Intended for healthcare professionals

Practice 10 minute consultation

Young people who self harm by cutting

BMJ 2013; 347 doi: (Published 30 August 2013) Cite this as: BMJ 2013;347:f5250
  1. Jane H Roberts, general practitioner, clinical senior lecturer, Royal College of General Practitioners youth mental health clinical champion1,
  2. Rachel Pryke, general practitioner partner2,
  3. Margaret Murphy, consultant child and adolescent psychiatrist3,
  4. Lucie Russell, director of campaigns, young minds 4
  1. 1Blackhall Community Health Centre, County Durham and Darlington Foundation Trust, Hartlepool TS27 4LQ, UK
  2. 2Winyates Health Centre, Redditch, UK
  3. 3Specialised Services Mental Health Programme, Cambridge Medical Directorate, Cambridge, UK
  4. 4YoungMinds, London, UK
  1. Correspondence to: J H Roberts jane.roberts{at}
  • Accepted 9 August 2013

Hayley, a 15 year old girl, comes to you about mild acne. You notice a scar just visible at wrist level. She is unaccompanied. There is a family history of depression and her parents are separated.

What you should cover

History and her feelings

Hayley may have needed considerable courage to consult; missing this opportunity to discuss her situation, by being dismissive or (inadvertently) patronising, may heighten her sense of isolation and risk further escalation of self harm.

After dealing with her concerns about acne and suggesting a topical skin preparation (and review) ask permission to talk about the scar and show that you are interested in her emotional wellbeing.

Aim to create a non-judgmental environment where Hayley can sense that you are genuinely interested in her as an individual.

Explain that the consultation is confidential, unless serious concerns for her safety mean that you must act, but that you would always discuss this with her first. Explain that you could seek advice from your local safeguarding clinical lead without identifying Hayley in the first instance, …

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