This is the first NICE guideline on the longer-term management of both single and recurrent episodes of self-harm.

Self-harm is common, especially in young people. It increases the likelihood that the person will eventually die by suicide by between 50- and 100-fold above the rest of the population in a 12-month period. A wide range of psychiatric conditions are associated with self-harm, such as borderline personality disorder, depression, bipolar disorder, schizophrenia, and drug misuse and alcohol-use disorders.

The focus of this guideline, which covers people aged 8 years and older, is to improve the longer-term care of people who self-harm after initial treatment of the injury or poisoning. The guideline reviews the evidence for comprehensive assessment, psychosocial and pharmacological interventions for both the self-harm and for any associated psychiatric conditions, staff training, and consent, capacity and confidentiality issues. The guideline also contains a chapter on the experience of care for people who self-harm and their families and carers.

Contents

• GUIDELINE DEVELOPMENT GROUP MEMBERS
• ACKNOWLEDGEMENTS
• 1. PREFACE
  • 1.1. NATIONAL CLINICAL GUIDELINES
  • 1.2. THE SELF-HARM: LONGER-TERM MANAGEMENT GUIDELINE
• 2. INTRODUCTION TO SELF-HARM
  • 2.1. THE BEHAVIOUR
  • 2.2. TREATMENT AND MANAGEMENT IN THE NATIONAL HEALTH SERVICE
  • 2.3. ECONOMIC COSTS OF SELF-HARM
• 3. METHODS USED TO DEVELOP THIS GUIDELINE
  • 3.1. OVERVIEW
  • 3.2. THE SCOPE
  • 3.3. THE GUIDELINE DEVELOPMENT GROUP
  • 3.4. REVIEW QUESTIONS
  • 3.5. SYSTEMATIC CLINICAL LITERATURE REVIEW
  • 3.6. HEALTH ECONOMICS METHODS
  • 3.7. STAKEHOLDER CONTRIBUTIONS
  • 3.8. VALIDATION OF THE GUIDELINE
• 4. EXPERIENCE OF CARE
  • 4.1. INTRODUCTION
  • 4.2. PERSONAL ACCOUNTS—PEOPLE WHO SELF-HARM
  • 4.3. PERSONAL ACCOUNTS—CARERS
  • 4.4. REVIEW OF THE QUALITATIVE LITERATURE
  • 4.5. FROM EVIDENCE TO RECOMMENDATIONS
  • 4.6. RECOMMENDATIONS
• 5. TRAINING
  • 5.1. INTRODUCTION
  • 5.2. IMPACT OF TRAINING ON HEALTHCARE PROFESSIONALS' KNOWLEDGE AND ATTITUDES
  • 5.3. IMPACT OF TRAINING ON CONDUCTING RISK AND NEEDS ASSESSMENT
  • 5.4. FROM EVIDENCE TO RECOMMENDATIONS
  • 5.5. RECOMMENDATIONS
• 6. PSYCHOSOCIAL ASSESSMENT
  • 6.1. INTRODUCTION
  • 6.2. RISK AND PROTECTIVE FACTORS
  • 6.3. RISK ASSESSMENT TOOLS AND SCALES
  • 6.4. NEEDS ASSESSMENT
  • 6.5. INTEGRATED PSYCHOSOCIAL ASSESSMENT
  • 6.6. FROM EVIDENCE TO RECOMMENDATIONS
  • 6.7. RECOMMENDATIONS
  • 6.8. RESEARCH RECOMMENDATION
• 7. PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS
  • 7.1. INTRODUCTION
  • 7.2. PSYCHOLOGICAL AND PSYCHOSOCIAL SERVICE-LEVEL INTERVENTIONS
  • 7.3. HARM REDUCTION
• 8. PHARMACOLOGICAL INTERVENTIONS
  • 8.1. INTRODUCTION
  • 8.2. PHARMACOLOGICAL INTERVENTIONS
  • 8.3. SAFER PRESCRIBING
  • 8.4. FROM EVIDENCE TO RECOMMENDATIONS
  • 8.5. RECOMMENDATIONS
• 9. CONSENT, CAPACITY AND CONFIDENTIALITY
  • 9.1. INTRODUCTION
  • 9.2. MENTAL CAPACITY
  • 9.3. PRINCIPLES INTO PRACTICE
  • 9.4. CONFIDENTIALITY
  • 9.5. SAFEGUARDING
  • 9.6. RECOMMENDATIONS
• 10. SUMMARY OF RECOMMENDATIONS
  • 10.1. GENERAL PRINCIPLES OF CARE
  • 10.2. PRIMARY CARE
  • 10.3. PSYCHOSOCIAL ASSESSMENT IN COMMUNITY MENTAL HEALTH SERVICES AND OTHER SPECIALIST MENTAL HEALTH SETTINGS: INTEGRATED AND COMPREHENSIVE ASSESSMENT OF NEEDS AND RISKS
  • 10.4. LONGER-TERM TREATMENT AND MANAGEMENT OF SELF-HARM
  • 10.5. TREATING ASSOCIATED MENTAL HEALTH CONDITIONS
• APPENDICES
  • Appendix 1. Scope for the development of the clinical guideline
  • Appendix 2. Declarations of interests by Guideline Development Group members
  • Appendix 3. Special advisors to the Guideline Development Group
  • Appendix 4. Stakeholders who responded to early requests for evidence
  • Appendix 5. Stakeholders and experts who submitted comments in response to the consultation draft of the guideline
  • Appendix 6. Researchers contacted to request information about unpublished or soon-to-be published studies
  • Appendix 7. Analytic framework and clinical questions
  • Appendix 8. Review protocols
  • Appendix 9. Search strategies for the identification of clinical studies
  • Appendix 10. Clinical study data extraction form template
  • Appendix 11. Quality checklist templates for clinical studies and reviews
  • Appendix 12. Search strategies for the identification of health economic evidence
  • Appendix 13. Methodology checklist for economic studies
  • Appendix 14. Evidence tables for economic studies
  • Appendix 15. Clinical study characteristics
  • Appendix 16. Clinical evidence forest plots
  • Appendix 17. GRADE evidence profiles
• REFERENCES
• ABBREVIATIONS

The views presented in this book do not necessarily reflect those of the British Psychological Society, and the publishers are not responsible for any error of omission or fact. The British Psychological Society is a registered charity (no. 229642).