NICE (National Institute for Health and Clinical Excellence) is developing a clinical guideline on the longer-term care of adults, children and young people who self-harm. As part of this process, draft recommendations have been published on the NICE website for public consultation. This new guideline will follow on from the NICE guideline on the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care (NICE clinical guideline 16). The new recommendations focus on the longer-term psychological treatment and management of self-harm. Self-harm commonly involves self-poisoning with medication or self-injury by cutting. People can self-harm for numerous reasons, for example, they may self-harm in order to obtain relief from a particular emotional state or overwhelming situation.
“Self-harm is when someone damages their body on purpose. It is not usually an attempt at committing suicide, but a way of expressing deep emotional feelings, such as low self-esteem. Although the physical effects of self-harm can often be treated easily, the underlying cause of the behaviour needs further attention.
“Our previous guideline on the short-term treatment of self-harm focused on the first 48 hours of an incident. This new guideline aims to help healthcare professionals support people that are known to self-harm in reducing and then stopping the behaviour.”
Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE
The draft recommendations are now available for public consultation. Anyone wishing to submit comments should visit the NICE website for more information on the consultation process. Draft recommendations issued for consultation include:
Working with people who self-harm
Health and social care professionals working with people who self-harm should aim to develop a trusting, supportive and engaging relationship with them and ensure that people are fully involved in decision-making about their treatment and care. Risk assessment: When assessing the risks of repetition of self-harm or suicide, identify and agree with the person who self-harms the specific risks for them, taking into account:
- methods and patterns of current and past self-harm
- specific risk factors and protective factors (social, psychological, pharmacological and motivational) that may increase or decrease the risks associated with self-harm
- coping strategies that the person has used to either successfully limit or avert self-harm or to contain the impact of personal, social or other antecedents
Care plans: Care plans should be multidisciplinary and developed collaboratively with the person who self-harms and their family, carers or significant others. The care plan should identify realistic and optimistic long-term goals, including employment and occupation and identify short-term treatment goals (linked to the long-term goals) and steps to achieve the
Interventions for self-harm: Consider offering six sessions of a psychological intervention specifically structured for people who self-harm with the aim of reducing self-harm. The intervention may have cognitive-behavioural, psychodynamic or problem-solving elements. Therapists should have significant experience of working with people who self-harm, and be able to work collaboratively with the person to identify the problems causing distress or leading to self-harm.
Treating associated mental health conditions: Provide psychological, pharmacological and psychosocial interventions for any associated conditions as described in the relevant NICE guidelines, for example, borderline personality disorder (NICE clinical guideline 78), depression (NICE clinical guideline 90),bipolar disorder (NICE clinical guideline 38) etc.
- Visit http://guidance.nice.org.uk/CG/WaveR/82/Consultation/Latest for details