What is Self Harm?

Treatment

The reason you self-harm is unique to you. Because of this there are different types of treatments that can be helpful. Be honest when telling professionals why you self-harm. This will help them find the right support for you.

If the first treatment you try doesn’t work, be persistent. Other treatments might be more effective for you.

If you need to go to hospital

The National Institute for Health and Care Excellence (NICE) produces best practice recommendations for health care providers. The NHS doesn’t have to follow them, but they should. NICE recommends the following.

Triage
If you need to use emergency services because of self-harm, healthcare staff should do an assessment with you to see how urgently you need treatment and what your mental state is. This is called ‘triage’. You may have to be admitted to hospital.

Physical treatment
Even if you don’t want any mental health support, the NHS will offer you treatment for any serious injuries you have as a result of self harm.

Detailed assessment
Healthcare staff should do a full assessment of your needs. They will ask you about what caused you to self-harm, if you have any mental health issues and if you are thinking about suicide.

Risk assessment
When they are doing the assessment with you they will think about your risk of harming yourself again. They may think you are at risk if you have:

  • been drinking or taking drugs,
  • a history of self-harm, or
  • mental health conditions.

Assessment outcome
The NHS has different options depending on your risk.

  • Discharge. They may feel that you are not a risk to yourself and do not need to stay in hospital. They will discharge you back to your GP so you can discuss treatment with them.
  • Stay in hospital. They may decide that you are a risk to yourself and they need to keep you in hospital overnight. In this situation they may only keep you 1 or 2 days depending how you are the next day.
  • Treatment. If you need treatment they might refer you to local mental health services. They should include you in making this decision if they can.

Talking treatments, medication or social care
Professionals should make sure you understand all the treatment options that are available. They should explain the benefits and any possible downsides of treatment.

Long-term management of self harm
If you self-harm regularly, then the steps above still apply if you need hospital care, but there are some other recommendations to make sure you get the right support.

Who should help?
Some people may be able to get enough support from their GP, but NICE recommends that mental health services should usually be responsible for your treatment. When specialist mental health services help you, this is usually under the ‘Care Programme Approach’ (CPA).

Care Plans
If you are under specialist mental health services, you should have a care plan that explains what the aims of your treatment are. You and your care coordinator should review your care plan every year. You can update it by adding new goals. These can include:

  • not letting the self-harm get worse,
  • stopping risky behaviours such as using drugs,
  • improving your social skills and support, and
  • getting into training, work or employment.

Risk management plans
This should be part of your care plan. It should look at:

  • long term and current risk issues,
  • triggers that increase your risk of self-harm, and
  • a crisis plan – this should tell you what to do in a crisis and some things you should do for self management.

Treatments
Your mental health team should normally offer you 3 – 12 sessions of therapy to help you stop self-harming. Your therapist should work with you to find the reasons why you self-harm, and should make sure your therapy is tailored to your needs.

Your doctor should not give you medication just to help you stop self-harming, but they may offer you medication if you have a mental illness. If they do this, they have to think about the risk of overdose.

The NHS may offer different treatments if you self-harm. They will only offer you some of these treatments if you self-harm and have mental health issue.

  • Cognitive behavioural therapy (CBT)
  • Cognitive analytic therapy (CAT)
  • Psychotherapy
  • Medication
  • Dialectical behavioural therapy (DBT)
  • Interpersonal therapy

Harm Reduction
If you can’t stop self-harming altogether, you and your care coordinator can talk about safer ways to self-harm.