This guideline has been developed to advise on the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. The guideline recommendations have been developed by a multidisciplinary group of healthcare professionals, patients and their representatives, and researchers after careful consideration of the best available evidence. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high quality care for those people who self-harm while also emphasising the importance of the experience of care for service users and carers.

Contents

• Guideline Development Group Membership
• Acknowledgements
• 1. Introduction
  • 1.1. National guidelines
  • 1.2. The national self-harm guideline
• 2. Introduction to self-harm
  • 2.1. What is self-harm and what does the guideline cover?
  • 2.2. A note about terminology
  • 2.3. Why do people self-harm?
  • 2.4. Methods of self-harm
  • 2.5. How common is self-harm?
  • 2.6. Factors that are associated with self-harm
  • 2.7. Special groups
  • 2.8. The consequences of self-harm
  • 2.9. Contact with services
  • 2.10. How people who self-harm experience services
  • 2.11. Assessment and treatment for people who self-harm
  • 2.12. The prevention of self-harm
  • 2.13. Research recommendations
• 3. Methods used to develop this guideline
  • 3.1. Overview
  • 3.2. The Guideline Development Group
  • 3.3. Clinical questions
  • 3.4. Systematic clinical literature review
  • 3.5. Stakeholder contributions
  • 3.6. Validation of this guideline
• 4. Recommendations
  • Key priorities for implementation
  • Guidance
  • 4.1. Issues for all services and healthcare professionals
  • 4.2. The management of self-harm in primary care
  • 4.3. The assessment and initial management of self-harm by ambulance services
  • 4.4. The treatment and management of self-harm in emergency departments
  • 4.5. Medical and surgical management of self-harm
  • 4.6. Support and advice for people who repeatedly self-harm
  • 4.7. Psychosocial assessment
  • 4.8. Referral, admission and discharge following self-harm
  • 4.9. Special issues for children and young people (under 16 years)
  • 4.10. Special issues for older people (older than 65 years)
  • 4.11. Psychological, psychosocial and pharmacological interventions
  • 4.12. Research recommendations
• 5. Service user experience of services
  • 5.1. Introduction
  • 5.2. Methods
  • 5.3. Findings
  • 5.4. Health professionals’ attitudes to self-harm
  • 5.5. Clinical practice recommendations
  • 5.6. Research recommendations
• 6. Consent
  • 6.1. Introduction
  • 6.2. Mental capacity
  • 6.3. Advance directives
  • 6.4. Who should assess capacity?
  • 6.5. The role of the Mental Health Act
  • 6.6. Intoxication
  • 6.7. Young people
  • 6.8. Putting these principles into practice
  • 6.9. Clinical practice recommendations
  • 6.10. Research recommendations
• 7. The medical and surgical care of people who have self-harmed
  • 7.1. Introduction
  • 7.2. The management of self-harm in primary care
  • 7.3. The management of self-harm by ambulance staff
  • 7.4. Information and laboratory services available to clinicians treating self-poisoning
  • 7.5. The role of triage in the management of self-harm in emergency departments
  • 7.6. Routine screening for plasma paracetamol concentrations
  • 7.7. The treatment and management of self-poisoning by gut decontamination
  • 7.8. Treatment and management of poisoning with salicylates
  • 7.9. Treatment and management of paracetamol overdose
  • 7.10. The use of flumazenil in the treatment and management of benzodiazepine overdose
  • 7.11. Treatment and management of opioid overdose
  • 7.12. The treatment and management of superficial wounds
  • 7.13. Post-care services and information
• 8. Psychosocial assessment after hospital attendance for self-harm
  • 8.1. Introduction
  • 8.2. Literature review
  • 8.3. The assessment of need
  • 8.4. The assessment of risk
  • 8.5. Integrating risk and needs assessment
  • 8.6. Who should undertake assessments?
  • 8.7. Clinical summary
  • 8.8. Clinical practice recommendations
  • 8.9. Research recommendations
• 9. Psychological, pharmacological and psychosocial interventions for the management of self-harm
  • 9.1. Introduction
  • 9.2. Current clinical practice
  • 9.3. Studies included
  • 9.4. Comparisons made
  • 9.5. Psychological interventions
  • 9.6. Pharmacological interventions
  • 9.7. Psychosocial and other interventions
  • 9.8. Clinical summary
  • 9.9. Clinical practice recommendations
  • 9.10. Research recommendations
• 10. References
• 11. Glossary
• 12. Abbreviations
• 13. Appendices
  • Appendix 1. Scope for the development of a clinical guideline on the management of self-harm
  • Appendix 2. Flowchart showing service user ‘journey’ through services
  • Appendix 3. Stakeholders who responded to early requests for evidence
  • Appendix 4. Stakeholders and experts who responded to the first consultation draft of the guideline
  • Appendix 5. Researchers and organisations contacted who submitted information or unpublished research
  • Appendix 6. Clinical questions
  • Appendix 7. Search strategies for the identification of clinical studies
  • Appendix 8. Systematic review and RCT eligibility checklist
  • Appendix 9. Systematic review quality checklist
  • Appendix 10. RCT quality checklist
  • Appendix 11. Clinical study data extraction form
  • Appendix 12. Methods for calculating standard deviations
  • Appendix 13. Focus group information sheet and consent form
  • Appendix 14. Focus group interview schedule
  • Appendix 15. Focus group and individual interview reports
  • Appendix 16. Recommendations generated during focus groups
  • Appendix 17. Characteristics of reviewed studies
  • Appendix 18. References to studies reviewed
  • Appendix 19. Forest plots for clinical evidence reviews
• Clinical practice algorithms

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).