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The Royal College of Psychiatrists Improving the lives of people with mental illness


This was a national quality improvement programme which brought together professionals from emergency departments, acute medical, mental health and ambulance services to review and improve the service they provided to people who self-harm.


Self-harm is one of the top five causes of acute medical admission in the UK (68,716 admissions in 2001/2002).


The quality of care for those who self-harm depends on the quality of joint working between emergency departments and mental health service and this currently varies across the UK.


Many people who attend an emergency department as a result of self-harm find the experience unpleasant.


This finding greatly influenced the recently published NICE guidelines which concluded that improving staff knowledge and attitudes is the key to better services and reduction in the substantial morbidity and mortality associated with self-harm.


NICE guideline on Self-Harm  


Our best practice guideline around self-harm incorporates the NICE guidance and includes other standards and current legislation from the Royal College of Psychiatrists, Faculty of Accident and Emergency Medicine, and The Department of Health.


Where appropriate, the standards are mapped to the Healthcare Commission’s ‘Standards for Better Health’, allowing services to demonstrate compliance against these.


Download a copy of manual of standards:

Better Services for People who Self-Harm – Quality Standards for Health Care Professionals



The programme was being partly funded by the Health Foundation an independent charity that aims to improve health and the quality of healthcare for the people of the UK.


This was one of several programmes that form the Health Foundation’s ’Engaging with Quality’ initiative, which aims to address the gap between ‘current’ and ‘best’ practice within healthcare settings.


The partners

The Royal College of Psychiatrist’s Centre for Quality Improvement worked in collaboration with the following partners who represent key professionals in the care of people who self-harm:

  • The British Association for Emergency Medicine and the College of Emergency Medicine
  • The Royal College of Nursing
  • The Royal College of Physicians
  • Mind
  • The NICE National Collaborating Centre for Mental Health

The programme was also working with national self-harm and patient support groups. A national patient advisor is a member of the Central Project Team.

  • Service User's Experiences of Emergency Services Following Self-Harm - A National Survey, 2006 - Click here to view

  • Capacity Algorithm


Wave 1 Member's Area

Guidance Documents Newsletters
Project Management Pack  

Service User Handbook

Manual of Standards

Sept 07 

May 07

July 06

Dec 05

Wave 2 Member's Area

Guidance Documents Newsletters
Project Management Pack 

Memorandum of Understanding  

Service User Handbook

Manual of Standards

Sept 07 

May 07

Oct 06

Wave 3 Member's Area

Guidance Documents Data Collection

Project Management pack

Service User Handbook

Memorandum of Understanding

Self-Harm Quality Standards

Newsletter Sept 2007

Wave 3 Re-audit Staff Survey

Wave 3 Re-audit Case Flow Audit



Wave 1 publications:


Wave 2 publications:


Wave 3 publications:

Service User Information

Change Interventions and Training Materials

The following interventions had been provided by the Central Project team to help members bring about positive changes in the quality of care they provided as well as educating staff so that they are better equipped to work with people who self-harm.


Please feel free to print off and circulate any of the following documents for use within your service.


Mental Health Triage Scale

Risk Assessment Matrix

Staff Education and Training Materials

‘Working with People who Self-harm – A staff information leaflet’ to be circulated to local staff – especially helpful for ambulance and ED staff

‘Understanding Self-Harm’ Training slide set

Working with People who Self-Harm’ slide set

Training Slide Set- Guidance Notes

‘Checked’ list for Staff - to be displayed in staff areas in the Emergency Department and/or medical wards

Online Training Exercise – Part One: Understanding Self-Harm

Online Training Exercise – Part Two: Working with People who Self-Harm

Online Training Exercise - Understanding Consent and Capacity

Presentation Slides - Understanding Consent and Capacity

Self-Harm Leaflet: Help is at Hand

Mental Health Champions: Final Report- Used by Team in Portsmouth

Resources for Patients

Distraction techniques

Template for local services leaflet – to be adapted by Local Project Teams

Example of a local services leaflet used by the team at North Durham

'Self-Harm: Limiting the damage' leaflet – basic first-aid and wound care advice

Self-Harm Leaflet: Help is at Hand


*A special thanks to the late Helen Blackwell, our Project Worker/Patient Adviser and friend who was key to this project.*

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