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Self-harm and suicidal crisis

Autolaesio et crisis suicidalis · Sebepoškozování a suicidální krize

What it is

Deliberately injuring or poisoning oneself, with or without intent to die; it is the strongest single predictor of later suicide, yet most crises pass — which is why fast, practical help saves lives.

Symptoms & signs

  • Cuts, burns or overdoses, often hidden
  • talk of being a burden or of no way out
  • withdrawal, giving things away
  • sudden calm after a decision
  • hopelessness, insomnia, heavier drinking

🚩 Get help if…

  • call 112 / 911 now Any overdose or swallowed poison — even if the person feels fine
  • call 112 / 911 now Deep wound, bleeding that will not stop, or a burn bigger than a palm
  • call 112 / 911 now A plan, means at hand and intent to die now
  • see a doctor soon Repeated self-harm or talk of having no way out

Where it strikes

Medical treatment

  • Ask directly — asking does not plant the idea
  • emergency care and a psychosocial assessment after every episode
  • Restricting means — safe storage of guns and medicines, smaller paracetamol packs, barriers at jumping sites trials support
  • Safety plan and follow-up contacts after discharge trials support
  • CBT or dialectical behaviour therapy — fewer repeat episodes trials support
  • treat depression, psychosis and substance use
  • Lithium in mood disorders — fewer suicides in trials; needs blood-level monitoring mixed evidence

Natural & lifestyle

  • Call a crisis line — 116 123 in much of Europe, 988 in the US — or emergency services; stay with the person
  • remove means at home
  • less alcohol, regular sleep
  • keep in touch with people

Emerging & experimental

  • Ketamine or esketamine — rapid, short-lived relief of suicidal thoughts mixed evidence
  • brief contact by letters or texts
  • Risk scores to decide who gets care — too inaccurate to use alone not confirmed in trials

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Peer support — helps some; few trials mixed evidence
  • Omega-3 fatty acids — one small trial with fewer suicidal thoughts early / small studies
  • Mindfulness apps — widely used; untested in crisis anecdotal / traditional

ICD codes