Health professionals who encounter someone who has self-harmed should refer them to a mental health specialist for a formal assessment as soon as possible, new guidance from the National Institute for Health and Care Excellence (NICE) states.
NICE has recommended that health professionals who are not mental health specialists but who have provided initial care to somebody who has self-harmed should organise a comprehensive psychosocial assessment at the earliest opportunity. This is so that the individual can get the help they need, as well as a diagnosis or more information about any mental health condition they have.
The guidance, which is subject to consultation, is aimed at all people working in all health settings, including occupational health professionals.
It also includes specific advice for health professionals working in sectors where they might encounter people at a higher risk of self-harming, including schools and prisons.
Although self-harm is one of the most common reasons for hospital attendance, with more than 200,000 hospital presentations in England each year, only a minority of people who have self-harmed have sought medical assistance at a hospital, according to NICE.
One in five people who have self-harmed will repeat self-harm within a year, and people who have self-harmed are at 30- to 50-times at risk of suicide within a year.
Dr Paul Chrisp, director of the centre for guidelines at NICE, said: “Self-harm is a growing problem and should be everyone’s business to tackle – not just those working in the mental health sector.
“These guidelines set out a way for every person who self-harms to be able to get the support and treatment they need.”
The guidance recommends that health professionals who encounter a person who has self-harmed should:
- treat the person with respect, dignity and kindness
- establish the means of self-harm and, if accessible to the person, discuss removing this with therapeutic collaboration or negotiation, or limit the potential of immediate risk
- assess whether there are concerns about capacity, competence, consent or duty of care. If necessary, they should seek advice from a senior colleague or appropriate clinical support
- seek consent to liaise with those involved in the person’s care, including family members and carers, to help understand the context of and reasons for the self-harm
- discuss with the person their current support network and any coping strategies.
The guidance also sets out best practice for mental health professionals who carry out psychosocial assessments, including making appropriate adjustments for physical, mental health and neurodevelopmental conditions; and providing the option for the assessment to be carried out by a health professional of the same sex.
Cognitive behavioural therapy (CBT) should be offered to adults who self-harm, it suggests, and health professionals should consider developing a “safety plan” with the individual, including coping strategies, contact details for mental health services and identification of self-harm triggers.
Professor Nav Kapur, topic advisor for the self-harm guidelines and professor of psychiatry and population health at the University of Manchester, said: “Self-harm can occur at any age and present to any setting.
“Historically, people who have harmed themselves have had a highly variable experience of services. This new guideline is an opportunity to make things better, particularly from the point of view of assessment and aftercare.”