09 Suicide Prevention and Self-Harm Care

Understand self-harm and suicide concerns

Care for suicide and self-harm concerns combines compassionate communication, assessment of immediate safety, attention to physical and psychological needs, and reliable follow-up. A person’s needs and safety should guide care, rather than a label or score.

Self-harm means intentional self-injury or self-poisoning. It may occur with suicidal intent, without intent to die, or with mixed or uncertain intent. Do not assume intent; ask directly and respectfully.

Build connection and address immediate needs

When possible, provide privacy, use a calm and nonjudgmental tone, and thank the person for sharing. Listen without arguing, blaming, minimizing, or expressing shock. A supportive response can acknowledge the disclosure and communicate a willingness to understand what is happening and work together to help keep the person safe.

Assess and treat injuries or poisoning promptly. When feasible, physical care and mental-health assessment should proceed together.

Assess thoughts, intent, history, and context

Use an approved screening tool when indicated by the care setting, then follow a positive screen with an appropriate assessment. Ask plainly about the following areas:

• Current thoughts: Thoughts of suicide or self-harm, how often they occur, and when they last occurred.

• Intent and plan: Whether the person intends to die, has considered a plan, and has access to what they might use. Ask about timing and steps already taken.

• History: Previous suicide attempts and self-injury, including the person’s intent and what happened afterward.

• Current state and context: Distress, hopelessness, agitation, impulsivity, sleep changes, substance use, mental-health symptoms, recent losses or conflicts, and immediate stressors.

• Supports and strengths: Trusted people, treatment connections, coping strategies, responsibilities, beliefs, and reasons for living.

Protective factors can inform a care plan, but they do not cancel out current intent, a feasible plan, access to lethal means, or other urgent concerns. Screening tools can identify a need for follow-up but cannot reliably predict an individual’s future behavior. Do not use a score or a simple “low/medium/high” label by itself to decide discharge or access to care.

Respond to immediate safety concerns

If the person reports current suicidal thoughts, has taken steps toward an attempt, or otherwise cannot be kept safe in the current setting, stay with them, promptly alert the responsible clinician, and arrange urgent emergency or specialist evaluation according to local policy. Do not allow the person to leave alone before safety has been assessed.

Use observation and environmental precautions appropriate to the person’s needs and the care setting. Remove or secure hazards when safe and practical. For self-harm, address urgent physical needs and seek specialist mental-health assessment as indicated.

Work collaboratively to reduce access to lethal means. When appropriate, involve a trusted support person, preferably with the person’s consent. If immediate safety requires action, follow applicable law, organizational policy, and clinical escalation procedures.

Create a collaborative safety plan

Make a practical, written plan with the person for what to do if distress or suicidal thoughts intensify. Include:

1. Personal warning signs that a crisis may be developing.

2. Coping strategies the person can try independently.

3. People or places that may provide distraction or connection.

4. Trusted people to contact for direct help.

5. Clinicians, crisis services, and emergency options.

6. Steps to make the environment safer by reducing access to lethal means.

Check that the steps are realistic and that the person knows how to use the plan. A safety plan is not a “contract for safety” or a promise not to self-harm. Such promises do not replace assessment, observation, treatment, or follow-up.

Maintain continuity and reassess

Before discharge or transfer, communicate the assessment, interventions, safety plan, referrals, and follow-up arrangements to the receiving team. Arrange timely mental-health follow-up and confirm how the person will access it. Follow-up contact after a positive screen or acute-care visit can help reconnect the person with care; timing and responsibility should follow the local pathway.

After self-harm, NICE recommends initial aftercare within 48 hours of psychosocial assessment when safety concerns continue. Reassess when circumstances change, because safety needs can change over time.

Document the person’s own words where relevant, findings about thoughts, intent, plan and access, observed concerns, consultation and escalation, agreed safety steps, referrals, and handoff. If self-harm recurs, continue respectful, nonpunitive care and reassess needs rather than treating a prior assessment as definitive.

Know crisis and emergency options

In the United States, a person in crisis can call or text 988 Suicide & Crisis Lifeline. If there is immediate danger or a medical emergency, use emergency services or the facility’s emergency response process.