Synopsis
Respond compassionately to self-harm or suicidal thoughts, treat physical injury or poisoning first, develop an individual formulation rather than a score-based prediction, identify immediate and contextual danger, create a collaborative safety plan, and secure psychosocial assessment and reliable follow-up.
- Treat injury, overdose and altered physiology first while beginning a compassionate mental-state and safeguarding assessment; psychological need never makes physical symptoms less real.
- Ask directly about thoughts of death, current intent, plan, preparation, access to means, deterrents, expected rescue and what has changed today; direct questions do not create suicidal ideas.
- Do not use a risk scale or low, medium or high label to predict suicide or decide discharge; build an individual formulation of needs, risks, strengths and near-term triggers.
- Explore the function and sequence of self-harm, previous episodes, medical lethality, impulsivity, substances, sleep, psychosis, mood, eating, neurodevelopment and recent service transitions.
- Speak privately but involve parents or a trusted adult when safe and necessary, explaining confidentiality limits and checking whether the home response could involve violence, rejection or coercion.
- Create a written safety plan with personal warning signs, internal coping actions, supportive people and places, professional crisis contacts, restriction of relevant means and reasons for staying alive.
- Arrange psychosocial assessment by an appropriately skilled mental-health professional after every self-harm presentation and make transfer and follow-up active rather than handing over a telephone number alone.
- Provide respectful wound and scar care, medicine-supply review, sleep and substance support and a rapid route back if suicidal intensity, injury or home safety worsens.
Key red flags
A current plan, preparatory behaviour, rehearsal, access to lethal means, suicide note or belief that death is inevitable indicates high immediate concern regardless of a screening score.
Escalating frequency or lethality, multiple methods, regret at survival, concealed rescue prevention or a recent discharge or bereavement increases concern.
Severe intoxication, psychosis, mania, agitation, dissociation, cognitive impairment or overwhelming shame may make stated reassurance unreliable until the acute state resolves.
Abuse, exploitation, bullying, family violence, homelessness, criminal involvement, online contagion or an unsafe adult response requires parallel safeguarding action.
Unexpected drowsiness, vomiting, abdominal pain, arrhythmia, bleeding or inconsistent overdose history requires ongoing medical assessment because toxicity can be delayed.
Investigation priorities
Detect and treat injury, poisoning and physiological compromise before deterioration.
Management branches
There is injury, poisoning, altered physiology, current intent, accessible means or inability to remain safe.
- Use ABCDE, control bleeding, treat pain and follow method-specific toxicology or surgical guidance without waiting for psychiatric clearance.
- Provide compassionate observation in an appropriate safe area and remove immediate means without humiliating searches or isolation.
- Obtain urgent paediatric and mental-health review, involve a safe carer and activate safeguarding or police support only as proportionate.
- Use senior legal and mental-health advice if the young person attempts to leave or refuses essential life-saving assessment.