Executive summary
- Definition: intentional self-poisoning or self-injury, irrespective of apparent purpose.
- First priority: immediate physical safety (toxicity, bleeding, injury) and safeguarding concerns.
- Second priority: a compassionate, non-judgemental approach that facilitates disclosure and engagement.
- Psychosocial assessment is central; avoid over-reliance on risk scores as a substitute for clinical assessment and planning.
- Aftercare matters: clear follow-up plan, safety planning, and involving family/carers (with consent) reduces future harm risk.
- Safer prescribing (limit quantities, review high-toxicity meds, coordinate with pharmacy) is a practical prevention lever.
Immediate assessment (primary care and urgent care interface)
- Medical assessment: ABCs, injuries requiring urgent care, bleeding risk, intoxication/overdose specifics (substance, dose, timing), and need for ED/toxicology pathway.
- Mental state: current suicidal intent, plans, protective factors, substance use, psychosis, agitation, and ability to maintain safety today.
- Safeguarding: children/young people, domestic abuse, coercion, exploitation, and capacity concerns.
- Documentation: what happened, why now, and what the agreed safety plan is — with clear escalation triggers.
Management (what to do today)
- Urgent referral if high suicide risk, inability to maintain safety, severe mental illness symptoms, or significant safeguarding concerns.
- Safety planning: collaboratively identify warning signs, internal coping strategies, people/places for distraction, contacts for help, crisis numbers, and means restriction steps.
- Involve supports (family/carers) where appropriate and with consent; consider supervised environment if risk is high.
- Aftercare: arrange follow-up within an appropriate timeframe (often 24–72h if recent episode/high risk) and ensure continuity with mental health services if involved.
- Substance use: address intoxication and dependency risk (brief intervention + signposting/referral).
Safer prescribing and means restriction (high impact in practice)
- Limit quantities of potentially lethal medications and coordinate dispensing intervals with pharmacy where appropriate.
- Review high-toxicity drugs (e.g., tricyclics, large paracetamol supplies, opioids) and adjust to lower-risk alternatives if clinically appropriate.
- Document an agreed plan for medication storage and access where feasible (especially in adolescents/households with risk).
Frequently asked questions
Should I use a risk score to decide what to do?
Risk tools can inform thinking but should not replace a compassionate psychosocial assessment and a clear safety/aftercare plan.
When is ED mandatory?
When there is significant injury, suspected serious overdose/toxicity, reduced consciousness, ongoing medical instability, or clinician concern about immediate safety.
How soon should I follow up after an episode?
As soon as clinically appropriate — often within 24–72 hours if risk is elevated — and ensure the person knows how to access crisis support immediately if needed.
What is the most practical prevention step in primary care?
Collaborative safety planning plus safer prescribing/dispensing (limiting quantities of high-toxicity medicines) and rapid connection to appropriate services.
What if the person refuses help?
Explore reasons, offer alternatives, provide written crisis contacts and a safety plan, consider safeguarding duties, and escalate if risk is immediate or capacity is impaired.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.