Citation

Butler JA. Medicine (Abingdon) 2020; 48(12): 769-773.

Copyright

(Copyright © 2020, Medicine Publishing)

DOI

10.1016/j.mpmed.2020.09.017

PMID

unavailable

Abstract

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 intent to harm themselves. Self-harm is associated with a significantly increased risk of future suicide, around 10% dying by suicide within 10 years, the risk being greatest in the first month. The National Institute for Health and Care Excellence quality standards and guidelines for the short-term management of self-harm make recommendations 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, as are 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 individuals who are middle-aged or elderly, have substance misuse or frequently self-harm. There are several standardized tools to aid risk assessment but none has adequate sensitivity and specificity to replace clinical judgement. © 2020

Language: en

Keywords

human; suicide; Review; alcoholism; self-harm; social support; risk assessment; Mental disorder; risk factor; mental disease; automutilation; priority journal; physical disease; practice guideline; treatment refusal; health care personnel; demography; needs assessment; Mini Mental State Examination; psychosocial management; MRCP