About this resource
Self-harm is often a way of coping with unbearable feelings, and people are more likely to seek help when they are met with compassion. NICE recommends a collaborative psychosocial assessment rather than risk scales. This record helps you explore what self-harm does for the person, check for injuries and medical needs, ask about suicide separately, and agree what would help.
Purpose
To understand self-harm from the person's point of view and record a shared plan.
Who it is for
Primary profession: Counsellors and therapists. Also relevant for psychologists, social workers, youth workers.
Client or participant group: Adults and young people seeing a counsellor or therapist.
Practice setting: Counselling and therapy services, including private practice, schools and community services.
Suggested uses
- When a client tells you about self-harm
- Regular check-ins during therapy
- Supervision and consultation
- Referral to a GP or mental health service
Instructions for practitioners
- Stay calm and curious, and thank the person for telling you.
- Check whether any injury needs medical care.
- Ask about suicide directly; self-harm and suicidal thoughts can overlap, and they are not the same thing.
- Explore what self-harm does for the person before suggesting alternatives.
- Agree next steps together and be honest about what you may need to share.
Accessibility considerations
Use the person's own words. Offer an interpreter, a support person or a different format where it helps.
Scope and limitations
A structured conversation and record. It is not a risk scale, gives no score or rating and cannot predict what someone will do. It does not replace clinical judgement, supervision, your professional code or your organisation's procedures. If someone is in immediate danger, call 000. Lifeline: 13 11 14. Suicide Call Back Service: 1300 659 467. 13YARN: 13 92 76. Kids Helpline: 1800 55 1800.
Higher-risk topic: use only within your training, supervision and organisational procedures.
Research basis
Research shows that risk scales and low, medium or high categories cannot reliably predict suicide or repeat self-harm. NICE advises against using them for this and recommends a compassionate psychosocial assessment that leads to a plan.
- Carter, G., Milner, A., McGill, K., Pirkis, J., Kapur, N., & Spittal, M. J. (2017). Predicting suicidal behaviours using clinical instruments: Systematic review and meta-analysis of positive predictive values for risk scales. British Journal of Psychiatry, 210(6), 387–395. https://doi.org/10.1192/bjp.bp.116.182717
- Chan, M. K. Y., Bhatti, H., Meader, N., Stockton, S., Evans, J., O'Connor, R. C., Kapur, N., & Kendall, T. (2016). Predicting suicide following self-harm: systematic review of risk factors and risk scales. British Journal of Psychiatry, 209(4), 277–283. https://doi.org/10.1192/bjp.bp.115.170050
- Large, M., Kaneson, M., Myles, N., Myles, H., Gunaratne, P., & Ryan, C. (2016). Meta-Analysis of Longitudinal Cohort Studies of Suicide Risk Assessment among Psychiatric Patients: Heterogeneity in Results and Lack of Improvement over Time. PLOS ONE, 11(6), e0156322. https://doi.org/10.1371/journal.pone.0156322
- National Institute for Health and Care Excellence. (2022). Self-harm: Assessment, management and preventing recurrence (NICE guideline NG225). https://www.nice.org.uk/guidance/ng225/chapter/Recommendations
What is included
A 3-page printable A4 PDF, including a practitioner notes page with the research basis (version 1.0).
Originality
Original Practitioner Plus content: wording, activity structure, layout and icons were created for this resource. No third-party worksheets, illustrations or text were reproduced. Written for Practitioner Plus from the guidelines and research listed in the research basis; no third-party template was used.
