Synopsis
Respond compassionately to adolescent self-harm, treat physical injury or poisoning, complete a developmentally informed psychosocial and safeguarding assessment, formulate suicide risk without discredited scoring, and provide collaborative safety planning and rapid aftercare.
- Self-harm means intentional self-poisoning or injury irrespective of the stated purpose; functions and suicidal intent can coexist and change between or within episodes.
- Use calm, validating and direct language, address pain and privacy, and ask what happened before, during and after the act rather than demanding a single reason.
- NICE says not to use risk scales to predict suicide or repetition, determine access to treatment or decide discharge, and not to classify global risk as low, medium or high.
- A skilled psychosocial assessment explores function, current and future intent, means, mental disorder, trauma, substances, development, family, peers, education, online life, safeguarding, strengths and goals.
- Do not postpone the mental-health assessment until every physical intervention is complete when the young person can engage; physical and psychosocial care should proceed in parallel.
- Consider general-hospital admission when safety concerns, abuse or exploitation, incomplete safeguarding planning or inability to engage in assessment make discharge unsafe, not as a punishment for self-harm.
- Create a personalised safety plan with warning signs, coping steps, supportive people and places, service contacts, emergency options and collaborative restriction of lethal means.
- When ongoing safety concerns remain, NICE recommends initial aftercare within 48 hours of the psychosocial assessment, with responsibility explicitly assigned.
- Do not prescribe a medicine specifically to reduce self-harm; identify and treat coexisting depression, anxiety, trauma, substance use or other disorders through their evidence-based pathways.
Key red flags
A current suicide plan, preparatory acts, intent to die, regret at survival, rehearsing, concealment or immediate access to highly lethal means requires urgent senior formulation and containment.
Hanging or strangulation, significant overdose, deep wounds, uncontrolled bleeding, reduced consciousness, seizure or severe pain requires emergency medical treatment even if the adolescent later minimises harm.
Psychosis, mania, intoxication, severe agitation, dissociation, hopelessness or rapidly changing intent can reduce the reliability of an apparently reassuring conversation.
Suspected abuse, trafficking, sexual exploitation, coercive control, bullying or fear of returning home may make routine discharge to carers unsafe and demands safeguarding action.
Repeated episodes, escalating lethality, stockpiling medication, online suicide content, anniversary stress or loss of support should alter formulation despite any low questionnaire score.
Investigation priorities
Identify poisoning, bleeding, airway, neurological, burn, infection and concealed injury requiring treatment.
Management branches
An adolescent presents after self-poisoning or intentional injury or with current suicidal danger.
- Treat airway, breathing, circulation, glucose, poisoning, bleeding, pain and hidden injury promptly and respectfully.
- Arrange age-appropriate psychosocial assessment as soon as the young person can participate, without unnecessary delay until medical treatment ends.
- Maintain a safe environment, communicate across medical and mental-health teams and activate safeguarding when return home or carer involvement may be unsafe.