All professionals working across the health and social care system have a role to play in supporting people who self-harm and the issue should not just be seen as the responsibility of those with mental health expertise, NICE has said in a new draft guideline.
In the first new guideline for 11 years looking at self-harm, the independent NICE committee has drawn up new recommendations for people working in settings from primary care to psychiatry.
The new guideline sets out the responsibilities of non-mental health specialists when caring for people who self-harm. This includes health and social care professionals working in primary care, non-mental health emergency department professionals, those working in general hospital settings and in social care. There are also recommendations for ambulance staff and paramedics, and for the first time it also include information for people working in education and criminal justice settings.
Join OnMedica to access more clinical updates
The guideline calls for non-specialists who have provided initial care to organise a comprehensive psycho-social assessment, at the earliest opportunity after an episode of self-harm, and that this should be carried out by a specialist mental health professional.
The aim of the comprehensive psycho-social assessment is to:
- develop a relationship with the person
- begin to understand why the person has self-harmed
- ensure that the person receives the care they need
- gives the person and their family members or carers information about their condition and diagnosis.
The guideline recommends offering a cognitive behavioural therapy (CBT)-based psychological intervention that is specifically structured for adults who self-harm.
For children and young people with significant emotional dysregulation difficulties who have frequent episodes of self-harm, mental health professionals should consider treating them with a dialectical behaviour therapy adapted for adolescents (DBT-A).
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.
—Professor Nav Kapur, topic advisor for the self-harm guideline and
professor of psychiatry and population health
at the University of Manchester
Self-harm is defined as intentional self-poisoning or injury irrespective of the apparent purpose of the act.
According to NICE, only a minority of people who have self-harmed present to hospital services, but it remains one of the commonest reasons for hospital attendance. Some estimates suggest upwards of 200,000 presentations in England every year, the majority for self-poisoning.
While prevalence statistics are unreliable because it is a problem that is sometimes hidden, a recent national study reported that 7.3% of girls, and 3.6% of boys, aged 11 to 16, had self-harmed or attempted suicide at some point. The figures for 17 to 19-year-olds were 21.5% for girls and 9.7% for boys.
Self-harm can occur at any age, but there is evidence that there has been a recent increase in self-harm among young people in England.
For some people, self-harm is a one-off episode but repetition is also common, with 20% of people repeating self-harm within a year.
People who have self-harmed are at greatly increased risk of suicide, with a 30- to 50-fold increase in risk in the year after hospital presentation.
A public consultation has now begun on the recommendations until Tuesday 1 March.
Related content on OnMedica
News: Warning over effects of pandemic on young people’s mental health
Known triggers for self-harm and poor mental health are aggravated by pandemic restrictions, warn experts
Quick case-based quiz: 16-year-old with an overdose attempt
What options are there for managing her self-harm? >>Take the quiz