Self-harm

Self-harm is one of the most common reasons for presentation to hospital. It is a reflection of distress rather than a diagnosis in itself. This article focuses on the management of people presenting to hospital with behaviour attributed to an intent to harm themselves, usually in relation to suicide-related impulses. Self-harm is associated with a significantly increased risk of future suicide and death from physical illness: around 10% of those who self-harm commit suicide within 10 years. The National Institute for Health and Care Excellence quality standards and guidelines for the short-term management of self-harm make recommendations that are relevant to all healthcare professionals, emphasizing the importance of parallel psychosocial and physical management and assessment of the risk of further self-harm or suicide. Observation levels and discharge plans are also important. Current mental illness is a major risk factor for suicide, along with high intent of suicide at the time of the self-harm, a history of self-harm, current physical illness, poor social support and demographic variables. Risk of further self-harm is also higher in certain groups, including those with substance misuse, elderly individuals and those who frequently self-harm. There are several standardized tools to aid risk assessment but none has adequate sensitivity and specificity to replace clinical judgement.