Previous changes

August 2024 — reviewed. A literature search was conducted in July 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The topic has undergone restructuring. No major changes to the recommendations have been made.

November 2023 — minor update. Update to the text relating to assessment of suicide risk added. 

September 2022 — minor update. This topic has been updated to align with the NICE guideline Self-harm: assessment, management and preventing recurrence, which replaces the NICE guidelines Self-harm in over 8s: short-term management and prevention of recurrence and Self-harm in over 8s: long-term management. The updated NICE quality standard Self-harm has also been added. This topic has been updated to align with the NICE guideline Self-harm: assessment, management and preventing recurrence, which replaces the NICE guidelines Self-harm in over 8s: short-term management and prevention of recurrence and Self-harm in over 8s: long-term management. The updated NICE quality standard Self-harm has also been added. 

August 2020 — minor update. Broken URL link updated.

January to February 2020 — reviewed. A literature search was conducted in January 2020 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The topic has undergone restructuring. No major changes to the recommendations have been made.

April to August 2014 — new topic. The evidence-base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.

New evidence

Evidence-based guidelines

• NICE (2025) Gambling-related harms: identification, assessment and management National Institute for Health and Care Excellence Homepage | NICE [Free full-text]

HTAs (Health Technology Assessments)

No new HTAs since 1 July 2024.

Economic appraisals

No new economic appraisals relevant to England since 1 July 2024.

Systematic reviews and meta-analyses

No new systematic reviews or meta-analysis which reach the CKS threshold for inclusion since 1 July 2024.

Primary evidence

No new primary evidence which reaches the CKS threshold for inclusion published since 1 July 2024.

New policies

No new national policies or guidelines since 1 July 2024.

New safety alerts

No new safety alerts since 1 July 2024.

Changes in product availability

No changes in product availability since 1 July 2024.

How should I manage a person presenting following an act of self-harm?

• When a person presents in primary care following an act of self-harm: 
  • Treat the person with respect, dignity and compassion, with an awareness of cultural sensitivity.
  • Establish the means of self-harm and, if accessible to the person, discuss removing this with therapeutic collaboration or negotiation, to keep the person safe.
    • For information on the management of self-poisoning, see the CKS topic on Poisoning or overdose.
    • Be aware that for people who have self-poisoned, accurate assessment may be difficult as the nature and quantity of the ingested substances may not be clear. In most circumstances, people who have self-poisoned should, therefore, be urgently referred to the nearest emergency department. Where there is uncertainty about the need for referral, consider accessing TOXBASE^® (the clinical toxicology database of the National Poisons Information Service [NPIS]). For more information, see the TOXBASE^® website http://www.toxbase.org/, or telephone the UK NPIS on 0344 892 0111 for a patient-specific risk assessment.
  • Assess whether there are concerns about capacity, competence, consent or duty of care, and seek advice from a senior colleague or appropriate clinical support if necessary; be aware and accept that the person may have a different view and this needs to be taken into account.
  • Seek consent to liaise with those involved in the person's care (including family members and carers, as appropriate) to gather information to understand the context of and reasons for the self-harm.
  • Discuss with the person and their families or carers (as appropriate), their current support network, and any safety plan or coping strategies.
  • Establish the following as soon as possible:
    • The severity of the injury and how urgently medical treatment is needed.
    • The person's emotional and mental state, and level of distress.
    • Whether there is immediate concern about the person's safety.
    • Whether there are any safeguarding concerns.
    • Whether the person has a care plan.
    • The need to refer the person to a specialist mental health service for assessment.
• For people who find it difficult to vocalise their distress, support them their family members or carers (as appropriate) in trying alternative methods of communication (such as non-verbal language, letters, emotional wellbeing passports, and using agreed safe words, phrases or emojis).
• Carry out concurrent physical healthcare and a psychosocial assessment as soon as possible after a self-harm episode. 
  • Assess their needs, including a full mental health and social needs assessment.
    • This should include the social, psychological and motivational factors surrounding the act of self-harm. It should also explore any suicidal intent and any feelings of hopelessness.
    • It should also include a full mental health and social needs assessment.
  • Assess their risks, including clinical and demographic factors associated with their self-harm.
    • This should identify the clinical and demographic factors that are associated with a higher risk for further self-harm or suicide. It should also identify any psychological characteristics such as depression, or other psychiatric co-morbidity.
      
  • If the appropriate expertise is not available in primary care arrange referral to a mental health specialist.  
• Risk assessment tools and scales should not be used to assess future risk of suicide or episodes of self-harm.
• Risk assessment tools and scales should not be used to guide who is offered treatment or discharge.
• Consider referring the person to mental health or social care services for a psychosocial assessment or informing their existing mental health team, with consent from the person and their family members or carers (as appropriate). 
• Make referral to mental health professionals a priority when: 
  • The person's levels of concern or distress are rising, high, or sustained.
  • The frequency or degree of self-harm or suicidal intent is increasing.
  • The person providing assessment in primary care is concerned.
  • The person asks for further support from mental health services.
  • Levels of distress in family members or carers of children, young people and adults are rising, high, or sustained, despite attempts to help.
• Consider admission to a general hospital after an episode of self-harm if:
  • There are concerns about the safety of the person (for example, the person is at risk of violence, abuse, or exploitation) and psychiatric admission is not indicated.
  • Safeguarding planning needs to be completed and psychiatric admission is not indicated.
  • The person is unable to engage in a psychosocial assessment (for example, because they are too distressed or intoxicated).
• Do not use aversive treatment, punitive approaches or criminal justice approaches such as community protection notices, criminal behaviour orders, or prosecution for high service use as an intervention for frequent self-harm episodes.
• Discuss and agree with the person, and their family members and carers (as appropriate) the purpose, format, and frequency of initial aftercare and which services will be involved in their care. 
  • Record this in the person's care plan and ensure that the person and their family members and carers have a copy of the plan and contact details for the team providing the aftercare.
• Ensure that a mental health professional with appropriate experience carries out a psychosocial assessment in: 
  • Older people. 
  • People with a learning disability.
  • Children and young people.
• Assess for any safeguarding concerns in children, young people, or vulnerable adults:
  • Dependent for their care on the person presenting with an episode of self-harm.
  • Presenting with an episode of self-harm that may have occurred in response to child maltreatment, domestic violence, or other violence or exploitation. For more information, see the CKS topic on Child maltreatment - recognition and management.
    • Where safeguarding concerns are identified, follow local safeguarding procedures.
• If the person's physical injuries and/or acute mental state are significant, offer urgent referral to the nearest emergency department. If there is any doubt seek advice from an emergency department consultant. 
• If referral to an emergency department is necessary, consider arranging for the person to be accompanied, particularly if there is a risk of further self-harm, or the person is reluctant to attend, or very distressed.
• If a child or young person has self-harmed, ensure they are referred to the nearest emergency department with expertise in dealing with people under the age of 16 years.
• If the person's physical injuries and/or acute mental state are not thought to necessitate referral to an emergency department:
  • Provide wound management as appropriate.
  • Determine the need for urgent referral to appropriate secondary mental health services, or onward referral to the community mental health team, and referral to drug and alcohol services. Consider:
    
    • The person's psychosocial needs, including home environment, living arrangements, social and family support network, personal relationships that may be supportive or represent a threat, needs of any dependent children, need for social care and support, history leading to the episode of self-harm/apparent motivation, recent life events and current difficulties, functioning at work and finances, need for occupational rehabilitation or financial advice, personal skills, strengths, assets, coping strategies, and the need for psychological intervention.
• Provide emotional support and help if necessary to the relatives/carers of people who have self-harmed, as they may also be experiencing high levels of distress and anxiety.
• Arrange follow up for the person who has self-harmed, within 48 hours of discharge from hospital to ensure any required ongoing management of psychosocial needs and risk of further self-harm or suicide. See the section on Initial follow up for more information.
• Ensure any person who has self-harmed gives informed consent for management, wherever possible.
  • If a person declines or refuses management that is perceived to be in their best interests, assess their mental capacity, to help decide whether they are unable to make an informed decision about whether to accept or refuse treatment. Mental capacity should be assumed in a person aged 16 years or over, unless there is evidence to the contrary. If possible, gather additional information from family, carers, and significant others, if the person allows.
    • If a person refuses treatment, provide information about the potential consequences of not receiving treatment, while trying to gain consent. 
    • If a person is judged to have diminished capacity and/or the presence of a significant mental health disorder, refer for an urgent mental health assessment or hospital admission, depending on clinical judgement. Healthcare professionals have a duty to act in the person's best interests. This may include taking the person to hospital for further assessment and treatment against their wishes.
    • If there is uncertainty about whether a person has capacity to make informed decisions, seek advice from a psychiatrist who has experience in assessing capacity. For more information, see the section on Assessing mental capacity.

Initial follow up

• If there are ongoing safety concerns after an episode of self-harm, provide initial aftercare within 48 hours of the psychosocial assessment.  
• If the person is being supported and given care in primary care, ensure that they have: 
  • Regular appointments for review of self-harm.
  • A medicines review.
    • Take into account the pharmacokinetic properties of medicines, for example, half-life, risk of toxicity, and the concurrent use of medicines such as benzodiazepines and opiates.
    • If necessary, contact the National Poisons Information Service for further advice.
    • For people with learning disabilities, autism, or both, the NHS England STOMP-STAMP principles may be useful. 
  • Information about available social care, voluntary and non-NHS sector support, and self-help resources.
  • Care for any coexisting mental health problems, including referral to mental health services as appropriate. 
    • For further information, see the CKS topics on Generalized anxiety disorder, Depression, Depression - antenatal and postnatal, Psychosis and schizophrenia, Bipolar disorder, Post-traumatic stress disorder, Dementia, Alcohol - problem drinking, and Opioid dependence.
• When planning treatment following self-harm, take into account any associated coexisting conditions and the psychosocial assessment. 
• Offer a structured, person-centred, cognitive behavioural therapy (CBT)-informed psychological intervention (for example, CBT or problem-solving therapy) that is specifically tailored for adults who self-harm. Ensure that the intervention: 
  • Starts as soon as possible.
  • Is typically between 4 and 10 sessions; more sessions may be needed depending on individual needs.
  • Is tailored to the person's needs and preferences.
  • For children and young people with significant emotional dysregulation difficulties who have frequent episodes of self-harm, consider dialectical behaviour therapy adapted for adolescents (DBT-A). Take into account the age of the child or young person and any planned transition between services. 
• Work collaboratively with the person, using a strengths-based approach to identify solutions to reduce their distress that leads to self-harm.
• Offer children and young people with significant emotional dysregulation who frequently self-harm, dialectic behavioural therapy adapted for adolescents (DBT-A).
  • This is typically a 16-week behaviour programme accompanied by muti-family skills training sessions, and family therapy.
  • The age of the young person needs to be considered when transferring between services.
• Consider developing a safety plan in partnership with people who have self-harmed. Safety plans should be used to: 
  • Establish the means of self-harm.
  • Recognise the triggers and warning signs of increased distress, further self-harm, or a suicidal crisis.
  • Identify individualised coping strategies, including problem-solving any factors that may act as a barrier.
  • Identify social contacts and social settings as a means of distraction from suicidal thoughts or escalating crisis.
  • Identify family members or friends to provide support and/or help resolve the crisis.
  • Include contact details for the mental health service, including out-of-hours services and emergency contact details.
  • Keep the environment safe by working collaboratively to remove or restrict lethal means of suicide.
• The safety plan should be in an accessible format and: 
  • Be developed collaboratively and compassionately between the person who has self-harmed and the professional involved in their care using the principles of shared decision-making. 
  • Be developed in collaboration with family and carers, as appropriate.
  • Use a problem-solving approach.
  • Be held by the person.
  • Be shared with the family, carers and relevant professionals and practitioners as decided by the person be accessible to the person and the professionals and practitioners involved in their care at times of crisis.
• Do not: 
  • Use diagnosis, age, substance misuse, or coexisting conditions as reasons to withhold psychological interventions for self-harm. 
  • Offer drug treatment as a specific intervention to reduce self-harm.
• Use consultations and medicines reviews as an opportunity to assess self-harm if appropriate. 
  • For example, asking about thoughts of self-harm or suicide, actual self-harm, and access to substances that might be taken in overdose (including prescribed, over-the-counter medicines, herbal remedies, and recreational drugs).
• When prescribing medicines to someone who has previously self-harmed or who may self-harm in the future, take into account: 
  • The toxicity of the prescribed medicines for people at risk of overdose (for example, opiate-containing painkillers and tricyclic antidepressants).
  • Their recreational drug and alcohol consumption, the risk of misuse, and possible interaction with prescribed medicines.
  • The person's wider access to medicines prescribed for themselves or others.
  • The need for effective communication where multiple prescribers are involved.
• Use shared decision-making to discuss limiting the quantity of medicines supplied to people with a history of self-harm (for example, weekly prescriptions), and ask them to return unwanted medicines for safe disposal.
• Ask the person whether and how they would like their family or carers to be involved in their care, and review this regularly. If the person agrees, share information with family members or carers (as appropriate), and encourage them to be involved. Take into account issues such as: 
  • Whether the person has consented for information to be shared and, if so, if the consent is limited to certain aspects of their care.
  • Any safeguarding concerns.
  • The person's mental capacity, age, and competence to make decisions.
  • The person's right to confidentiality and autonomy in decision making.
  • The balance between autonomy (in children and young people, their developing independence and maturity) and the need to involve family members or carers.
  • The balance between the possible benefits and risks of involving family members of carers and the rights of the person.
• When involving family members or carers in supporting a person who has self-harmed: 
  • Encourage a collaborative approach to:
    • Empower and support the person who has self-harmed.
    • Minimise the person's self-harm behaviours.
    • Support the person's recovery to prevent recurrence.
  • Give them opportunities to be involved in decision-making, care planning and developing safety plans to support the person beyond the initial self-harm episode, and through their care pathway.
  • Ensure that there is ongoing and timely communication with the family or carers.
  • Regularly review whether the person who has self-harmed still wants their family or carers to be involved in their care, and ensure that they know they can withdraw consent to share information at any time.
  • Note: if the person has not consented to involving their family or carers in their care, family members or carers can still provide information about the person.
• Provide information and support for people who have self-harmed, and share information with family members or carers (as appropriate). Discuss the following:
  • What is meant by the term self-harm.
  • Why people self-harm and, where possible, the specific circumstances of the person.
  • Support and treatments available.
  • Self-care including when to seek help.
  • How to deal with injuries.
  • How to manage scars.
  • Care plans and safety plans, and what they involve.
  • The impact of encountering stigma around self-harm.
  • Who will be involved in their care and how to get in touch with them.
  • Where appointments will take place.
  • What to do if they have any concerns.
  • What do to in an emergency.
  • Local services and how to get in touch with them, including out-of-hours.
  • Local peer support groups, online forums, local and national charities, and how to get in touch with them. For example:
    • Childline — a free, confidential telephone service for children, telephone 0800 1111.
    • Selfharm (www.selfharm.co.uk) — provides support for young people affected by self-harm and has online support groups.
    • YoungMinds (www.youngminds.org.uk) — has leaflets written for children about self-harm.
    • Harmless (www.harmless.org.uk) — provides support and information to people who self-harm, their friends, and families; and training for healthcare professionals.
    • Mind (www.mind.org.uk) — provides information and support, helplines, local support groups, and publications aimed at anyone who self-harms, and their friends and family.
    • National Self Harm Network (www.nshn.co.uk) — aims to support, empower, and educate people who self-harm and their families and carers.
    • Rethink Mental Illness (www.rethink.org) — provides a comprehensive factsheet about self-harm.
    • Royal College of Psychiatrists (www.rcpsych.ac.uk) — provides a variety of factsheets.
    • Sane (www.sane.org.uk) — campaigns to raise mental health awareness and provides emotional support, practical help, and information including online support.
    • The Samaritans (www.samaritans.org) — provides a free 24-hour confidential telephone helpline for anyone in a crisis, telephone 116 123. Email is also an available option but response may take several days: jo@samaritans.org.
• Provide information and support for the family members or carers (as appropriate) of the person who has self-harmed. Topics to discuss include:
  • The emotional impact on the person and their family members or carers.
  • Advice on how to cope when supporting someone who self-harms.
  • What to do if the person self-harms again.
  • How to seek help for the physical consequences of self-harm.
  • How to assist and support the person.
  • How to recognise signs that the person may self-harm.
  • Steps to reduce the likelihood of self-harm in the future.
  • How to address any gambling-related harms, where appropriate. 
  • Support for families and carers and how to access it.
  • The impact of encountering stigma around self-harm.
  • Local services and how to get in touch with them, including out-of-hours.
  • Local peer support groups, online forums, local and national charities, and how to get in touch with them. For example:
    • Royal College of Psychiatrists (www.rcpsych.ac.uk) — has a range of factsheets.
    • The Samaritans (www.samaritans.org) — have information for family and friends of people who self-harm, and information on suicide and self-harm for parents.
    • YoungMinds (www.youngminds.org.uk) — offers free confidential online and telephone support for parents, telephone 0808 8025544.
  • Their right to a formal assessment of their own needs including their physical and mental health (known as a 'carer's assessment'), and how to access this.
• Ensure that information for people who have self-harmed and their family members is: 
  • Tailored to their individual needs and circumstances, taking into account, for example, whether this is a first presentation or repeat self-harm, the severity and type of self-harm, and if the person has any coexisting health conditions, neurodevelopmental conditions or a learning disability.
  • Provided throughout their care.
  • Sensitive and empathetic.
  • Supportive and respectful.
  • Consistent with their care plan, if there is one in place.
  • Conveyed in the spirit of hope and optimism.
  • Adapted for people who may be subject to discrimination, for example, people who are physically disabled, people with neurodevelopmental conditions or a learning disability, people from underserved groups, people from Black, Asian and minority ethnic backgrounds and people who are LGBTQ+.
• Provide emotional support and help if necessary to the relatives/carers of people who have self-harmed, as they may also be experiencing high levels of distress and anxiety.
• Arrange for review and follow-up depending on clinical judgement, if the person has ongoing issues that need monitoring and support, maintaining continuity of therapeutic relationships wherever possible. See Scenario: Long term management following an act of self-harm for more information. 
• Ensure: 
  • Continuity of care, wherever possible, in the staff caring for people who have self-harmed by minimising the number of different staff they see.
  • The care plans of people who have self-harmed can be accessed by primary and secondary care plus other professionals and practitioners involved in their care. 

How should I manage a person at risk of self-harm?

• Treat the person with respect, dignity and compassion, with an awareness of cultural sensitivity. 
• Ensure that a psychosocial assessment has been carried out (referral to specialist mental health services may be appropriate, but if this is not possible or practical, it may be in primary care by a person with appropriate training). Such assessments should incorporate:
  • The person's psychosocial needs, including:
    • Social needs — home environment, living arrangements, social and family support network, personal relationships, needs of any dependent children, need for social care and support, history leading to the thoughts of self-harm, recent life events and current difficulties, functioning at work and finances, need for occupational rehabilitation, or financial advice).
    • Psychological and physical needs — mental health disorders, or misuse of recreational drugs and/or alcohol, physical health problems, personal skills, strengths, assets, coping strategies, and the need for psychological intervention.
  •  Factors that increase the person's risk, such as:
    •  Features of depression. For further information, see the CKS topic on Depression.
    • Feelings of hopelessness.
    • Features that suggest suicidal intent. Always ask people directly about suicidal ideation and intent. 
    • Consider the history and frequency of any past self-harm, medical seriousness, use of violent methods, evidence of planning such as suicide notes or changes to will, and precautions taken to prevent rescue.
    • Other clinical, demographic, and psychological features associated with risk, including male sex; physical health problems; low socioeconomic status; high-risk employment (such as farmers or healthcare professionals); unemployment; bereavement; changes in relationships; social isolation; gambling-related harms, neglectful, abusive, or violent relationships; and access to the means to self-harm (such as a supply of their own or other people in their household's medications, or a firearm).
    • For more information on assessing the risk of suicide, see the CKS topic on Depression. 
• Identify protective factors that may reduce the person's risk, including coping strategies, supportive relationships, dependent children, and religious beliefs.
• Identify any safeguarding concerns in children, young people, or vulnerable adults:
  • Dependent for their care on the person presenting with an episode of self-harm.
  • Presenting with an episode of self-harm that may have occurred in response to child maltreatment, domestic violence, or other violence or exploitation. For more information, see the CKS topic on Child maltreatment - recognition and management.
    • Where safeguarding concerns are identified, follow local safeguarding procedures.
• Note: For people who repeatedly present at risk of self-harm, ensure that their needs and risk are assessed at each presentation. 
• Where assessments of risk and psychosocial needs are carried out in primary care, use clinical judgement depending on the findings of the assessments to determine whether referral is required immediately:
  • If there is thought to be an immediate risk of self-harm or suicide — refer to a crisis resolution and home treatment team.
  • If there is thought to be a mental health disorder of a nature or severity requiring specialist management, or cognitive impairment, or the person is experiencing high levels of distress, their risk of self-harm is increasing, they are unresponsive to other strategies, they request intervention from specialist services, or there are high levels of distress in family members, carers, or significant others — refer to a community mental health team and/or psychology services. If the person is aged under 18 years, refer them to Child and Adolescent Mental Health Services (CAMHS).
  • If there is misuse of recreational drugs or alcohol — refer to appropriate drug and alcohol services.
• Manage and follow up in primary care people those who decline specialist referral, maintaining continuity of therapeutic relationships wherever possible.
  • Offer financial and occupational rehabilitation advice, where appropriate.
  • Advise the person to seek further help if their situation deteriorates. 
  • Manage any identified mental health and other problems that may have been identified as appropriate. For further information, see the CKS topics on Generalized anxiety disorder, Depression, Depression in children, Depression - antenatal and postnatal, Psychosis and schizophrenia, Bipolar disorder, Post-traumatic stress disorder, Dementia, Alcohol - problem drinking, and Opioid dependence.
• When prescribing medicines, take into account:  
  • The toxicity of the prescribed medicines for people at risk of overdose (for example, opiate-containing painkillers and tricyclic antidepressants).
  • Their recreational drug and alcohol consumption, the risk of misuse, and possible interaction with prescribed medicines.
  • The person's wider access to medicines prescribed for themselves or others.
  • The need for effective communication where multiple prescribers are involved.
• Offer written and verbal information to the person and their family, carers, or significant others. For further details, see the section on follow-up.
• Ensure that all members of the multidisciplinary team including primary care and specialist mental health services are kept informed about the assessment, support, and treatment of any episode where a person presents at risk of self-harm. Ensure that people who do not attend appointments for review in primary care or specialist mental health services are followed up.
• Ensure that any person who presents at risk of self-harm gives informed consent for management, wherever possible.
  • If a person declines or refuses management that is perceived to be in their best interests, assess their mental capacity to help decide whether they are unable to make an informed decision about whether to accept or refuse treatment. Mental capacity should be assumed in a person aged 16 years or over, unless there is evidence to the contrary. If possible, gather additional information from family, carers, and significant others, if the person allows.
    • If a person refuses treatment, provide information about the potential consequences of not receiving treatment, while trying to gain consent.
    • If a person is judged to have diminished capacity and/or the presence of a significant mental health disorder, refer for an urgent mental health assessment or hospital admission, depending on clinical judgement. Healthcare professionals have a duty to act in the person's best interests. This may include taking the person to hospital for further assessment and treatment against their wishes.
    • If there is uncertainty about whether a person has capacity to make informed decisions, seek advice from a psychiatrist who has experience in assessing capacity. For more information, see Assessing mental capacity.

What long-term management is required for a person who self-harms?

• For people who have previously self-harmed and are at risk of repetition, ensure that a psychosocial assessment has been carried out (this may be by referral to specialist mental health services, but if this is not possible or practical, in primary care by a person with appropriate training). 
• Make referral to mental health professionals a priority when: 
  • The person's levels of concern or distress are rising, high, or sustained.
  • The frequency or degree of self-harm or suicidal intent is increasing.
  • The person providing assessment in primary care is concerned.
  • The person asks for further support from mental health services.
  • Levels of distress in family members or carers of children, young people and adults are rising, high, or sustained, despite attempts to help.
• Mental health services (including community mental health teams and liaison psychiatry teams) are usually responsible for the longer-term treatment and management of self-harm. Management may include:
  • If stopping self-harm is unrealistic in the short-term, providing information about harm minimization strategies (less destructive or harmful methods of self-injury) as agreed with the multidisciplinary team, such as: 
    • Distraction or coping strategies.
    • Approaches to self-care.
    • Wound hygiene and aftercare for self-harm scars.
    • Providing factual information on the potential complications.
    • The impact of alcohol and recreational drugs on the urge to self-harm. 
  • Providing psychological interventions if appropriate — for example, cognitive-behavioural therapy (CBT), dialectical behavioural therapy, or problem-solving therapy. This should be tailored to the person's needs and preferences. Pharmacotherapy is unlikely to be helpful.
  • Drawing up an individual care plan — goals may include improving social or occupational functioning, improving quality of life, reducing risk-taking behaviour, and managing any associated mental health problems.
  • Compiling a crisis plan that outlines self-management strategies, contact numbers and information about what to do and whom to contact in a crisis, if self-management strategies are not helping.
  • Ensuring that all members of the multidisciplinary team including primary care are updated about any episodes of self-harm and information held in care and crisis plans, if appropriate. Note: the person should have been made aware that this information may be shared with other healthcare professionals where necessary, for example, if there are serious concerns for the person's safety.
• The roles of a primary care physician may include:
  • Management of any identified psychosocial needs, including offering advice and support to facilitate any goals (such as education, employment, and occupation) outlined in the person's care plan.
  • Managing any mental health or other problems that have been identified, if appropriate (possibly as part of a shared-care arrangement). For further information, see the CKS topics on Generalized anxiety disorder, Depression, Depression - antenatal and postnatal, Psychosis and schizophrenia, Bipolar disorder, Post-traumatic stress disorder, Dementia, Alcohol - problem drinking, and Opioid dependence.
  • Monitoring the person's physical health, including the physical consequences of self-harm as well as other healthcare needs.
  • Considering what medicines are prescribed and taking into account: 
    • The toxicity of the prescribed medicines for people at risk of overdose (for example, opiate-containing painkillers and tricyclic antidepressants).
    • The person's recreational drug and alcohol consumption, the risk of misuse, and possible interaction with prescribed medicines.
    • The person's wider access to medicines prescribed for themselves or others.
    • The need for effective communication where multiple prescribers are involved.
  • Offering written and verbal information to the person and their family, carers, or significant others. For further information see the section on follow-up.
  • Working cooperatively with secondary health and social care professionals to ensure the routine sharing of up-to-date care and risk management plans.