National Institute for Health and Clinical Excellence (NICE)
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Self-harm is everyone’s business, NICE says in new draft guideline

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 assessment, management and preventing recurrence of self-harm guideline provides information, for the first time, for people working in education and criminal justice settings.

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.

The guideline calls for non-specialists who have provided initial care to organise a comprehensive psychosocial 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 psychosocial 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.

Self-harm is defined as intentional self-poisoning or injury irrespective of the apparent purpose of the act.

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.

Dr Paul Chrisp, director of the centre for guidelines at NICE, yesterday said:

“Self-harm is a growing problem and should be everyone’s business to tackle – not just those working in the mental health sector.

“It is important that our committee has made recommendations for education and criminal justice settings as data in the past few years has shown that people working within these sectors would benefit from clear guidance about how they should help someone who is self-harming.

“These guidelines set out a way for every person who self-harms to be able to get the support and treatment they need.”

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).

Professor Nav Kapur, topic advisor for the self-harm guideline and professor of psychiatry and population health at the University of Manchester yesterday 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.”

A public consultation has now begun on the recommendations via until Tuesday 1 March.


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