ABSTRACT
Self-harming can usefully be seen as a form of communication. There has been a trend in the UK recently to drop the word ‘deliberate’ in front of self-harm, and to abandon the term ‘attempted suicide’, on the grounds that the person’s intention is not always clear. Risk factors could be divided into groups in several ways, for instance using the four-P grid, or looking at the impact of culture, parents and friends on what leads to self-harm, the function it serves and the aftermath. Many young people say that their self-harm gets worse partly because of professional attempts to stop it without understanding and without an alternative outlet being provided for the underlying feelings. Referral may be dictated by the nature of the self-harm, such as an overdose, in which case a detailed prior assessment may be superfluous. If referral is not immediately indicated, an assessment should aim to develop some understanding of the context and intent of the self-harm.
