Self-harm and suicide-related presentations

Describe the presentation precisely #

Self-harm describes intentional self-injury or self-poisoning, regardless of the stated purpose. Distinguish the act, its medical consequences, suicidal intent and the surrounding psychiatric or social formulation. A denial of intent after an episode does not remove the need to understand the sequence and current circumstances.

Focused psychiatric and psychosocial assessment #

Ask about current thoughts, frequency, intent, preparation, access to means and past attempts. Explore mood, hopelessness, psychosis, agitation, substance use, sleep, recent losses, violence or abuse, supports and reasons for living. Ask privately where appropriate. Current suicidal thoughts or inability to maintain immediate safety require urgent evaluation and appropriate observation, not an unattended referral.

Formulation beyond the act #

Physical consequences and toxicology #

Establish what happened, when, possible co-ingestion and the evolving physical state. Investigation and treatment depend on the injury or suspected toxin; obtain emergency medical and poison-service advice when indicated. This chapter does not provide a universal overdose clearance interval. Document who is managing the physical consequences and how clinical information is being shared.

Intervention and collaborative planning #

Offer a tailored CBT-informed intervention; NICE describes a usual starting framework of 4–10 sessions, with more when needed. No medicine is recommended specifically to reduce self-harm; treat established coexisting disorders on their own indications. Develop a practical safety plan and address access to potentially lethal medicines and other means.

Doses & prescribing #

Each prescribing record identifies its population and source jurisdiction; international labeling does not establish Indian approval. The clinician selects treatment after assessment.

This presentation does not have a routine diagnosis-based drug regimen. Indication-specific prescribing and its limitations are described in the treatment section.

Recurrent episodes or disrupted care #

Review what the previous plan asked the person to do, whether it was accessible during distress and which practical barriers remain. Frequent presentations warrant coordinated multidisciplinary review and a named clinician, rather than punitive responses. Reassess each episode; a familiar pattern does not establish that the medical or psychological consequences are unchanged.

Continuity and medication access #

Coordinate with the existing clinician, pharmacy and support network with appropriate consent. Discuss manageable prescription quantities and disposal or secure storage of unused medicines. A safety plan should be available to the person, understandable in their preferred language and usable outside clinic hours. It is a collaborative action plan, not a guarantee.

Communication and safeguarding #

Adapt assessment for cognitive, sensory, language and developmental needs. Consider safeguarding and coercive relationships separately from whether the person wants admission. Involve trusted supports when helpful and appropriate; do not assume every accompanying relative is safe or supportive.

Disposition and early aftercare #

Document the clinical formulation, unresolved concerns and reasons for the chosen setting. Where ongoing safety concerns remain, NICE recommends initial aftercare within 48 hours of psychosocial assessment. Arrange a concrete appointment and contact route; simply giving a telephone number may not overcome access barriers. Confirm the handover rather than assuming a referral was received.

Avoid false reassurance #

Do not use “low/medium/high” score categories to decide discharge or access to treatment. NIMH distinguishes a safety plan from an ineffective no-suicide contract. A negative response to needing help does not itself establish safety. Screening instruments support identification and conversation; they cannot replace formulation or clinical responsibility.

Assessment tools #

Open assessment flowchart ↗

Choose the instrument for its intended purpose; interpretation accompanies the linked tool.

Patient discussion #