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Practice Guidelines

Longer term management of self harm: summary of NICE guidance

BMJ 2011; 343 doi: (Published 23 November 2011) Cite this as: BMJ 2011;343:d7073
  1. Tim Kendall, director 1, visiting professor2, consultant psychiatrist and medical director3,
  2. Clare Taylor, editor1,
  3. Henna Bhatti, research assistant1,
  4. Melissa Chan, systematic reviewer1,
  5. Navneet Kapur, professor of psychiatry and population health4, honorary consultant psychiatrist5
  6. On behalf of the Guideline Development Group
  1. 1National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London E1 8AA, UK
  2. 2University College London (Clinical, Educational and Health Psychology), London WC1E 7HB
  3. 3Sheffield Health and Social Care NHS Foundation Trust, Sheffield S10 3TH, UK
  4. 4Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Manchester M13 9PL, UK
  5. 5Manchester Mental Health and Social Care Trust, Manchester M21 9UN, UK
  1. Correspondence to: Professor T Kendall, National Collaborating Centre for Mental Health tim2.kendall{at}

Self harm is common but its prevalence may be underestimated because many studies rely on self report. In a study of 17 countries an average of 2.7% of adults reported self harm.1 A survey in the United Kingdom of 15-16 year olds estimated that more than 10% of girls and 3% of boys had self harmed in the previous year.2 Self harm and psychiatric disorder are strongly associated.3 4 Importantly, once a person has self harmed, the likelihood that he or she will die by suicide increases 50 to 100 times,5 6 with 1 in 15 dying by suicide within nine years of the index episode.7 The UK suicide rate is 17.5 for males and 5.2 for females per 100 000 population,8 which is nearly 10 times the homicide rate. Understanding and helping people who self harm is therefore likely to be an important part of an effective suicide prevention strategy.

This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the longer term management of self harm.9 This guideline is intended to complement the earlier NICE guideline on the short term management of self harm (treatment within the first 48 hours after an episode of self harm).10


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice.

General principles of care

  • When working with people who self harm:

    • -Aim to develop a trusting, supportive, and engaging relationship

    • -Be aware of stigma and discrimination sometimes associated with self harm and be non-judgemental

    • -Ensure that people are fully involved in decision making about their treatment and care

    • -Aim to foster people’s autonomy …

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