Self-harm assessment
A careful, compassionate conversation with a mental health professional to understand why a young person has hurt themselves, what they need, and how to keep them safe.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- If a young person is in immediate danger, call 999 or go to A&E now; for urgent support call Samaritans 116 123, Papyrus HOPELINE247 0800 068 4141 (under 35s), or text SHOUT to 85258. For urgent mental health help, call 111 and choose the mental health option in England, Scotland or Wales; in Northern Ireland call Lifeline on 0808 808 8000.
- A self-harm assessment is a kind, careful conversation to understand what a young person needs and to keep them safe, not a test or a telling-off.
- It should end with a shared safety plan and clear follow-up; NICE says tick-box risk scores should not decide who gets help.
- Confidentiality is respected, but professionals must share information if there is a serious worry about safety, and they should explain this from the start.
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.
Helps the young person feel heard and taken seriously, often a relief in itself
A planned assessment is not the right route when a young person is in immediate danger; that needs 999 or A&E now.
The young person talks with a professional, sometimes alone and sometimes with family. Strengths, worries and safety are explored, and a plan begins to...
A written, jointly made safety plan with warning signs, coping strategies and means safety
The young person talks with a professional, sometimes alone and sometimes with family. Strengths, worries and...
You should leave with a safety plan and contact details for urgent help. If safety concerns continue, initial...
Agreed support starts: this might be follow-up appointments, talking therapy, school support, or help for another...
The plan is reviewed and adjusted. Recovery from self-harm is often gradual, with better and harder days, and...
What is a self-harm assessment?
If you are worried that a young person is in immediate danger, do not wait for an assessment. Call 999 or go to A&E now. You can also call Samaritans free any time on 116 123, call Papyrus HOPELINE247 on 0800 068 4141 (for people under 35), or text SHOUT to 85258. For urgent mental health support in England, Scotland or Wales, you can call 111 and choose the mental health option. In Northern Ireland, call Lifeline free on 0808 808 8000, or contact your GP out-of-hours service.
A self-harm assessment is a careful, kind conversation between a young person and a mental health professional after they have hurt themselves on purpose (for example by cutting, taking too many tablets, or hurting themselves in another way). It is not a test you pass or fail, and it is not a telling-off.
The aim is to understand what is going on in the young person's life, how they are feeling, what led to the self-harm, and what would help. The professional also looks at safety, what makes things harder or easier, and who can support the young person. Together they agree a plan.
Self-harm is more common than many families realise, and it does not always mean a young person wants to end their life. But it is always a sign that someone is struggling and deserves help and a proper look at what they need.
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.
Emergency assessment in A&E
After self-poisoning or an injury, a young person is first checked for physical safety. A mental health assessment usually follows, often by a specialist children and young...
Psychosocial assessment
The main part: a conversation that explores feelings, home, school, friendships, social media, any worries about safety, and what support is needed. It looks at strengths as...
Safety planning
Working out together what helps when things feel overwhelming: warning signs, coping ideas, people to contact, and making the home safer (for example agreeing where medicines...
Involving family or carers
Where possible, parents or carers are part of the conversation, because they are a big part of keeping a young person safe and supported at home.
Preparing for your test
- If there is any immediate danger, call 999 or go to A&E first; an assessment can follow once the young person is safe.
- There is little to prepare in advance; honesty matters far more than getting things right.
- It can help to jot down any medicines the young person takes and roughly when difficulties started.
- A parent, carer or trusted adult is usually welcome to come and may be asked to wait nearby for part of the conversation.
- It is fine for the young person to say they find something hard to talk about, or to ask for a break.
- Bring details of any current support, such as a school counsellor, GP or CAMHS worker already involved.
- If English is not the young person's first language, you can ask for an interpreter.
What happens
A trained mental health professional, experienced in working with young people, will talk with the young person in a private, unhurried way. They will ask gently about what happened, how the young person has been feeling, and what is going on at home, school and with friends. They will usually ask about social media and online life, any caring responsibilities, sleep, and whether there are any thoughts of suicide or of hurting themselves again.
The professional is not there to judge. They will also ask about strengths, things that help, and people the young person trusts. Part of the conversation may be just with the young person, and part with the family, depending on the young person's wishes and their safety.
They will explain confidentiality: what is said is usually kept private within the team, but if they are worried about the young person's safety or someone else's, they have a duty to share that to keep people safe. Good professionals explain this clearly at the start.
By the end, you should have a shared plan: what support is being offered, who to contact, and what to do if things feel worse. National guidance (NICE) is clear that tick-box risk scores should not be used to decide who gets help; the focus is on understanding the person and their needs.
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…
- A planned assessment is not the right route when a young person is in immediate danger; that needs 999 or A&E now.
- A quick, tick-box or online-only risk score is not an adequate assessment after self-harm.
- Assessment alone is not enough if it does not lead to a safety plan and follow-up support.
- It is not a substitute for treating an underlying problem such as abuse, exploitation, depression or an eating disorder.
Delay or rearrange if…
- There is an immediate safety emergency; deal with that first via 999 or A&E.
- The young person is too physically unwell after self-poisoning to take part; medical care comes first.
- Key people who could keep the young person safe cannot yet be involved and safety can be held safely in the meantime.
- Do not delay simply because a young person is reluctant; gentle, flexible engagement is part of the assessment.
Alternatives to discuss
- Urgent NHS crisis assessment through A&E, a crisis line, or by calling 111 and choosing the mental health option (in Northern Ireland, Lifeline on 0808 808 8000) when waiting is not safe
- Support through the GP, school counsellor or pastoral team for milder, longer-standing distress
- Talking therapies such as CBT, or DBT-A for frequent self-harm with strong emotions
- Charity helplines and text services for immediate listening support alongside, not instead of, assessment
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
- Helps the young person feel heard and taken seriously, often a relief in itself
- Builds a clearer picture of what is driving the distress
- Leads to a practical safety plan the young person has helped to make
- Connects the family to the right support and follow-up
- Can pick up other difficulties, such as low mood, anxiety, bullying or abuse, that need help
- Reduces the sense of being alone with something frightening
Risks & complications
- Talking about painful things can feel upsetting or exhausting at the time
- A young person may feel embarrassed, exposed or worried about being judged
- Uncertainty about how much will be shared with parents or carers
- Feeling worse for a short time after opening up before support starts to help
- Disagreement within a family about what should happen next
- Waiting for follow-up support if local services are stretched
- Information has to be shared without consent when there is a serious safety or safeguarding concern
- A young person needs a short hospital stay if they cannot be kept safe at home
The biggest risk is not having an assessment at all, because untreated distress can deepen. The assessment itself is a conversation, not a procedure. Ask who will do it, how confidentiality and its limits work, what the plan is if things feel worse, and how quickly follow-up support will start.
Published figures to discuss
There are no meaningful 'success' or 'complication' percentages for a self-harm assessment, and it would be misleading to attach them. NICE is explicit that risk-prediction tools and low, medium or high risk labels should not be used to predict suicide or repeat self-harm, or to decide who is offered help. The value of the assessment lies in understanding the young person, reducing immediate danger and connecting them to support, not in producing a score.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Future self-harm or suicide risk | Must be assessed individually | NICE recommends psychosocial assessment by someone experienced with young people who self-harm. | NICE NG225 — Self-harm: assessment, management and preventing recurrencenice.org.ukSource-linked context |
| Safeguarding concern missed | Must be actively considered | Abuse, bullying, exploitation, domestic violence, online harms and substance use may all be relevant. | Guide sourcesClinical context |
| Assessment focuses only on wounds | Avoidable | Physical treatment is not enough; the assessment should explore the story, triggers, supports and immediate safety. | NICE NG225 — Self-harm: assessment, management and preventing recurrencenice.org.ukSource-linked context |
| Means and safety plan not addressed | Avoidable | Good aftercare includes a written safety plan, crisis contacts, family involvement where safe and rapid follow-up. | 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. Afterwards, a young person may feel relieved, drained, or a mix of both. What matters most is that a clear plan is in place and the family knows who to contact.
- Feeling emotionally tired or tearful after talking about difficult things
- Relief at having shared something heavy, sometimes mixed with worry
- Ups and downs over the following days as support gets going
- Needing extra reassurance, rest and gentleness from those around them
Aftercare
- Keep the agreed safety plan somewhere easy to find and revisit it together calmly.
- Make the home safer by agreeing where medicines and other means are kept.
- Save crisis numbers in phones: 999 or A&E for emergencies, Samaritans 116 123, Papyrus HOPELINE247 0800 068 4141, text SHOUT to 85258. For urgent mental health support, call 111 and choose the mental health option in England, Scotland or Wales, or in Northern Ireland call Lifeline on 0808 808 8000.
- Keep follow-up appointments and let the team know quickly if things feel worse.
- Stay connected without pressure: regular, gentle contact often helps more than big conversations.
- Look after the wider family too; supporting a young person who self-harms is hard and parents need support as well.
- Tell school only what the young person is comfortable sharing, unless safety requires more.
- Crisis numbers saved in everyone's phones
- A copy of the safety plan kept at home
- Medicines and other means stored more safely
- Follow-up appointment date written down
- Name and contact route for the team or worker
- Plan agreed for what to do at night or weekends
- Support arranged for parents or carers too
⚠ Get urgent help if…
- Any sign that a young person is about to harm themselves, or has taken an overdose: call 999 or go to A&E now
- Talking about wanting to die, feeling hopeless, or saying others would be better off without them
- A sudden calm after a period of distress, giving away belongings, or saying goodbye
- Self-harm that is more frequent, more severe, or where they have hidden injuries
- Drinking heavily or using drugs to cope
- Withdrawing completely from family, friends or things they used to enjoy
- Any disclosure of abuse, exploitation or being unsafe at home
- For urgent but non-emergency worry: Samaritans 116 123, Papyrus HOPELINE247 0800 068 4141, text SHOUT to 85258. In England, Scotland or Wales you can also call 111 and choose the mental health option; in Northern Ireland call Lifeline on 0808 808 8000
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 ends with the young person feeling listened to and a plan everyone understands. It should make clear what support is being offered, who to contact, and what to do if things get worse.
An assessment cannot predict exactly what will happen, and no professional can promise a young person will never self-harm again. What it can do is understand the person, reduce immediate danger, and connect them to help. Recovery usually takes time and ongoing support rather than a single conversation.
A safety plan is a living document, not a one-off. It should be revisited and updated as circumstances change, because what helps a young person can shift over weeks and months. If self-harm returns or worsens, a fresh assessment and review of the plan are appropriate.
Related tests, treatments or support
An assessment after self-harm often leads on to other support: talking therapy such as CBT or, for some young people with frequent self-harm and strong emotions, a form of dialectical behaviour therapy adapted for adolescents (DBT-A). It may also uncover depression, anxiety or other difficulties that need their own treatment.
Follow-up & long-term care
If safety worries continue after the assessment, initial follow-up should usually be arranged quickly, often within a day or two. After that, support is tailored to need and might involve a community mental health team, talking therapy, school and GP. The young person and family should always know who to contact and how.
- Keep the safety plan up to date as things change
- Keep crisis numbers easy to find
- Attend follow-up appointments and reviews
- Tell the team early if self-harm or distress increases
- Keep medicines and other means stored safely at home
Repeat, follow-on and what comes next
- Assessment is not a one-off; if self-harm continues or worsens, a fresh assessment and review of the plan are appropriate.
- The safety plan should be updated as circumstances and what-helps change.
- A first conversation may need to be revisited as trust builds and more of the picture emerges.
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 written, jointly made safety plan with warning signs, coping strategies and means safety
- A named contact route and clear crisis numbers for out of hours
- Prompt initial follow-up, often within a day or two, if safety concerns continue
- A plan to treat any underlying difficulty and to involve school and GP appropriately
- Support offered to parents and carers as well as the young person
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 the assessment is urgent (NHS crisis care) or a planned private appointment
- The length and depth of the assessment and any report produced
- Whether family sessions and collateral information from school are included
- How much follow-up, therapy or onward support is arranged
- Whether other difficulties found need their own assessment or treatment
- Travel and time, especially if seeing a specialist some distance away
- Who carries out the assessment and their experience with young people
- What the assessment includes and whether family input is part of it
- Whether a written summary or safety plan is provided
- What follow-up is offered and how to reach the team in a crisis
- What happens, and what it costs, if further appointments are needed
- How confidentiality and information sharing are handled
- Cancellation policy and arrangements if the young person is too unwell to attend
On the NHS? Assessment after self-harm is available on the NHS, including urgently through A&E and crisis services; some families also use private child and adolescent psychiatry for choice or speed.
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 confidentiality and its limits clearly before the conversation starts
- Leaving without a safety plan or clear crisis contacts
- Relying on a risk score instead of a proper understanding of the young person
- Sharing information with school or others beyond what is needed for safety, without the young person's agreement
- Not making sure the young person and family know what to do if things worsen out of hours
Marketing red flags
- Promising to 'predict' or 'rule out' suicide risk with a questionnaire
- Offering a one-off online risk score as a substitute for a proper assessment
- Claiming a single session will 'fix' self-harm
- Pressuring families into paid packages at a moment of crisis instead of signposting urgent NHS help
- Downplaying the need for follow-up support
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.
- Who will carry out the assessment, and do they have experience with young people?
- How will confidentiality work, and when would you need to share information?
- What is the safety plan, and what should we do if things feel worse tonight or at the weekend?
- How quickly will follow-up support start, and who will provide it?
- What support is there for me as a parent or carer?
- Were any other difficulties found that need their own help?
- 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
My child is in danger right now. What do I do?
Does self-harm mean my child wants to die?
Will the professional tell me everything my child says?
Can we get this on the NHS or do we need to pay?
Will my child be sectioned or kept in hospital?
Is it true that risk scores decide who gets help?
What can I do at home to help?
Find a verified psychiatrist for self-harm assessment
Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.
No verified consultants list this procedure yet — browse the full directory.
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: NICE NG225 — Self-harm: assessment, management and preventing recurrence NHS — Help for suicidal thoughts NHS — Self-harm advice Royal College of Psychiatrists — Self-harm in young people: for parents and carers Papyrus — HOPELINE247 (0800 068 4141) Samaritans — call 116 123 free, any time YoungMinds — Self-harm: a guide for parents nidirect — urgent and emergency care services (Northern Ireland) nidirect — GP out-of-hours service (Northern Ireland) NHS England — 111 mental health crisis support NHS inform Scotland — get urgent mental health help NHS 111 Wales — mental health and wellbeing nidirect — mental health emergency / Lifeline 0808 808 8000 (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.
Related guides: Depression in children and teenagers · Anxiety in children and teenagers · Low mood and self-esteem support · ADHD assessment in children · Child and adolescent mental health assessment