Standards of care for people who self-harm must be improved, says NICE
The National Institute for Health and Care Excellence (NICE) has published a quality standard to improve the quality of care and support for children, young people, and adults who self-harm.
The term self-harm is used to refer to any act of self-injury or self-poisoning carried out by a person, irrespective of their motivation. This commonly involves self-injury by cutting or self-poisoning with medication. Hospitals in England deal with around 220,000 episodes of self-harm by 150,000 people each year [i].
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 are 50 to 100 times more likely to die by suicide in the 12-month period after an episode than people who do not self-harm [ii].
The NICE quality standard on self-harm is designed to improve the management and longer-term support of people who self-harm. In summary:
- People who have self-harmed should be treated with the same compassion, dignity and respect as everyone else using healthcare services. Judgemental or negative staff attitudes towards those who have self-harmed can contribute to poor experiences of care, and may also lead to further self-harm.
- People who have self-harmed should have an initial assessment of physical health, mental state, social circumstances and risks of repetition or suicide. This can identify if a person is at immediate physical risk, so that steps can be taken to reduce this risk, including referral for more urgent care if needed.
- A comprehensive psychological assessment should be carried out each time a person presents with an episode of self-harm. This is aimed at identifying why it has happened. The assessment can also start a therapeutic relationship with the healthcare professional and be used to develop an effective management plan.
- A risk-management plan can help people who have self-harmed reduce their risk of self-harming again. This should be developed in collaboration with the person who has self-harmed, who should have joint ownership of the plan. It should include what can be done if they are at risk of self-harming again and who to contact in a crisis.
Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: “Self-harm can be a way of expressing very deep distress or trauma. Those who self-harm often say that it helps them feel in control, and reduce uncomfortable feelings of tension and anxiety. The new quality standard from NICE outlines clear, practical ways to improve the care and treatment of people who self-harm. It will help ensure healthcare professionals deliver the very best care for people who self-harm, and help people who self-harm to know what level of care to expect.”
Sarah Rae, lay member of the topic expert group which developed the quality standard said: “As someone who has occasionally resorted to harming myself as a last-ditch coping strategy, I feel that the publication of a quality standard for self-harm is immensely important. People who have been treated for self-inflicted injuries often report receiving care that is inferior, and feel that they have been discriminated against. The new quality standard aims to raise the bar, so that the treatment provided to people like myself is consistently high, across the country. This will be an enormous step forward, because good quality care will also help to challenge the stigma surrounding self-harm.”
Professor Navneet Kapur, Professor of Psychiatry and Population Health at the University of Manchester, Honorary Consultant at Manchester Mental Health and Social Care Trust, and chair of the topic expert group which developed the quality standard said: “Self-harm is common, but we know that in the past services have varied enormously. This quality standard includes some of the key components of best practice that, when implemented, will help to raise the standards of care for people who self-harm. Its publication represents a real opportunity to improve services, and ensure that people who self-harm receive the help they deserve.”
Professor Sue Bailey, President of the Royal College of Psychiatrists said: “Self-harm is poorly understood in society and people who harm themselves are often subject to stigma and hostility. Worryingly, the rate of self-harm has continued to rise in the UK over the past 20 years, and many people are failing to receive the help they need because of a patchy provision of services. The Royal College of Psychiatrists welcomes and supports this new quality standard, which we hope will help drive up the quality of services and ensure people who self-harm receive the care they need.”
Dr Adrian Boyle, Consultant Emergency Physician at Addenbrooke's Hospital in Cambridge, and Chair of the Clinical Effectiveness Committee of the College of Emergency Medicine which endorsed the quality standard said: “Our nation's emergency physicians regularly see patients who have self-harmed by poisoning or injuring themselves. The NICE quality standard is important and should help reduce the variations in quality of care that exist around the country. The College welcomes and endorses this work by NICE to try and improve the lives of self-harming patients when they are at their lowest.”
Notes to Editors
ii. Owens D, Horrocks J, House A: Fatal and non-fatal repetition of self-harm. Br J Psychiatry 2002; 181:193-199, and Hawton K, Fagg J: Suicide and other causes of death, following attempted suicide. Br J Psychiatry 1988; 152:359-366.
About the quality standard
1. The NICE quality standard for self-harm is available on the NICE website from Friday 28 June.
2. The NICE quality standard for self-harm is based on its clinical guidelines:
- National Institute for Health and Clinical Excellence (2011) Self-harm: longer-term management. NICE clinical guideline 133.
- National Institute for Health and Clinical Excellence (2004) Self-harm. NICE clinical guideline 16.
3. NICE quality standards identify describe high-priority areas for quality improvement in a defined care or service area. They are derived either from NICE guidance or guidance from other sources that have been accredited by NICE, and apply right across the NHS in England.
4. The new quality standard on self-harm consists of specific, concise and measurable statements that, when delivered collectively, should contribute to improving the effectiveness, quality, safety and experience of care of children, young people and adults who self-harm.
Related NICE guidelines and quality standards
5. Patient experience in adult NHS services. NICE quality standard 15 (2012).
6. Service user experience in adult mental health. NICE quality standard 14 (2011).
7. Depression. NICE quality standard 8 (2011).
8. Depression in children and young people. NICE quality standard. Publication expected September 2013.
9. Anxiety. NICE quality standard. Publication expected March 2014.
Future quality standards
About NICE quality standards
11. NICE quality standards aim to help commissioners, health, social care and public health professionals and service providers improve the quality of care that they deliver.
12. NICE quality standards help demonstrate delivery of high quality care in a particular high-priority improvement area through measurable statements. There is an average of 6-8 statements in each quality standard.
13. Quality standards are derived from evidence-based guidance, such as NICE guidance or NICE accredited sources, and are produced collaboratively with the NHS, social care or public health organisations, along with their partner organisations, patients, carers and service users.
14. NICE quality standards are not mandatory but they can be used for a wide range of purposes both locally and nationally. For example, patients and service users can use quality standards to help understand what high-quality care should include. Health, social care and public health professionals can use quality standards to help deliver excellent care and treatment.
15. NICE quality standards are not requirements or targets, but the healthcare system is obliged to have regard to them in planning and delivering services, as part of a general duty to secure continuous improvement in quality.
16. Quality standard topics are formally referred to NICE by NHS England (an executive non-departmental public body, established in October 2012) for health-related areas, and by the Department of Health and Department for Education for non-health areas such as social care.
17. NICE is also publishing a quality standard on rheumatoid arthritis, on Friday 28 June.
The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.
Formerly the National Institute for Health and Clinical Excellence, our name changed on 1 April 2013 to reflect our new and additional responsibility to develop guidance and set quality standards for social care, as outlined in the Health and Social Care Act (2012).
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This page was last updated: 28 June 2013