Synopsis
Combine toxicological care with an early psychosocial assessment, formulate ongoing safety needs and arrange a specific shared plan after intentional self-poisoning.
- Self-harm includes intentional self-poisoning irrespective of the stated purpose or apparent lethality.
- Begin psychosocial assessment at the earliest opportunity alongside physical treatment, rather than waiting for every medical investigation to finish.
- Intoxication is not an automatic exclusion; assess the person's ability to engage and review repeatedly if they cannot yet participate.
- Explore the circumstances, meaning and function of the overdose, current thoughts, previous episodes, strengths and practical support.
- Do not use numerical risk scales or low, medium and high categories to predict suicide or determine discharge.
- Create a collaborative safety plan with warning signs, coping actions, supportive contacts, emergency access and safer access to medicines.
- With ongoing safety concerns, NICE recommends initial aftercare within forty-eight hours of the psychosocial assessment.
Key red flags
An uncertain ingestion time, sustained-release preparation, mixed overdose, impaired consciousness, seizure or ECG abnormality requires a toxicological plan before discharge is considered.
Persistent intent, preparations for another attempt, access to lethal means, severe agitation, psychosis or an unsafe home environment needs prompt senior mental-health review and protection.