National Institute for Health and Clinical Excellence (NICE)
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Offer psychological interventions to people who self-harm

Psychological interventions should be offered to people who self-harm to help them overcome their behavioural problems, latest NICE guidance suggests.

Healthcare professionals should offer 3 to 12 sessions of a psychological intervention that is specifically structured for people who self-harm.

The intervention should aim to reduce self-harm and should be tailored to individual need and could include cognitive-behavioural, psychodynamic or problem-solving elements.

Therapists should be trained and supervised in the therapy they are offering to people who self-harm. Therapists should also be able to work collaboratively with the person to identify the problems causing distress or leading to self-harm.

The guidance on the longer-term management and secondary prevention of self-harm in primary and secondary care also recommends that care plans are developed collaboratively with the person who self-harms and, provided the person agrees, with their family, carers or significant others.

The care plan should identify realistic and optimistic long-term goals, including employment and occupation and identify short-term treatment goals (linked to the long-term goals) and steps to achieve them.

Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE, said: “Self-harm is a very broad term for a behaviour that can be expressed by those affected in very individual ways, which is why it is so important that each person receives the right care plan for them.

“The previous NICE guideline on the short-term treatment of self-harm focused on the first 48 hours of an episode and the care they received in the Emergency Department. This new guideline aims to help healthcare professionals support, in the longer term, people who are known to self-harm in reducing and then stopping the behaviour.”

Professor Tim Kendall, Director of the National Collaborating Centre for Mental Health who helped develop the recommendations, said: “Self-harm is very common and involves a wide range of methods, the most common being self-poisoning with prescribed or over the counter medicines, or by cutting.

“People self-harm for numerous reasons, and although self harm is not usually an attempt at committing suicide, it is a way of expressing deeper emotional feelings, such as low self-esteem, the emotional results of previous abuse and hurts.

“However, people who self harm are much more likely to die by suicide, and many suffer from long term physical effects of self injury and self poisoning, as well as psychiatric problems such as depression. It is very important that we help identify people who self harm sooner and to help them come to terms with the underlying problems and access treatment when they need it. This guideline is a really important step to achieving this”.

Professor Navneet Kapur, Professor of Psychiatry and Population Health at the University of Manchester and Chair of the Guideline Development Group, said: “People may keep self-harm a secret which means it is difficult to know how widespread it is.

“Many cases are unreported unless medical treatment is required. However, it is thought to be common, especially amongst young people, with one UK study finding that 1 in 10 girls aged 15-16 had self-harmed in the previous year.”

“This new guideline is an important step in improving health professionals' understanding of self-harm and thereby helping to ensure people receive the treatment and support they need,” he added.

NICE has produced a number of support tools to help put this guidance into practice including a podcast with Professor Kapur and a podcast with service user Gareth Allen.

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