9 Child and adolescent psychiatry9.9 Treatment options and inpatient care
9.9.2 Self-harm and crisis assessment in young people
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Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
Immediate priorities
Self-harm means intentional self-poisoning or self-injury, whatever the apparent purpose. A young person who says they did not want to die still needs a full assessment. Low stated suicidal intent does not remove that need.
Physical treatment and a timely psychosocial assessment happen side by side. The child's needs decide how they fit together.
Offer the young person time to talk to you alone. Some thoughts and circumstances are hard to describe with carers in the room.
Understanding risk and needs
Cover each of these areas.
Area | What to explore |
|---|---|
Current episode | How much they meant to harm themselves, any planning, how much harm they expected, access to means, and whether they sought help |
Current state | Hopelessness, agitation, intoxication, psychosis, and how well they can engage |
History | Previous self-harm, suicide attempts, violence, and how they responded to treatment |
Context | Family conflict, abuse, bullying, exploitation, losses and online influences |
Protection | Trusted people, ways of coping, reasons for living, and willingness to use support |
Acute risk is about current intent and circumstances that can change quickly. Longer-term vulnerability shapes ongoing care. Bring both together in an individual formulation.
Traps
Do not use risk scales to predict suicide or repeated self-harm. Do not use them to decide who gets treatment or who is discharged.
Do not use global categories of low, medium or high risk for those predictions or decisions either. Instead, set out the specific concerns and the actions needed for immediate and longer-term safety.
Planning care
Safety plan. This lists the young person's warning signs, things they can do to cope, people they can contact, and crisis services. It also includes reducing access to means, agreed together with the young person.
Family involvement. Take into account the young person's wishes, their competence, confidentiality, and whether the family environment is safe.
Psychological treatment. Base this on the formulation and treat any coexisting disorders. Consider adolescent dialectical behaviour therapy for a young person who self-harms frequently and has marked difficulty managing their emotions (emotional dysregulation).
Admission. Consider this when the care or safety they need cannot be provided in a less restrictive setting. Set clear aims for the admission and an onward plan.
Aftercare. If safety concerns remain after self-harm, provide aftercare within 48 hours of the psychosocial assessment.
Repeated presentations should prompt you to review the young person's changing needs and the care plan. Do not withdraw treatment, and do not assume the behaviour is harmless.