Psych · Child and adolescent psychiatry — youth self-harm and suicide
Youth self-harm and suicide
Also known as Adolescent self-harm · Adolescent suicide · Youth NSSI · CAMHS self-harm · Paediatric suicide risk · Child adolescent deliberate self-harm · Teen suicide attempt · Youth safety planning
Exam-exhaustive fellowship reference on youth (child and adolescent) self-harm and suicide — epidemiology, developmental risk and protective factors, NSSI vs suicide attempt on the intent continuum, psychosocial assessment with private youth interview plus family and school interfaces, Gillick/developmental competence and confidentiality limits, safety planning and means restriction without graphic methods, CAMHS disposition pathways, DBT-A and family intervention evidence, antidepressant monitoring context, and non-stigmatising language. Distinct from adult suicide-risk-assessment and adult self-harm-and-crisis-intervention topics. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Clear intent to die, high expected lethality, preparatory behaviour, or disappointment at survival — treat as elevated near-term suicide risk; do not discharge to an empty plan
- Ongoing plan with accessible means at home and carers unable or unwilling to secure the environment
- Escalating NSSI frequency or intensity with emerging suicidal intent, severe hopelessness, or intoxication
- Safeguarding concerns (abuse, neglect, exploitation, domestic violence) — escalate child-protection pathways; do not treat as 'family conflict only'
- Command hallucinations, severe psychosis, or acute mania/depression driving self-harm — urgent psychiatric intensity and medical review
- Stigmatising dismissal as 'attention-seeking', reliance on a no-suicide contract, or promising absolute confidentiality when safety requires carer involvement
Meet the patient
A 16-year-old is in the emergency department after taking a paracetamol overdose following a relationship breakup and online bullying. She is tearful, ashamed, and says she "just wanted it to stop". Her mother, frightened and angry, asks whether she is "doing it for attention".[8][9]
The registrar wants a risk score and a decision. The examiner's question is sharper and kinder: "What is the intent here, who else needs to be in the room, and what keeps her safe tonight?" This topic is the structured answer to that question.[13][17]
References28ShowHide
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- [13]Kapur N, Murphy E, Cooper J, et al. Psychosocial assessment following self-harm: results from the multi-centre monitoring of self-harm project J Affect Disord, 2008.PMID 17761308
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- [18]Mehlum L, Tørmoen AJ, Ramberg M, et al. Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial J Am Acad Child Adolesc Psychiatry, 2014.PMID 25245352
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- [20]Kothgassner OD, Goreis A, Robinson K, et al. Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis Eur Child Adolesc Psychiatry, 2021.PMID 33875025
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- [22]Witt KG, Hetrick SE, Rajaram G, et al. Interventions for self-harm in children and adolescents Cochrane Database Syst Rev, 2021.PMID 33677832
- [23]Cottrell DJ, Wright-Hughes A, Collinson M, et al. Effectiveness of systemic family therapy versus treatment as usual for young people after self-harm: a pragmatic, phase 3, multicentre, randomised controlled trial Lancet Psychiatry, 2018.PMID 29449180
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