Self-harm and suicidal thoughts assessment
A careful, kind conversation with a mental health professional to understand your thoughts of suicide or self-harm, keep you safe, and plan the support that will help.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- If you are in immediate danger or have badly harmed yourself, call 999 or go to A&E now. For support any time, call Samaritans free on 116 123 or text SHOUT to 85258. For urgent mental health help, call 111 and choose the mental health option in England, Scotland or Wales, or in Northern Ireland call Lifeline free on 0808 808 8000.
- The assessment is a kind, non-judgemental conversation to understand you and keep you safe — not a test, and not about being 'sectioned' by default.
- You usually leave with a shared safety plan; many people start to feel some relief simply from talking openly and being taken seriously.
- This help is always free and urgent on the NHS — you should never feel you must pay privately to be kept safe in a crisis.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your psychiatrist will give you advice for your situation.
Being heard without judgement, often for the first time, which many people find a relief in itself
If you are in immediate danger, have taken an overdose or seriously harmed yourself, a planned assessment is the wrong route — you need emergency care...
You may feel relieved, tired, tearful or a mix of these. Be gentle with yourself, and use your safety plan if difficult thoughts return. Keep the crisis...
A personal safety plan you helped write and can take away
You may feel relieved, tired, tearful or a mix of these. Be gentle with yourself, and use your safety plan if...
If there are ongoing safety concerns, UK guidance says you should be offered initial follow-up within 48 hours of...
Support such as a crisis team, GP review, talking therapy or specialist appointment begins. It is normal for...
Your plan is reviewed and adjusted as things change. Because how you feel can shift quickly, regular check-ins are...
What is a self-harm and suicidal thoughts assessment?
If you are having thoughts of ending your life or hurting yourself, please know this first: you can get help, and things can get better. You are not a burden, you will not be judged, and you deserve support. If you are in immediate danger or have seriously harmed yourself, call 999 or go to your nearest A&E now. You can also call the Samaritans free, any time, on 116 123, or text SHOUT to 85258. For urgent mental health support, in England, Scotland and Wales you can call 111 and choose the mental health option. In Northern Ireland, where there is no region-wide 111 service, call Lifeline free on 0808 808 8000 or contact your GP out-of-hours service.
A self-harm and suicidal thoughts assessment (often called a psychosocial assessment) is a careful, compassionate conversation with a mental health professional — usually a psychiatrist, mental health nurse or psychologist. Its purpose is to understand what you are going through, why you feel this way, what makes things harder or safer, and what support will help. It is not a test you can pass or fail, and it is not about being judged or locked up.
The assessment looks at your thoughts and feelings, anything you have done to harm yourself, your life situation, relationships, physical health, and what has helped before. Together you usually make a safety plan — practical steps and people to turn to when things feel worse. Modern UK guidance is clear that this kind of personal, needs-based assessment matters far more than ticking boxes.
Importantly, good clinicians no longer try to label you simply as 'low', 'medium' or 'high' risk, because those labels do not reliably predict what will happen and can mean people miss out on help. The aim is to understand you as a person and keep you safe, not to put a number on you.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Psychosocial assessment
The core conversation: your thoughts, feelings, any self-harm, your background, relationships, physical health and what helps. UK guidance says this needs (NICE NG225) is...
Crisis or emergency assessment
Done urgently in A&E, by a crisis (home treatment) team, or by liaison psychiatry, when you are at immediate risk or have just harmed yourself. Physical treatment and...
Safety planning
Made together with you: your personal warning signs, coping steps, people and services to contact, and ways to make your environment safer. It is yours to keep and use.
Routine or planned assessment
A booked appointment when you are not in immediate danger but need help with ongoing thoughts of self-harm or suicide, often arranged through your GP, a community mental...
Preparing for your test
- There is no special preparation needed — you can come exactly as you are. Reaching out is the hardest and bravest step.
- If it helps, bring or jot down what has been happening, how long you have felt this way, and anything that has helped or made things worse.
- Bring a list of any medicines you take, including anything bought without a prescription, as some matter for safety.
- You can bring a trusted friend, family member or supporter with you, or ask to be seen on your own — both are fine.
- It is okay to say you are finding it hard to talk; the professional is used to this and will go at your pace.
- If you are waiting in A&E, tell staff you are there because of your mental health so the right team can see you.
- You do not need to be 'in enough of a crisis' to deserve help — if you are struggling, that is reason enough.
What happens
The professional will start gently and let you talk in your own words. They will ask about your thoughts of suicide or self-harm, anything you have done to hurt yourself, how you are feeling, and what is going on in your life — relationships, money, work, loss, physical health and sleep. They ask directly about suicidal thoughts because talking about it openly helps and does not put the idea in your head.
They will also ask about what has helped you before, who supports you, and what gives you reasons to keep going. If you have harmed yourself physically, any wounds or effects of an overdose are looked after at the same time — your physical and emotional care go together.
Towards the end, you usually work together on a plan. This often includes a safety plan you help write, agreement on what support comes next (such as a crisis team, talking therapy, a GP follow-up or specialist referral), and clear advice on what to do if things get worse. You should leave knowing who to contact and when.
Everything you say is treated confidentially. The main exception is if there is a serious risk to your life or someone else's, when the team may need to share information to keep people safe — they will normally explain this to you.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- If you are in immediate danger, have taken an overdose or seriously harmed yourself, a planned assessment is the wrong route — you need emergency care (999 or A&E) now.
- A privately booked, non-urgent appointment is not a substitute for urgent NHS crisis services when you cannot keep yourself safe.
- A brief tick-box risk screen alone is not an adequate assessment; a full psychosocial assessment is what UK guidance recommends.
- If serious physical injury or overdose effects are present, physical emergency care must come first or alongside.
Delay or rearrange if…
- Do not delay if you are at immediate risk — seek emergency help straight away rather than waiting for any appointment.
- If heavily intoxicated, a fuller assessment may need to wait until you are safer and more able to talk, but you should still be kept safe in the meantime.
- If a planned private appointment would mean waiting while you are in crisis, use free NHS crisis services instead.
- If key people who support you cannot be involved and their input is important, it may help to arrange the assessment when they can attend.
Alternatives to discuss
- NHS or HSC crisis services: A&E, local crisis or home treatment teams, and the urgent mental health line (call 111 and choose the mental health option in England, Scotland and Wales; in Northern Ireland call Lifeline on 0808 808 8000)
- Samaritans (116 123, free, any time), CALM, Papyrus HOPELINE247 for young people, and text SHOUT to 85258
- Your GP, who can assess, support and refer urgently or routinely
- Your local NHS or HSC psychological therapies service for ongoing low mood, anxiety or distress — in England this is often called NHS Talking Therapies and may allow self-referral, while Scotland, Wales and Northern Ireland have their own services and referral routes (usually via your GP)
- A safety plan and support from trusted family or friends alongside professional help
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Being heard without judgement, often for the first time, which many people find a relief in itself
- A clearer understanding of what is driving how you feel and what can change
- A practical, personal safety plan to use when things feel worse
- Faster access to the right support, such as a crisis team, talking therapy or specialist care
- Treatment of any physical injury alongside emotional support
- Reassurance that help exists and that these feelings, however overwhelming, can ease with support
Risks & complications
- Talking about painful thoughts and events can feel upsetting or exhausting at the time
- You may feel emotionally drained or tearful afterwards, which is normal
- It can take more than one conversation to feel properly understood
- Feeling the professional did not fully 'get' you, especially if rushed — you can ask for another assessment or a second opinion
- Worry about who will know; confidentiality has limits when life is at risk, which should be explained to you
- Being asked to wait in a busy A&E before a mental health team can see you
- In rare situations where you are at serious risk and cannot be kept safe any other way, admission to hospital — sometimes under the Mental Health Act — may be needed to protect your life. This is a last resort, not the usual outcome.
The hardest moment is often reaching out, and some people fear being judged or 'locked up'. In reality, most assessments lead to support in the community, not admission. If you ever feel an assessment was rushed or box-ticking, you are entitled to ask for a fuller psychosocial assessment — UK guidance says everyone who self-harms or feels suicidal should have one. Tell the professional honestly how you feel, including any plans, because that helps them help you.
Published figures to discuss
There are no meaningful 'success rates' for an assessment, and crucially no tool can reliably predict suicide. UK guidance (NICE NG225) and the Royal College of Psychiatrists are explicit that risk-prediction scales and 'low/medium/high' stratification do not work and should not decide who gets help. The honest position is that suicidal thoughts and risk can change quickly, which is why personalised assessment, safety planning and follow-up matter more than any number.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Immediate suicide risk | Must be assessed directly | Intent, plans, access to means, past attempts, intoxication, psychosis, agitation and protective factors should be covered. | Royal College of Psychiatrists — on suicide risk assessmentrcpsych.ac.ukSource-linked context |
| Risk fluctuation | Can change rapidly | A safety plan should include warning signs, means restriction, supports and what to do if risk escalates. | Royal College of Psychiatrists — on suicide risk assessmentrcpsych.ac.ukSource-linked context |
| Self-harm without suicidal intent | Still clinically important | Even when intent is not to die, self-harm predicts future risk and distress that needs care. | Royal College of Psychiatrists — on suicide risk assessmentrcpsych.ac.ukSource-linked context |
| Safeguarding concern | Must be considered | Domestic abuse, exploitation, child safeguarding, elder abuse or coercion may need urgent protective action. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery from the assessment itself. 'Afterwards' is about the plan you leave with, the support that follows, and looking after yourself as feelings settle.
- Feeling emotionally tired or low for a day or two after talking about difficult things
- Thoughts of self-harm or suicide easing for a while, then returning — this is common and worth telling someone
- Mixed feelings about having opened up, alongside some relief
- Needing more than one conversation before things feel clearer
Aftercare
- Keep your safety plan and crisis numbers somewhere you can reach them quickly, such as saved in your phone.
- Use the people and services on your plan when warning signs appear — that is what they are for.
- Try to make your environment safer, for example asking someone to look after medicines or other means of harm.
- Stay connected with at least one trusted person, even if it is just a text.
- Attend any follow-up appointments, and tell your GP or team if your mood drops again.
- Avoid alcohol and recreational drugs when you feel low, as they can make thoughts harder to manage.
- If thoughts become overwhelming or you feel unsafe, contact a crisis line — call 111 and choose the mental health option in England, Scotland or Wales, or Lifeline on 0808 808 8000 in Northern Ireland — or go to A&E, at any hour.
- Crisis numbers saved: 999, Samaritans 116 123, SHOUT text 85258, and your local urgent mental health line (111 mental health option in England, Scotland and Wales; Lifeline 0808 808 8000 in Northern Ireland)
- A copy of your safety plan kept somewhere easy to find
- One trusted person who knows how you are feeling
- Medicines and other means of harm made less accessible where possible
- Follow-up appointment date and a named contact noted down
- GP aware, so they can support you between appointments
⚠ Get urgent help if…
- Immediate thoughts of ending your life, or feeling you cannot keep yourself safe — call 999 or go to A&E now
- You have taken an overdose or seriously harmed yourself — seek medical help or call 999 even if you feel unsure
- Suicidal thoughts becoming stronger, more constant, or you have made a plan
- Feeling completely hopeless, trapped, or that others would be better off without you
- A sudden sense of calm after deep despair, which can sometimes mean a decision to act
- Using alcohol or drugs to cope and feeling increasingly out of control
- Remember: Samaritans 116 123 (free, any time) and SHOUT text 85258 are always there; for urgent mental health support call 111 and choose the mental health option in England, Scotland or Wales, or Lifeline on 0808 808 8000 in Northern Ireland
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your psychiatrist gives you.
Results & realistic expectations
A good assessment is not about a score or a label. A good outcome means you feel listened to and a little less alone, you understand what is happening to you, and you leave with a clear, personal plan and people to turn to.
No assessment can promise how you will feel tomorrow, and it cannot predict the future — feelings of suicide can rise and fall quickly. That is exactly why ongoing support, an up-to-date safety plan and the freedom to reach out again at any time matter so much. Asking for help more than once is not failure; it is how recovery often works.
How you feel can change from day to day, so a plan made today may need updating soon. Safety plans work best when they are revisited and kept current. If your circumstances or feelings change, or the plan no longer fits, tell your GP or mental health team so it can be reviewed.
Related tests, treatments or support
An assessment often leads to other support working together: a crisis or home treatment team for the short term, talking therapy such as CBT for the longer term, treatment of any underlying depression or anxiety, and help with practical problems like money, housing or relationships that are adding to the strain.
Follow-up & long-term care
If there are ongoing safety concerns, UK guidance recommends initial follow-up within 48 hours of the assessment. Beyond that, you should have a clear plan for who is coordinating your care, when you will be seen again, and how to get urgent help in between. Any letter or report (for example to your GP) should be shared appropriately, and you can ask what will be written and who will see it.
- Keep your safety plan and crisis contacts up to date and within reach
- Stay engaged with follow-up and any talking therapy offered
- Tell your GP or team early if your mood drops or thoughts return
- Keep means of harm less accessible during difficult periods
- Look after sleep, eating and connection with others where you can
Repeat, follow-on and what comes next
- One assessment is rarely the whole picture; reassessment is normal and expected, not a sign of failure.
- Safety plans need updating as feelings and circumstances change.
- A diagnosis or plan may be revised as more is understood about what is driving your distress.
- Asking for another assessment or a second opinion is reasonable if you did not feel heard.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A personal safety plan you helped write and can take away
- Clearly named contacts and crisis routes available day and night
- Initial follow-up within 48 hours when there are ongoing safety concerns (per NICE NG225)
- Compassionate, non-judgemental treatment throughout, with your physical health looked after too
- Coordinated onward support — GP, crisis team, talking therapy or specialist care — with a clear review plan
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether you are seen urgently (always NHS and free) or are arranging planned, non-urgent private support
- The professional's seniority (for example consultant psychiatrist versus other team members) for any private appointment
- Length of the appointment and whether more than one session is needed
- Whether a written report or letter to your GP is provided
- Any follow-up appointments or onward talking therapy arranged
- Whether liaison with your GP, family or other services is included
- Confirmation that urgent or crisis care is signposted to free NHS services, not delayed for payment
- Who will carry out the assessment and their qualifications
- Appointment length and whether follow-up is included
- Whether a safety plan and a written letter or report are provided
- What out-of-hours and crisis support is available, and how to access it
- What happens, and what it costs, if further appointments or referrals are needed
On the NHS? Assessment and crisis support for suicidal thoughts or self-harm are always available free and urgently through NHS or HSC services — A&E, crisis teams, and the urgent mental health line (call 111 and choose the mental health option in England, Scotland and Wales, or Lifeline on 0808 808 8000 in Northern Ireland). Private routes are only for non-urgent, planned support and should never replace emergency NHS care.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not explaining the limits of confidentiality, so you do not know when information might be shared to keep you safe
- Using a risk questionnaire as if it were the whole assessment, or to decide you do not qualify for help
- No clear written safety plan or crisis contacts given before you leave
- Failing to explain follow-up, so you are unsure who to contact or when
- Not offering you the choice to be seen with, or without, a supporter
Marketing red flags
- Any private service implying you must pay to be kept safe, or that NHS crisis care is inferior
- Promises to 'predict' or 'rule out' suicide risk with a test or score
- Reducing a crisis to a quick tick-box assessment with no safety plan
- Discouraging you from using free NHS crisis services or A&E when you are at risk
- Guarantees of a particular outcome or 'fixing' suicidal feelings in a single session
Choosing a specialist safely
- Check the psychiatrist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the psychiatrist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good psychiatrist will welcome every one of these.
- Can I have a full psychosocial assessment, not just a risk questionnaire?
- Can we make a safety plan together that I can take away?
- Who will contact me next, and when, if things feel worse?
- What support are you arranging for me, and how soon will it start?
- Who will see any notes or letter from today, and what will it say?
- How do I get urgent help out of hours, including this evening and weekends?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the psychiatrist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Will I be judged or told off for self-harming or feeling suicidal?
Will I be sectioned or kept in hospital?
Is what I say confidential?
Do I have to pay or go private to be assessed?
What if talking about it makes me feel worse?
What if I am asked to fill in a risk questionnaire?
Can I bring someone with me?
What if I live in Scotland, Wales or Northern Ireland?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Help for suicidal thoughts NHS — Where to get help for self-harm NICE NG225 — Self-harm: assessment, management and preventing recurrence Royal College of Psychiatrists — on suicide risk assessment Samaritans — get help (call 116 123) Mind — suicidal feelings Staying Safe — safety plans nidirect — urgent and emergency care (Northern Ireland) nidirect — GP out-of-hours service (Northern Ireland) NHS England — 111 mental health crisis support NHS inform (Scotland) — urgent mental health help NHS 111 Wales — mental health and wellbeing nidirect — mental health emergency / Lifeline (Northern Ireland) NHS — find NHS Talking Therapies (England) NHS inform (Scotland) — psychological therapies NHS 111 Wales — counselling nidirect — mental health care professionals (Northern Ireland)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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