What self-harm, suicidal thoughts and immediate safety mean

NICE defines self-harm as intentional self-poisoning or injury, whatever the apparent purpose. In children's homes this can include cutting, burning, ligature use, overdosing, swallowing harmful items, hitting, scratching, reopening wounds or other deliberate acts that injure the body. Staff do not need to establish why it happened before acting to keep the child safe.

Self-harm and suicide risk overlap but are not the same. Some children self-harm without wanting to die; others who say little may nonetheless be at significant suicide risk. Treat all self-harm seriously, remain alert to signs of suicidal thinking and follow the home's escalation process when risk may be increasing.

What staff should hold in mind

• Self-harm is always important: never dismiss it because the injury looks small.
• Intent may be mixed: children can feel both an urge to stop and a wish to escape at the same time.
• Immediate safety comes first: consider injury, means, supervision and urgent help before lengthy discussion.
• Language matters: record what was seen and said, not assumptions about the child's intent.
• Local procedure matters: follow the home's plan for medical care, escalation and urgent mental health response.

Staff do not need to be therapists to respond effectively. They need to be steady, factual, compassionate and clear about when the situation requires urgent escalation beyond ordinary support.

For frontline staff, the first question is not "Do I fully understand this?" but "How safe is this child right now?"