Introduction and overview

Introduction and overview

Introduction

The term self‑harm is used in this quality standard to refer to any act of self‑poisoning or self‑injury carried out by a person, irrespective of their motivation. This commonly involves self‑poisoning with medication or self‑injury by cutting. Self‑harm is not used to refer to harm arising from overeating, body piercing, body tattooing, excessive consumption of alcohol or recreational drugs, starvation arising from anorexia nervosa or accidental harm to oneself.

A wide range of mental health problems are associated with self‑harm, including borderline personality disorder, depression, bipolar disorder, schizophrenia, and drug and alcohol‑use disorders. People who self‑harm have a 50‑ to 100‑fold higher likelihood of dying by suicide in the 12‑month period after an episode than people who do not self‑harm.

This quality standard covers the initial management of self‑harm and the provision of longer‑term support for children and young people (aged 8 years and older) and adults (aged 18 years and older) who self‑harm. For more information see the scope for this quality standard.

NICE quality standards describe high‑priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. They draw on existing guidance, which provides an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement. The quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following frameworks:

The table below shows the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving:

NHS Outcomes Framework 2013/14

Domain 1: Preventing people from dying prematurely

Overarching indicator

1a Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare

Improvement areas

Reducing premature death in people with serious mental illness

1.5 Excess under 75 mortality rate in people with serious mental illness

Domain 4: Ensuring that people have a positive experience of care

Overarching indicator

4a Patient experience of primary care

4b Patient experience of hospital care

Improvement areas

4.2 Responsiveness to in-patients' personal needs

4.3 Patient experience of A&E services

4.7 Patient experience of community mental health services

Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm

Overarching indicator

5a Patient safety incidents reported

5b Safety incidents involving severe harm or death

A Public Health Outcomes Framework for England 2013–2016

Domain 2: Health improvement

Objective

People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities

Indicators

2.10 Hospital admissions as a result of self-harm

Domain 4: Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

Indicators

4.9 Excess under 75 mortality in adults with serious mental illness

4.10 Suicide

Overview

The quality standard for self‑harm requires that services should be commissioned from and coordinated across all relevant agencies encompassing the whole care pathway. A person‑centred approach to provision of services is fundamental to the delivery of high‑quality care to people who self‑harm.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of healthcare should cross‑refer across the library of NICE quality standards when designing high‑quality services.

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating people who self‑harm should be sufficiently and appropriately trained and competent to deliver the actions and interventions described in the quality standard.