Self-harm

Abstract 

Self-harm is one of the commonest reasons for presentation to hospital. It is a reflection of distress rather than a diagnosis in itself. This article focuses on the management of people who present to hospital with behaviour that they report, or which staff suspect, was related to an intent to harm themselves, usually in relation to suicidal-related impulses. Self-harm is associated with a significantly increased risk of future suicide: around 10% of those who self-harm will commit suicide within 10 years. The National Institute for Health and Clinical Excellence (NICE) guidelines for the short-term management of self-harm make recommendations relevant to all healthcare professionals: it is important to instigate psychosocial and physical management in parallel and to assess the risk of further self-harm or suicide. Current mental illness is a major risk factor for suicide, along with high intent of suicide at the time of the self-harm, a history of self-harm, current physical illness, poor social support and demographic variables. Risk of further self-harm is also higher in certain groups, including those with substance misuse, the elderly and those who frequently self-harm. There are several standardized tools to aid risk assessment but none have adequate sensitivity and specificity to replace clinical judgement. In addition to physical management, it is necessary to consider observation levels and discharge plans.

Keywords: mental disorder, psychosocial management, risk assessment, self-harm, suicide