Self-Harming and Suicidal Behaviour

Scope of this chapter

This chapter should be read in conjunction with the Multi-Agency Safeguarding Children Procedures for your area.

Relevant Regulations

Regulation 20 Supported Accommodation (England) Regulations 2023

Amendment

In March 2026, this chapter was updated to contain information from the Mental Health Foundation 2003, NICE guidance for Self-harm: assessment, management and preventing recurrence, and the NHS England Staying safe from suicide guidance. Additional website links were also added.

March 20, 2026

1. Introduction

Many young people who come into the 'looked after' system have experienced significant trauma in their lives and are often highly vulnerable. It is likely that these young people will sometimes have multiple and complex needs and significant behavioural and emotional difficulties, which can lead to acting in ways that place themselves in situations of high risk.

NICE guidelines define self-harm as "self-poisoning or self-injury, irrespective of the apparent purpose of the act".

Definitions from the Mental Health Foundation (2003) are:

Deliberate self-harm is self-harm without suicidal intent, resulting in non-fatal injury;
Attempted suicide is self-harm with intent to take life, resulting in non-fatal injury;
Suicide is self-harm, resulting in death.

The term self-harm rather than deliberate self-harm is the preferred term as it a more neutral terminology recognising that whilst the act is intentional it is often not within the young person's ability to control it.

Self-harm is a common precursor to suicide and children and young people who deliberately self-harm may kill themselves by accident.

Self-harm can be described as wide range of behaviours that someone does to themselves in a deliberate and usually hidden way. In the vast majority of cases self-harm remains a secretive behaviour that can go on for a long time without being discovered. Many children and young people may struggle to express their feelings in another way and will need a supportive response to assist them to explore their feelings and behaviour and the possible outcomes for them.

2. Planning and Prevention

As part of Placement Planning, relevant information should be gathered. There is evidence to conclude that many individuals who act on self-harm or suicidal impulses can have no plans or intentions to do so, even minutes before hand. Both the NICE guidance for Self-harm: assessment, management and preventing recurrence, and the NHS England Staying safe from suicide guidance emphasise that the use of suicide prediction tools, scales and stratification are flawed and should not be used and that a psychosocial approach should be taken.

All planning should be dynamically reviewed in line with the children/young person’s needs.

In situations where staff are involved with a young person who is actively self-harming or suicidal, they should, in consultation with other members of the team, ensure there is a plan to manage the effects such as distress or grief, that an incident of self-harm or suicide may cause other workers, family members and other young people in the setting.

All reasonable measures should be taken to reduce or prevent continuation of the behaviour.

This may include providing additional supervision, confiscation of materials that may be used to self-harm or, as a last resort, use of physical intervention or calling for assistance from the emergency services.

Staff should support the young person to access suitable professional support to help keep the young person safe and to help the young person to better understand their previous experiences and behaviours of self-harm (where applicable).

The young person should be involved in decision making around any changes to their support package and living arrangements.

3. Notifications Self Harm or Suicide Attempts

Staff should keep appropriate records of self-harming incidents. The registered person should be notified, and they will make the decision to share relevant information and decisions with the young person’s accommodating authority and other relevant professionals.

The social worker should give consideration to whether a Child Protection Referral should be made, if so, see Safeguarding Children and Young People and Referring Safeguarding Concerns Procedure.

3.1 Recording and Review

All self-harming must be recorded.

If First Aid is administered, details must be recorded.

The Placement Plan should be reviewed with a view to incorporating strategies to reduce or prevent future incidents.

3.2 Debriefing

Whilst the person who has harmed will understandably be the focus of the response, those who have witnessed the harm and its aftermath will also require support. It is essential that staff receive a debrief and have the opportunity to discuss their feelings with the management.

All young people will require key care sessions to explore any additional support that they may need.