The latest evidence from NICE on the longer-term management of self-harm

Young woman thinking

The NICE guideline on the longer-term care and treatment of self-harm was published in November 2011 and contains research published up until January 2011.

A group of experts including psychiatrists, psychologists and social workers has compiled an evidence update looking at the high quality research that has been published in the last two years (from 25 Jan 2011 – 24 Oct 2012).

Methods

They searched 10 biomedical databases looking for systematic reviews, RCTs and cohort studies and found 926 references, which they gradually whittled down to 11 records for inclusion in their report (2 systematic reviews, 6 RCTs and 3 cohort studies).

Key points

We don't know enough about what treatments work for self-harm and suicide among young people

We don’t know enough about what treatments work for self-harm and suicide among young people

None of the key points impact on the existing NICE guidelines, but they’re worth reading nonetheless:

  • Primary care
    • Asking about suicidal ideation in people with signs of depression does not appear to increase feelings that life is not worth living
  • Psychosocial assessment in community mental health services and other specialist mental health settings: integrated and comprehensive assessment of needs and risks
    • There appears to be consistency in the predictive value of risk assessments for self-harm between junior psychiatrists and mental health nurses
    • Limited evidence suggests that among those attempting suicide, taking precautions against discovery of the attempt may be a predictor of eventual suicide
    • Evidence suggests that the SAD PERSONS and modified SAD PERSONS scales are poor predictors of future suicide attempts
  • Longer-term treatment and management of self-harm
    • An assertive outreach intervention does not appear to reduce subsequent suicide attempts versus standard treatment
    • Problem-solving therapy to prevent self-harm does not appear to be more effective than usual care among people presenting with self-harm for the first time, but it may be more effective for those presenting with recurrent self-harm
    • An outreach, problem solving, adherence, and continuity intervention may potentially reduce repeated suicide attempts, but further research is needed
    • Evidence from a non-Western setting suggests that postcard communication following self-poisoning may reduce suicidal ideation and suicide attempts compared with treatment as usual
    • There is a general insufficiency of evidence for the effectiveness of interventions for self-harm and suicide among adolescents and further research is needed
    • A year-long mentalisation-based treatment programme may be more effective than treatment as usual in reducing self-harm among adolescents, but further research is needed

Uncertainties

This work also flagged up two new treatment uncertainties that have been added to the UK DUETs database:

  1. Treatments (i.e. Signs of Suicide, family interventions, therapeutic assessment, dialectical behaviour therapy, cognitive behavioural therapy, pharmacological therapy) in adolescents with self-harm for prevention of recurrence
  2. Attachment-based family therapy in young people to prevent suicide and suicidal behaviours

If you need help

If you need help and support now and you live in the UK or the Republic of Ireland, please call the Samaritans on 116 123.

If you live elsewhere, we recommend finding a local Crisis Centre on the IASP website.

We also highly recommend that you visit the Connecting with People: Staying Safe resource.

Links

Self-harm: longer-term management (PDF). NICE Evidence Update 39, April 2013.

Self-harm (longer term management) (PDF). NICE, Clinical Guideline 133, 23 Nov 2011.

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Andre Tomlin

Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol with his wife, dog and three little elflings.

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