About 150,000 people each year present themselves to NHS after an episode of self harm. This project has tried to provide an easy, step by step guideline to help the assessor to make safe and rational management plans for self harming patients in an acute setting.

A flowchart was designed on the basis of current literature, guidelines and consulting with few experienced psychiatry consultants. Then its validity and reliability was tested in three small pilot studies. Anonymous cases studies were used for these pilot studies.

The flowchart divides patients to five groups between “No risk” and “Definite risk to self/others” on the basis of assessor's observations and reports by patient, carer and other medical professionals.

In next step, answering to three basic questions: “Is there any history of previous serious self harm with similar presentation?”, “Is there a supportive adult at home?” and finally “Is there any severe mental illness in the patient?” would lead the assessor to one of these management plans: “Admit”, “Home with crisis team support”, “Home and CMHT referral” and finally “Home with GP follow up”.

The preliminary results suggest some potentials for clinical use of this guideline by GPs, psychiatry liaison services and junior doctors. However this guideline is not and shall not be used as a replacement of doctor's clinical judgment and seeking proper advice. Further clinical studies on real cases are required to confirm validity of above findings.