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Self-harm is ‘not just responsibility of mental health professionals’

All professionals working across the health and social care system have a role to play in supporting people who self-harm, the National Institute for Health and Care Excellence has stated.

depressed teen

In draft guidance, NICE said the issue should not just be seen as the responsibility of those with mental health expertise.

Dr Paul Chrisp, director of the centre for guidelines at NICE, 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.”

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.

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.

The independent NICE committee has drawn up new recommendations for people working in settings from primary care to psychiatry in the guidance which has been refreshed for the first time in 11 years.

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 responsibilities of non-mental health specialists including 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emergency department professionals, those working in general hospital settings and in social care are outlined in the draft guidance. There are also recommendations for ambulance staff and paramedics.

Non mental health specialists, who have provided initial care, should arrange a comprehensive psychosocial assessment to be carried out by a specialist mental health professional, at the earliest opportunity following an episode of self-harm.

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.

Only a minority of people who have self-harmed present to hospital services, but it remains one of the most common reasons for hospital attendance. Some estimates suggest upwards of 200,000 presentations in England every year, the majority for self-poisoning.

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.

Structured cognitive behavioural therapy (CBT)-based psychological intervention should be provided to 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 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 with a closing date of Tuesday 1 March.

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