Royal Australian and New Zealand College of Psychiatrists clinical practice guideline for the management of deliberate self-harm

Abstract

The clinical practice guidelines for deliberate self-harm address self-harm within specific population sub-groups and provide up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus.

Accuracy of Clinician Predictions of Future Self‐Harm: A Systematic Review and Meta‐Analysis of Predictive Studies

“…The NICE Clinical Guideline #133 in the UK recommends that risk assessment tools and scales to predict future suicide or repetition of self‐harm should not be used as the basis to allocate after‐care (NICE, ), as does the Royal Australian and New Zealand College of Psychiatrists (Carter et al., ). Instead, recommendations are made for a needs‐based approach combined with an assessment of modifiable risk factors to inform possible allocation of after‐care on an individual patient basis (subject to agreement from the patient).…”

“…Given the low prevalence of future self‐harm as an outcome, even in clinically high‐risk populations, prediction by any method will not be clinically useful at the individual patient level. Instead we would recommend three approaches to allocation of clinical after‐care: (1) an individual needs‐based assessment aimed at reducing exposure to modifiable risk factors (Carter et al., ; Ryan & Large, ); (2) allocation of proven interventions for particular selected high‐risk subpopulations, for example, those with borderline personality disorder (National Health and Medical Research Council, ); and (3) allocation of proven interventions that can be delivered to unselected high‐risk clinical populations (Hetrick et al., ; Milner, Carter, Pirkis, Robinson, & Spittal, ). There is currently no sufficiently accurate way to determine which patient is safe for discharge, whether the outcome of interest is suicide or self‐harm.…”

“…A second systematic review estimated a pooled PPV (5.5%; Carter et al., ) and a third review reported a range of PPV (1.3%–16.7%; Chan et al., ) for a high risk of suicide classification. There have been seven recent systematic reviews that when considered collectively have demonstrated that any individual risk factor, instrument, or scale used to classify patients into a high‐risk group for later suicide may do so modestly better than chance; however, around half of all suicides come from the low‐risk classification, while very few of the patients in the high‐risk classification die by suicide (Carter et al., ; Chan et al., ; Chapman et al., ; Franklin et al., ; Hubers et al., ; Large et al., ; Ribeiro et al., ). None of these systematic reviews included studies of unassisted clinician prediction.…”

Acute Alcohol Co‐Ingestion and Hospital‐Treated Deliberate Self‐Poisoning: Is There an Effect on Subsequent Self‐Harm?

“…While an episode of DSP involving co‐ingested alcohol may not be viewed as serious as one where alcohol is not involved, and the level of absconding in this population is higher, the risk of repeated DSP and suicide is equally likely. Hence, it is important to introduce measures to ensure that all DSP episodes receive the recommended management for deliberate self‐harm (Carter et al., ).…”

Deliberate self‐harm in older adults: A national analysis of US emergency department visits and follow‐up care

“…d High lethality methods include firearms, drowning, suffocation, fall, fire, and motor vehicle; low lethality methods include cutting and poisoning; unknown includes unspecified or poorly specified.Values in bold indicate significant risks ratios at P ≤ .01. that a sizable proportion of the follow-up mental health visits simply represented continuation of ongoing mental health care rather than ED-driven referrals for new outpatient mental health services. Because active contact and mental health care following self-harm events reduce repeated selfharm 68,69 and suicide mortality, 10,11 guidelines in the management of self-harm emphasize the importance of rapid referral and outreach to ensure receipt of mental health care 33,34,[70][71][72]. One factor that may partially explain the lower rate of follow-up care in this sample is US older adults, in general, report significantly lower levels than younger adults of perceived need for and receipt of any mental health care, 63,64 including among those with recent suicide plans and attempts 65.…”