Draft NICE guidance on self-harm updates advice for GPs

Draft NICE guidance calls for patients to receive urgent psychosocial assessment after an episode of self-harm and sets out advice for GPs and other healthcare professionals for ongoing care.

NHS logo on tiled wall
Updated advice on self-harm (Photo: Ollie Millington/Getty Images)

The draft guideline - the first overhaul of NICE advice on self-harm in more than a decade - says around half of people who attend A&E after an episode of self-harm will have visited their GP in the previous month.

The updated advice says all staff across health and social care 'have a role to play' in supporting people who self-harm - and warns that the issue should not be left to mental health experts alone.

It calls for non-specialist health and care staff who have provided initial care to organise a comprehensive psychosocial assessment at the earliest opportunity after an episode of self-harm, which should be carried out by a specialist mental health professional.

Self-harm

Following this assessment, 'initial aftercare' should be provided within 48 hours by mental health services, the patient's GP practice or the team who carried out the psychosocial assessment, the draft advice says.

It also suggests that in cases where an ambulance or paramedic attends a patient who has self-harmed but who does not need urgent medical care, they should decide with the patient whether they can be assessed and treated by either their GP or a specialist mental health service.

GPs and community pharmacy staff are urged to 'use consultations and medicines reviews as an opportunity to assess self-harm if appropriate' - potentially through questions about 'thoughts of self-harm or suicide, actual self-harm, and access to substances that might be taken in overdose'.

Where ongoing support is being provided in primary care for a person who has self-harmed, the guidance says 'their GP should ensure that the person has regular follow-up GP appointments; regular reviews of self-harm behaviour; a medicines review; information, social care, voluntary and non-NHS sector support and self-help resources; and care for any coexisting mental health problems, including referral to mental health services as appropriate'.

NICE advice

NICE says self-harm 'is defined as intentional self-poisoning or injury irrespective of the apparent purpose of the act' - and that it remains among the 'commonest reasons for hospital attendance'.

The institute cited estimates suggesting more than 200,000 presentations a year in Englandand pointed to a recent national study suggesting '7.3% of girls, and 3.6% of boys, aged 11 to 16, had self-harmed or attempted suicide at some point'. Among 17- to 19-year-olds the figures rise to '21.5% for girls and 9.7% for boys'.

Dr Paul Chrisp, director of the centre for guidelines at NICE, said: 'Self-harm is a growing problem and should be everyone’s business to tackle – not just those working in the mental health sector.

'It is important that our committee has made recommendations for education and criminal justice settings as data in the past few years has shown that people working within these sectors would benefit from clear guidance about how they should help someone who is self-harming.

'These guidelines set out a way for every person who self-harms to be able to get the support and treatment they need.'

The guideline recommends offering a CBT-based psychological intervention that is specifically structured for adults who self-harm, and calls for dialectical behaviour therapy adapted for adolescents (DBT-A) to be considered for children and young people with 'significant emotional dysregulation difficulties who have frequent episodes of self-harm'.

A NICE consultation on the draft guideline will remain open until 1 March.

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