# Self-Harm and Suicide Risk - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: NICE Guideline NG225: Self-harm: assessment, management and prevention by non-specialists 2022 · NICE Clinical Guideline CG133: Longer-term management of self-harm 2011 · Suicide: Assessment and Management - StatPearls (NCBI Bookshelf NBK617057) - https://www.ncbi.nlm.nih.gov/books/NBK617057/: "A safety plan is a brief intervention that can be implemented in any clinical setting to address modifiable risk factors." and "High-risk patients requiring more restrictive measures to ensure safety, eg, an inpatient admission, must be deemed to be at imminent and significant risk of harm to themselves." - Verified date: 2026-08 ## Verified against - Suicide: Assessment and Management - StatPearls (NCBI Bookshelf NBK617057) - https://www.ncbi.nlm.nih.gov/books/NBK617057/: "A safety plan is a brief intervention that can be implemented in any clinical setting to address modifiable risk factors." and "High-risk patients requiring more restrictive measures to ensure safety, eg, an inpatient admission, must be deemed to be at imminent and significant risk of harm to themselves." ## Treatment metadata - Urgent psychiatric referral and crisis safety planning (No primary care drug therapy) ## Complete treatment card ```text SELF-HARM AND SUICIDE RISK Sources: NICE Guideline NG225: Self-harm: assessment, management and prevention by non-specialists 2022 · NICE Clinical Guideline CG133: Longer-term management of self-harm 2011 · Suicide: Assessment and Management - StatPearls (NCBI Bookshelf NBK617057) - https://www.ncbi.nlm.nih.gov/books/NBK617057/: "A safety plan is a brief intervention that can be implemented in any clinical setting to address modifiable risk factors." and "High- risk patients requiring more restrictive measures to ensure safety, eg, an inpatient admission, must be deemed to be at imminent and significant risk of harm to themselves." Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (9) - Thoughts of suicide accompanied by a specific method, an intent to act, and access to lethal means signal imminent danger - Feeling trapped with no way out, combined with hopelessness, is a warning sign for imminent self-harm [low mood · suicidal thoughts] - Anxiety marked by agitation or severe sleep disturbance is a dynamic driver of suicide risk [anxiety · insomnia · irritability] - Escalating or uncontrolled anger, rage, or hostility is a warning sign for self-harm [suicidal thoughts] - Among warning signs, anger is the one most reliably tied to an actual suicide attempt in people already having suicidal thoughts [suicidal thoughts] - The absence of reasons to keep living is itself a recognized warning sign - Passive thoughts of suicide carry a risk of death by suicide equal to active suicidal thoughts [suicidal thoughts] - Many people who ultimately die by suicide deny having any suicidal thoughts shortly before the death [suicidal thoughts] - How severe suicidal thoughts were at their worst point in a person's life predicts death by suicide better than how they feel right now [suicidal thoughts] SIGNS - what you find (4) - A recent escalation in alcohol or drug use is a warning sign worth noting - Pulling back from friends and family networks is a recognized warning sign - A jump in high-risk or impulsive behavior is a warning sign for imminent self-harm [suicidal thoughts] - Unstable or dysregulated mood is counted among the recognized warning signs TESTS (2) - Structured instruments such as the Columbia scale, the ASQ toolkit, or the PHQ-9 help flag people needing a fuller risk work-up - Screening instruments carry limited ability to predict an actual suicide attempt or death and cannot substitute for full assessment IF NOT THIS - what else fits (3) - Suicidal claims aimed at prolonging a hospital stay or delaying discharge point toward contingency-based ideation rather than acute risk - Repeat emergency visits with no change in the modifiable risk factors suggest the baseline risk is unchanged rather than a new crisis - A pattern of visits timed to disability-payment or financial cycles suggests secondary gain rather than acute crisis Source StatPearls "Suicide: Assessment and Management" - disease-level clinical article Status traced to the source above 1. URGENT PSYCHIATRIC REFERRAL AND CRISIS SAFETY PLANNING (NO PRIMARY CARE DRUG THERAPY)[1st line] Adult Conduct immediate suicide risk and psychosocial assessment. If acute imminent risk or medical self-harm/poisoning is present, arrange emergency department transport immediately. Do NOT prescribe lethal quantities of medications. Develop a collaborative crisis safety plan. - Immediate emergency referral Peds Immediate emergency referral to pediatric psychiatry / CAMHS and emergency department for any child or adolescent presenting with self-harm or suicidal intent. Source Suicide: Assessment and Management - StatPearls (NCBI Bookshelf NBK617057) - https://www.ncbi.nlm.nih.gov/books/NBK617057/: "A safety plan is a brief intervention that can be implemented in any clinical setting to address modifiable risk factors." and "High-risk patients requiring more restrictive measures to ensure safety, eg, an inpatient admission, must be deemed to be at imminent and significant risk of harm to themselves." Why Self-harm and acute suicidal ideation are psychiatric emergencies requiring immediate safety assessment and specialist intervention; drug therapy is not indicated as initial primary care treatment. Caution TIME-CRITICAL EMERGENCY: Do not leave patient unattended if acute suicidal intent, active plan, or severe agitation is present. Do not prescribe large quantities of toxic drugs (e.g. TCAs, paracetamol, opioids, lithium); limit prescription duration to 7 days if any medication is essential. Remove access to lethal means (medications, firearms, sharp objects, ropes) immediately in consultation with family/carers. NG225 1.11.10 is explicit that there is no drug for this: do not offer drug treatment as a specific intervention to reduce self-harm. Treat the underlying condition if there is one; do not treat the self-harm. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)