Assessment and management of self-harm and suicide risk in young people
BMJ 2024; 386 doi: https://doi.org/10.1136/bmj-2022-073515 (Published 05 August 2024) Cite this as: BMJ 2024;386:e073515
- Faraz Mughal
, GP and NIHR doctoral fellow1, - Dennis Ougrin, professor of child and adolescent psychiatry and global mental health2,
- Lucy Stephens, certified health and wellbeing coach3,
- Lakshmi Vijayakumar, head of department psychiatry4,
- Nav Kapur, professor of psychiatry and population health, National Confidential Inquiry into Suicide and Safety in Mental Health5
- 1School of Medicine, Keele University, Keele, UK; Department for General Practice and Primary Care, Melbourne Medical School, University of Melbourne
- 2Youth Resilience Unit, Queen Mary University of London, London
- 3Berkshire
- 4Voluntary Health Service, Chennai, India
- 5Centre for Mental Health and Safety; Manchester Academic Health Sciences Centre; Mersey Care NHS Foundation Trust; NIHR Greater Manchester Patient Safety Research Collaboration, School of Health Sciences, University of Manchester
- Correspondence to F Mughal f.mughal{at}keele.ac.uk
What you need to know
Speak to young people with respect, compassion, and sympathy
Do not solely use risk assessment scores, tools, or stratification to inform treatment
Each young person requires a personalised assessment of unmet clinical needs and tailored treatment
A 16 year old girl visits her general practitioner (GP) with her mother and describes how she is being bullied at school and how she has felt more anxious as a result. The GP notices a cut on her left wrist.
A 23 year old man is brought into the emergency department by paramedics after taking an overdose of paracetamol at home a few hours earlier.
In both cases, the doctor wants to know how to adequately assess the self-harm episode and how best to help the young person.
Self-harm and suicide in young people are growing and serious public health concerns. Young people can present with self-harm or suicidal thoughts in all clinical contexts. However, the frontline settings of general practice and emergency care allow for early identification and intervention. Managing self-harm or suicidal thoughts in young people is a daily reality for many GPs and non-mental health clinicians. In this practice pointer, we outline how GPs and non-mental health clinicians can assess and manage young people aged 12-25 after self-harm or suicidal thoughts. Our approach is informed by the 2022 National Institute for Health and Care Excellence (NICE) guideline for managing self-harm.1
How common is self-harm and suicide in young people?
The NICE definition of self-harm is intentional self-poisoning or injury irrespective of the apparent purpose.1 This definition encompasses self-harm with or without suicidal intent and examples of self-harm include cutting, medication overdose, burning, or hair pulling.2
Self-harm is common among young people, with a pooled 17% lifetime prevalence of self-harm in adolescents aged 12-18.3 Self-cutting is the most common (45%) type of self-harm, followed by head …
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