Self-harm and suicide-related presentations

Presentation and immediate needs

Assess injury or poisoning alongside a compassionate psychosocial assessment. Self-harm, suicidal thoughts, intent and behaviour are related but not interchangeable.

Begin assessment → History, examination and context

History, examination and context

Explore the person’s account, current thoughts, intent, planning, access to means, recent behaviour, distress, supports and immediate needs. Assess physical consequences promptly.

Consider the branch → Injury, poisoning, current intent or other urgent assessment needs?

Injury, poisoning, current intent or other urgent assessment needs?

Use clinical findings and collateral. Uncertainty needs clarification, not a default negative answer.

Yes / concerning features → Priority assessment; No / not established → Formulation and care discussion; Uncertain / not assessed → Obtain the missing information

Priority assessment

Arrange the appropriate urgent medical and mental health evaluation.

After appropriate assessment → Formulation and care discussion

Obtain the missing information

Review the examination, timeline, relevant investigations and consented collateral. Escalate urgent concerns while uncertainty is resolved.

Reassess the branch → Injury, poisoning, current intent or other urgent assessment needs?

Formulation and care discussion

Arrange appropriate medical and mental health assessment and collaborative care planning. Risk scales must not be used to predict suicide or determine discharge or access to treatment.

Agree follow-up → Reassess and follow up

Reassess and follow up

Agree specific follow-up, crisis contacts appropriate to the location, support and means-safety discussion. Record a formulation and uncertainties rather than a numerical safety verdict.