THE TREATMENT OF
SUICIDAL BEHAVIOUR IN
THE CONTEXT OF
THE SUICIDAL PROCESS
Effective treatment of suicidal individuals is a key element in suicide prevention. This chapter will focus specifically on the treatment of patients who have deliberately self-harmed. This includes patients who have taken overdoses and those who have self-injured in some way. The term “deliberate self-harm” (DSH) avoids implying any specific single motivation, as is the case, for example, with the term “attempted suicide”. Despite extensive knowledge of the characteristics of DSH patients, treating them often proves difficult and there is very little hard evidence regarding efficacy and effectiveness to guide the clinician when making treatment decisions.
Deliberate self-harm appears to be an increasing problem in many countries. In the UK, for example, rates of DSH have risen in the past 10—15 years such that the number of general hospital presentations per year has increased from approximately 100 000 to at least 150 000 (Hawton et al, 1997; Kapur et al, 1998). There is wide variation between countries in Europe regarding rates of DSH presentations to general hospitals, as is clearly illustrated by findings from the WHO/Euro Multicentre Study of Suicidal Behaviour (Schmidtke et al, 1996). There is also marked variation in the rates in different age