Self-harm is usually understood to be a coping mechanism and behaviour. It is useful to make the distinction between physical and emotional pain, although there is overlap between the two. People sometimes self-harm to stop themselves feeling numb or to cope with distressing thoughts or feelings.
Self-harm can include self-injury or self-poisoning, regardless of intent, and may be associated with a range of underlying difficulties. While it is not always linked to suicidal intent, it is recognised as a significant indicator of distress and should always be taken seriously.
Whilst some will need referral for higher level services, CAMHS Tier 2 provides assessment, psychoeducation and signposting to children and young people who are experiencing mild to moderate mental health concerns and do not meet the criteria for intervention within Tier 3 or 4 services. It may be appropriate for Tier 2 to complete an assessment where self-harm is a presentation in order to better understand level of need, including any emerging impact on functioning. Tier 2 can then signpost to the most appropriate service if ongoing intervention/treatment for self-harm is required.
Please see the Primary Care Management tab for useful approaches to take in primary care with routes for local referral.
C.M, J.F & P.R – 10-8-26
Who to refer:
Emergency referral to A&E
Patients who have taken overdoses or otherwise serious self-harm or there is risk to life, should be sent directly to A&E in the first instance. They will be assessed, often by liaison services who will consult with CAMHS and decide whether or not a referral for further treatment is indicated.
Referrals to CAMHS
Refer to CAMHS if self-harm is evident with moderate to severe mental illness, if the risk to self is moderate or severe, or where there is a significant impact on day-to-day functioning (e.g. school attendance, social withdrawal, or deterioration in self-care).
Also consider referral where:
- Self-harm is repeated, escalating, or persistent
- There is uncertainty about level of risk
- There are complex contextual or safeguarding concerns.
CAMHS Referral criteria can be found on the main welcome page: Mental Health Child and Adolescent (CAMH) – RefHelp.
Where self-harm is low risk, please visit the primary care management tab for alternative local options for referral. Where you are unsure about risk and whether they meet criteria for CAMHS, then please contact the Tier 2 consultation line to discuss – please see above for detail. If you phone CAMHS Tier 2 and they are already known to CAMHS, you will be transferred to the appropriate person.
Who to talk to for advice – PROFESSIONAL USE ONLY:
Consultation Line Tier 2, East, Mid and West Lothian 01560 585007 (Monday- Friday 1:30pm-4:30pm) or email CAMHSTier2EMW@nhs.scot
Consultation Line Tier 2 Edinburgh: 01506 585 000 (Monday-Friday 9am-12pm) or email CAMHSTier2Edinburgh@nhs.scot
CAMHS Unscheduled Care: 0131 312 1352 – for an urgent mental health assessment
How to refer
All referrals should be submitted via SCI Gateway or directly to the individual locality referrals e-mail inbox. See the main CAMHS page for information on how to refer to each locality.
In primary care, it can be helpful to:
- Use a supportive, non-judgemental approach
- Consider the function of the self-harm behaviour
- Explore risk, protective factors, and any changes in functioning (e.g. school, sleep, relationships)
- Offer brief advice, safety planning, and follow-up where indicated.
For children and young people who do not meet the criteria for CAMHS you may wish to direct them to:
West Lothian
West Lothian ISS – Inclusion and Support Service – Health & Social Care Partnership
West Space – West Space | Mental Health and Wellbeing West Lothian
East Lothian
MYPAS – Home – MYPAS HOME
Eastspace | Mental Health and Wellbeing East Lothian
School Nursing offer sessions on self-harm
Mid Lothian
MYPAS – Home – MYPAS HOME
Midspace | Mental Health and Wellbeing Midlothian
School Nursing offer sessions on self-harm
Edinburgh
Mental Health and Wellbeing Supports in the local area for young people at high school – The City of Edinburgh Council
iThrive | Edinburgh Mental Health and Wellbeing
Pan-Lothian: Online Resources – Child and Adolescent Mental Health Services
Please also see Primary Care Management for more specific referral advice to local resources.
National Self Harm Supports
Home – Self-Harm Network Scotland Penumbra
Alumina | Selfharm – 7-week programme for self-harm support 10-17
Youngminds – https://www.youngminds.org.uk/
Understanding self-harm – for 11-18 year olds | Mind
Link to apps stem4 – supporting teenage mental health
Link to alternatives to self harm – https://sift.org.uk/for-people-who-self-harm/distractions-and-alternatives-to-self-harm/
First Aid for self harm – https://sift.org.uk/for-people-who-self-harm/first-aid-for-self-harm/?highlight=first%20aid
Crisis Lines
Self-harm/Suicide Support
Text SHOUT – 85258
Samaritans-call 116123
Papyrus – Hopeline 247 – 0800 068 41 41 or TEXT 07860 039 967.
Childline – 0800 1112
NHS – 111
This guidance is informed by current best practice, including NICE NG225: Self-harm – assessment, management and preventing recurrence, and aligns with national CAMHS and Scottish service frameworks.
