Self-harm

Abstract

Self-harm is one of the most common reasons for presentation to hospital. It reflects distress rather than a diagnosis in itself. This article focuses on the management of people presenting to hospital with behaviour attributed to intent to harm themselves. Self-harm is associated with a significantly increased risk of future suicide, around 10% dying by suicide within 10 years, with the risk being greatest in the first month. The UK National Institute for Health and Care Excellence quality standards and guidelines for the short-term management of self-harm make recommendations relevant to all healthcare professionals, emphasizing the importance of parallel psychosocial and physical management and assessment of the risk of further self-harm or suicide. Observation levels and discharge plans are also important. Current mental illness is a major risk factor for suicide, as are 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 individuals who are middle-aged or elderly, have substance misuse or frequently self-harm. There are several standardized tools to aid risk assessment but none has adequate sensitivity and specificity to replace clinical judgement.