Synopsis
Provide consistent physical and psychosocial care after every episode of self-harm, understand changing functions and safety needs, reduce access to lethal means and avoid punitive, dismissive or diagnosis-driven responses.
- Self-harm means intentional self-poisoning or injury irrespective of apparent purpose; suicidal and non-suicidal intentions can coexist or change within one episode.
- Treat the physical consequences and pain promptly and respectfully; familiarity, a personality diagnosis or previous normal tests never justifies delayed care.
- Offer a psychosocial assessment at the earliest opportunity and do not wait for medical treatment to finish or use an alcohol level alone to postpone it.
- Explore what happened, the function for this person at this time, intent, method, access to means, mental state, needs, strengths, safeguarding and future events.
- Do not use a score or global low, medium or high category to predict suicide, determine treatment or decide discharge.
- Use person-first behavioural language; avoid attention-seeking, manipulative, frequent flyer, failed attempt and other terms that assign motive or blame.
- Develop or review a collaborative care and safety plan, consider safer prescribing and provide initial aftercare within 48 hours when safety concerns continue.
- Frequent episodes or ineffective treatment should prompt a multidisciplinary review with the person, one coordinator and a jointly agreed approach rather than exclusion.
Key red flags
A more lethal method, larger dose, concealment, preparation, farewell behaviour or persistent intent makes the current episode different even when self-harm is recurrent.
Unknown ingestion, modified-release medicine, delayed-toxicity agent or unreliable timing needs urgent poison-information and medical assessment despite initially normal observations.
Increasing frequency, loss of control, intoxication, severe hopelessness or withdrawal of usual support signals a changing trajectory requiring multidisciplinary review.
Self-harm linked to domestic abuse, exploitation, bullying, custody, unsafe care or child risk requires active safeguarding and environmental intervention.
Investigation priorities
Identify airway, breathing, circulation, neurological, exposure, wound and pain priorities after the act.
Management branches
A person presents after intentional self-poisoning or injury.
- Triage and treat physical harm, pain and intoxication promptly, obtain method-specific advice and provide compassionate observation in an appropriate environment.
- Begin psychosocial engagement as early as the person's condition allows, assessing current intent, function, means, mental state, capacity, safeguarding and support.
- Coordinate physical and mental-health decisions, explain the plan and ensure no discharge occurs on the basis of a risk score or diagnosis alone.