Community pharmacy teams should use consultations and medicines reviews as an 'opportunity to assess self-harm if appropriate', according to a consultation on the first new guidance for self-harm to be drawn up in 11 years.

The draft NICE guidance, out for consultation until 1 March, says that community pharmacy staff should be aware of warning signs relating to self-harm, including identifying people who are buying large amounts of over-the-counter medicines, or those who have access to large amounts of medicines.

It said: ‘The committee agreed that when pharmacy staff are aware of warning signs and when healthcare professionals are prepared to use consultations to discuss self-harm, the opportunities for people to self-poison or overdose are reduced.

‘The committee also agreed that the recommendations provide the chance for staff to enact safe prescribing principles.’

It added that: ‘Consultations and medicines reviews provide an opportunity for healthcare staff to assess self-harm and therefore whether existing or new medicines might be taken in overdose. This would allow for staff to amend any prescriptions as appropriate to reduce the risk of future self-poisoning.’

The draft guidance said these recommendations may increase communication with healthcare professionals from other settings, such as specialist mental health centres and specialist pharmacies, which ‘should limit variations in prescribing practices and improve continuity of care’.

Training for all staff

The document emphasised the importance of referring patients to specialist mental health services, but also recommended that both specialist and non-specialist staff receive formal training on how to work with people who have self-harmed.

This included training in observation methods that ‘promote therapeutic engagement and rapport building’ to allow for clinical observation in the ‘least distressing’ way for patients.

Dr Paul Chrisp, director of the centre for guidelines at NICE, said: ‘Self-harm is a growing problem and should be everyone’s business to tackle – not just those working in the mental health sector.

‘These guidelines set out a way for every person who self-harms to be able to get the support and treatment they need.’

Professor Nav Kapur, topic advisor for the self-harm guideline and professor of psychiatry and population health at the University of Manchester said: ‘Self-harm can occur at any age and present to any setting. Historically, people who have harmed themselves have had a highly variable experience of services.

‘This new guideline is an opportunity to make things better, particularly from the point of view of assessment and aftercare.’

Professor Kapur told The Pharmacist’s sister title Pulse: ‘Primary care is a really important setting for providing care after self-harm and we’ve attempted to strengthen the existing guidance in this area.’

In September, a study found that almost 90% of pharmacy students have not had mental health first aid training.

Some community pharmacists have reported an increase in patients showing new or exacerbated mental illness since the initial Covid-19 lockdown.