals ensure that people are offered a comprehensive psychosocial assessment or are referred to a specialist mental health professional for the assessment after an episode of self-harm.
Commissioners ensure that they commission services that provide comprehensive psychosocial assessments for people after an episode of self-harm.
People who have self-harmed are offered a comprehensive psychosocial assessment that considers their needs, social situation, psychological state, reasons for harming themselves, feelings of hopelessness, depression or other mental health problems and any thoughts of suicide.

Source guidance

NICE clinical guideline 16 recommendations 1.7.2.1 and 1.7.3.1
NICE clinical guideline 133 recommendations 1.3.1 to 1.3.6

Data source

Structure
Local data collection.
Process
a) and b) Local data collection.

Definitions

People who have self-harmed
Children or young people (aged 8 years and older) and adults who have carried out an act of self-poisoning or self-injury, irrespective of motivation.
Specialist mental health professional
A health professional employed to provide expertise in mental healthcare.
Comprehensive psychosocial assessment
NICE clinical guideline 16 and NICE clinical guideline 133 state that a psychosocial assessment is the assessment of needs and risks to understand and engage people who self-harm and initiate a therapeutic relationship. Recommendations 1.3.1 to 1.3.6 in NICE clinical guideline 133 give further details on undertaking comprehensive psychosocial assessments. The comprehensive psychosocial assessment should be offered to people being treated in primary care, emergency departments and inpatient settings, and may require referral to a specialist mental health professional

Equality and diversity considerations

NICE clinical guideline 16 recommendation 1.9.1.10 states that children and young people should be assessed by professionals experienced in the assessment of children and young people who self-harm.
NICE clinical guideline 16 recommendation 1.9.1.10 and NICE clinical guideline 133 recommendation 1.3.4 state that assessment of children and young people should follow the same principles as for adults, but should also include a full assessment of the family, their social situation and child protection issues.
NICE clinical guideline 16 recommendation 1.10.1.1 and NICE clinical guideline 133 recommendation 1.3.3 state that older people (over 65) should be assessed by professionals experienced in the assessment of older people who self-harm.
NICE clinical guideline 16 recommendation 1.10.1.1 states that assessment of older people should follow the same principles as for adults, but should also pay attention to the potential presence of depression, cognitive impairment or physical ill health, and include a full assessment of their home and social situation.

Monitoring

This quality statement is taken from the self-harm quality standard. The quality standard defines clinical best practice for self-harm and should be read in full.

Quality statement

People who have self-harmed receive the monitoring they need while in the healthcare setting, in order to reduce the risk of further self-harm.

Rationale

Monitoring people who have self-harmed when they are in a healthcare setting can reduce distress, ensure that the person feels supported and help reduce the risk of further self-harm while in the healthcare setting.

Quality measure

Structure
Evidence of local arrangements to ensure that people who have self-harmed receive the monitoring they need while in the healthcare setting, in order to reduce the risk of further self-harm while in the healthcare setting.
Process
Proportion of people who have self-harmed who have a record of monitoring arrangements while in the healthcare setting, in order to reduce the risk of further self-harm.
Numerator: the number of people in the denominator with a record of monitoring arrangements while in the healthcare setting, in order to reduce the risk of further self-harm.
Denominator: the number of people with a new episode of self-harm.
Outcome
Number of episodes of self-harm occurring in healthcare settings.

Description of what the quality statement means for each audience

Service providers ensure that staff carry out monitoring in the healthcare setting according to the needs of people who have self-harmed, in order to reduce the risk of further self-harm.
Healthcare professionals ensure that people who have self-harmed receive the monitoring they need while in the healthcare setting, in order to reduce the risk of further self-harm.
Commissioners ensure that they commission services that monitor people who have self-harmed according to their needs while in the healthcare setting, in order to reduce the risk of further self-harm.
People who have self-harmed are checked regularly by healthcare staff, and are accompanied when required, when they are in hospital or another part of the health service, to make sure they are safe.

Source guidance

NICE clinical guideline 16 recommendation 1.4.2.3

Data source

Structure
Local data collection. NHS Litigation Authority risk management standards assess the process for managing the risks associated with the observation and engagement of patients.
Process
Local data collection.
Outcome
Local data collection. The National Reporting and Learning System contains national and local figures on patient safety incidents including self-harm.

Definitions

People who have self-harmed
Children or young people (aged 8 years and older) and adults who have carried out an act of self-poisoning or self-injury, irrespective of motivation.
Monitoring
Includes observation and accompaniment of people who have self-harmed, either by healthcare professionals or by their families or carers with support from healthcare professionals.
Monitoring applies to people being treated in primary care, ambulance services, emergency departments and inpatient settings.

Equality and diversity considerations

NICE clinical guideline 16 recommendation 1.9.1.1 states that children and young people under 16 years who have self-harmed should be assessed and treated by appropriately trained children's nurses and doctors in a separate children's area of the emergency department.

Safe physical environments

This quality statement is taken from the self-harm quality standard. The quality standard defines clinical best practice for self-harm and should be read in full.

Quality statement

People who have self-harmed are cared for in a safe physical environment while in the healthcare setting, in order to reduce the risk of further self-harm.

Rationale

Caring for people who have self-harmed in a safe physical environment within the healthcare setting can reduce distress, help them to feel supported and reduce the risk of further self-harm in the healthcare setting.

Quality measure

Structure
Evidence of local arrangements to undertake environmental assessments of healthcare settings, including assessing the risks to people who have self-harmed.
Outcome
Number of episodes of self-harm occurring in healthcare settings.

Description of what the quality statement means for each audience

Service providers ensure that they undertake environmental assessments to ensure healthcare settings are safe for people who have self-harmed and to reduce the risk of further self-harm while in the healthcare setting.
Healthcare professionals ensure that people who have self-harmed are cared for in a safe physical environment while in the healthcare setting to reduce the risk of further self-harm.
Commissioners ensure that they commission services that provide safe physical environments in healthcare settings for people who have self-harmed to reduce the risk of self-harm.
People who have self-harmed are cared for in a safe physical environment that reduces the risk of harming themselves further while in hospital or another part of the healthcare service.

Source guidance

NICE clinical guideline 16 recommendation 1.4.2.3

Data source

Structure
Local data collection. NHS Litigation Authority risk management standards assess the process for managing the risks associated with the physical security of premises and assets.
Outcome
Local data collection. NHS surveys ask questions about the environment of services; however, data on diagnosis are not collected. The National Reporting and Learning System contains national and local figures on patient safety incidents, including self-harm.

Definitions

People who have self-harmed
Children or young people (aged 8 years and older) and adults who have carried out an act of self-poisoning or self-injury, irrespective of motivation.
Safe physical environment
People who have self-harmed should be offered an environment that is safe, supportive and minimises any distress.
Examples of environmental risks to people who self-harm include, but are not limited to:
  • ligature points
  • open windows
  • access to sharps
  • access to medication.
Consideration should be given to the individual needs and safety requirements of each service user.
A safe physical environment refers to primary care settings, ambulance services, emergency departments and inpatient settings where people who have self-harmed are being cared for.

Equality and diversity considerations

NICE clinical guideline 16 recommendation 1.9.1.1 states that children and young people under 16 years who have self-harmed should be assessed and treated by appropriately trained children's nurses and doctors in a separate children's area of the emergency department.

Risk management plans

This quality statement is taken from the self-harm quality standard. The quality standard defines clinical best practice for self-harm and should be read in full.

Quality statement

People receiving continuing support for self-harm have a collaboratively developed risk management plan.

Rationale

A risk management plan can help people who self-harm reduce their risk of self-harming again. It should be based on a risk assessment and developed with the person who has self-harmed, who should have joint ownership of the plan. They should fully understand the content of the plan, including what can be done if they are at risk of self-harming again and who to contact in a crisis.

Quality measure

Structure
Evidence of local arrangements to ensure that people receiving continuing support for self-harm have a collaboratively developed risk management plan.
Process
Proportion of people receiving continuing support for self-harm who have a collaboratively developed risk management plan.
Numerator: the number of people in the denominator who have a collaboratively developed risk management plan.
Denominator: the number of people receiving continuing support for self-harm.

Description of what the quality statement means for each audience

Service providers ensure that collaboratively developed risk management plans are in place for people receiving continuing support for self-harm.
Healthcare professionals ensure that people receiving continuing support for self-harm have a collaboratively developed risk management plan.
Commissioners ensure that they commission services that have collaboratively developed risk management plans in place for people receiving continuing support for self-harm.
People who are having long-term support after self-harming have a risk management plan developed with their healthcare professional that helps them reduce their risk of harming themselves again.

Source guidance

NICE clinical guideline 133 recommendations 1.4.3 and 1.4.4

Data source

Structure
Local data collection.
Process
Local data collection.

Definitions

People receiving continuing support for self-harm
Children or young people (aged 8 years and older) and adults who have carried out an act of self-poisoning or self-injury, irrespective of motivation, and are receiving longer-term psychological treatment and management. It includes people with both single and recurrent episodes of self-harm. It does not include people having immediate physical treatment or management for self-harm in emergency departments.
Risk management plan
NICE clinical guideline 133 recommendation 1.4.4 states that a risk management plan should:
  • address each of the long-term and more immediate risks identified in the risk assessment
  • address the specific factors (psychological, pharmacological, social and relational) identified in the assessment as associated with increased risk, with the agreed aim of reducing the risk of repetition of self-harm and/or the risk of suicide
  • include a crisis plan outlining self-management strategies and how to access services during a crisis when self-management strategies fail
  • ensure that the risk management plan is consistent with the long-term treatment strategy.

Equality and diversity considerations

NICE clinical guideline 133 recommendation 1.3.3 highlights the higher risks of suicide following self-harm in people aged over 65 years. These risks should be reflected in risk management plans.

Psychological interventions

This quality statement is taken from the self-harm quality standard. The quality standard defines clinical best practice for self-harm and should be read in full.

Quality statement

People receiving continuing support for self-harm have a discussion with their lead healthcare professional about the potential benefits of psychological interventions specifically structured for people who self-harm.

Rationale

There is some evidence that psychological therapies specifically structured for people who self-harm can be effective in reducing repetition of self-harm. The decision to refer for psychological therapy should be based on a discussion between the service user and healthcare professional about the likely benefits.

Quality measure

Structure
Evidence of local arrangements to provide psychological interventions specifically structured for people who self-harm.
Process
a) Proportion of people receiving continuing support for self-harm who have a record of a discussion with their lead healthcare professional about the potential benefits of psychological interventions specifically structured for people who self-harm.
Numerator: the number of people in the denominator who have a record of a discussion with their lead healthcare professional about the potential benefits of psychological interventions specifically structured for people who self-harm.
Denominator: the number of people receiving continuing support for self-harm.
b) Proportion of people who self-harm who accept referral for psychological intervention and receive at least 3 sessions of a psychological intervention specifically structured for people who self-harm.
Numerator: the number of people in the denominator receiving at least 3 sessions of a psychological intervention specifically structured for people who self-harm.
Denominator: the number of people who self-harm who accept referral for psychological intervention.

Description of what the quality statement means for each audience

Service providers ensure that systems are in place for healthcare professionals to refer people receiving continuing support for self-harm for 3 to 12 sessions of a psychological intervention specifically structured for people who self-harm.
Healthcare professionals ensure that they discuss with people receiving continuing support for self-harm the potential benefits of psychological interventions specifically structured for people who self-harm.
Commissioners ensure that they commission services that discuss potential benefits of psychological interventions specifically structured for people who self-harm with people receiving continuing support for self-harm and can refer them for 3 to 12 sessions.
People who are having long-term support after self-harming discuss the possible benefits of psychological treatments for self-harm with their healthcare professional.

Source guidance

NICE clinical guideline 133 recommendation 1.4.8

Data source

Structure
Local data collection.
Process
a) and b) Local data collection.

Definitions

People receiving continuing support for self-harm
Children or young people (aged 8 years and older) and adults who have carried out an act of self-poisoning or self-injury, irrespective of motivation, and who are receiving longer-term psychological treatment and management. It includes people with both single and recurrent episodes of self-harm. It does not include people having immediate physical treatment or management for self-harm in emergency departments.
Lead healthcare professional
The professional with overall responsibility for the care and support of a person who has self-harmed. This could include, but is not limited to, professionals from primary care and community mental health services.
Psychological interventions
NICE clinical guideline 133 recommendation 1.4.8 states:
Consider offering 3 to 12 sessions of a psychological intervention that is specifically structured for people who self-harm, with the aim of reducing self-harm. In addition:
  • the intervention should be tailored to individual need, and could include cognitive-behavioural, psychodynamic or problem-solving elements
  • therapists should be trained and supervised in the therapy they are offering to people who self-harm
  • therapists should also be able to work collaboratively with the person to identify the problems causing distress or leading to self-harm.

Moving between services

This quality statement is taken from the self-harm quality standard. The quality standard defines clinical best practice for self-harm and should be read in full.

Quality statement

People receiving continuing support for self-harm and moving between mental health services have a collaboratively developed plan describing how support will be provided during the transition.

Rationale

Moving to different mental health services (for example, from services for young people to services for adults) can be a difficult period for people who self-harm. Unless there are plans to manage these transitions, service users can feel isolated and unsupported, and be at increased risk of further self-harm. It is important that service users are involved in agreeing how their support will be managed and understand who they can contact in a crisis.

Quality measure

Structure
Evidence of local arrangements to ensure that providers collaboratively plan in advance and coordinate effectively when people who have self-harmed move between mental health services.
Process
Proportion of people receiving continuing support for self-harm and moving between mental health services who have a collaboratively developed plan describing how support will be provided during the transition.
Numerator: the number of people in the denominator with a collaboratively developed plan describing how support will be provided during the transition.
Denominator: the number of people receiving continuing support for self-harm and moving between mental health services.

Description of what the quality statement means for each audience

Service providers ensure that systems are in place to coordinate effectively with other providers when people who have self-harmed move between mental health services.
Healthcare professionals ensure that people receiving continuing support for self-harm and moving between mental health services have a collaboratively developed plan describing how support will be provided during the transition.
Commissioners ensure that they commission services that provide people receiving continuing support for self-harm and moving between mental health services with a collaboratively developed plan describing how support will be provided during the transition.
People who are having long-term support after self-harming and are moving between mental health services agree a plan with their healthcare professionals that describes how they will be supported while they move from one service to another.

Source guidance

NICE clinical guideline 133 recommendation 1.1.25

Data source

Structure
Local data collection.
Process
Local data collection.

Definition

People moving between mental health services for continuing support for self-harm
Children or young people (aged 8 years and older) and adults who have carried out an act of self-poisoning or self-injury, irrespective of motivation, who are receiving longer-term psychological treatment and are moving from child and adolescent to adult mental health services, or from one adult mental health service to another. Continuing support refers to longer-term psychological treatment and management. It includes people with both single and recurrent episodes of self-harm. It does not include people having immediate physical treatment or management for self-harm in emergency departments.

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

All healthcare professionals who are able to offer activated charcoal to people who have self-poisoned should ensure that they know how and when this should be administered. This should include:
  • knowing for which poisons activated charcoal should and should not be used
  • the potential dangers and contraindications of giving activated charcoal
  • the need to encourage and support service users when offering activated charcoal.
CAMHS professionals who work with young people who self-harm should balance the developing autonomy and capacity of the young person with perceived risks and the responsibilities and views of parents or carers.

Glossary

child and adolescent mental health services
care programme approach
National Poisons Information Service
primary care trusts
refers not just to a partner but also to friends and any person the service user considers to be important to them
selective serotonin reuptake inhibitors

Paths in this pathway

Pathway created: November 2011 Last updated: September 2019

© NICE 2019. All rights reserved. Subject to Notice of rights.

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