8 Psychotherapy8.7 Psychotherapeutic psychiatry
8.7.6 Psychological responses to self-harm and violence
2 min read
Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
Understanding the event
Start with a psychosocial assessment. Find out what happened and in what context, what the person needs, how safe they are now and what the behaviour meant to them. Do not assume one motive fits everyone.
Self-harm may help someone manage overwhelming emotion or express distress, or it may happen with suicidal intent. Intentions can change within a single episode and from one episode to the next.
Suicidal thinking must be asked about directly. Cover intent, plans, access to means, reasons for living and whether the person is able to use support.
Violence formulation looks at triggers, beliefs, emotional arousal, substance use, mental disorder and the interpersonal context, alongside previous behaviour.
Turning understanding into action
Task | Clinical action |
|---|---|
Immediate safety | Treat any injury, reduce immediate danger and arrange appropriate urgent care |
Shared formulation | Work out the triggers and the sequence of events that led up to it |
Coping | Practise alternatives that meet the same need the behaviour was meeting |
Safety planning | Agree warning signs, sources of support, crisis contacts and ways to reduce access to means |
Continuing care | Treat any associated disorders and review the plan with the relevant clinicians |
Do not use risk scales to predict suicide, or to decide who gets treatment after self-harm.
A safety plan made together with the person is a practical intervention. An agreement where the person simply promises not to self-harm does not make them safe.
Base psychological treatment on the person's needs and the evidence-based approach indicated for them. Do not withhold care because self-harm keeps happening.
Families and staff
Involving the family means thinking about consent, confidentiality and safeguarding, and whether contact would be supportive or unsafe.
After a suicide or serious violence, relatives and staff may feel grief, guilt, anger or fear, or develop traumatic stress. They need clear information and access to support.
Reflective practice gives staff space to think about their emotional responses and the relationship patterns involved. It should be free of blame, and nobody should be required to disclose personal material.
Incident review and emotional support do different jobs. Staff need to be clear about each process and how confidential it is.