Draft self-harm guidance to include advice for schools

School staff in England and Wales are to be included in draft guidance on how to identify people who have self-harmed for the first time.

In the first new guideline for 11 years looking at self-harm, the independent NICE committee has drawn up new recommendations which are out for consulation.

Self-harm is defined as intentional self-poisoning or injury irrespective of the apparent purpose of the act.

Only a minority of people who have self-harmed present to hospital services, but it remains one of the commonest reasons for hospital attendance. Some estimates suggest upwards of 200,000 presentations in England every year, the majority for self-poisoning.

While prevalence statistics are unreliable because it is a problem that is sometimes hidden, a recent national study reported that 7.3% of girls, and 3.6% of boys, aged 11 to 16, had self-harmed or attempted suicide at some point. The figures for 17- to 19-year-olds were 21.5% for girls and 9.7% for boys.

Self-harm can occur at any age, but there is evidence that there has been a recent increase in self-harm among young people in England.

For some people, self-harm is a one-off episode but repetition is also common, with 20% of people repeating self-harm within a year.

People who have self-harmed are at greatly increased risk of suicide, with a 30- to 50-fold increase in risk in the year after hospital presentation.

Dr Paul Chrisp, director of the centre for guidelines at NICE, said: “Self-harm is a growing problem and should be everyone’s business to tackle – not just those working in the mental health sector.

“It is important that our committee has made recommendations for education and criminal justice settings as data in the past few years has shown that people working within these sectors would benefit from clear guidance about how they should help someone who is self-harming.

“These guidelines set out a way for every person who self-harms to be able to get the support and treatment they need.”

The guideline recommends offering a cognitive behavioural therapy (CBT)-based psychological intervention that is specifically structured for adults who self-harm.

For children and young people with significant emotional dysregulation difficulties who have frequent episodes of self-harm, mental health professionals should consider treating them with a dialectical behaviour therapy adapted for adolescents (DBT-A).

A public consultation has now begun on the recommendations via nice.org.uk until Tuesday 1 March.