When a young person presents after self-harm, clinicians have an opportunity to understand their distress, identify their needs and organise support. Research by Aggarwal and colleagues (2025), examines the circumstances surrounding self-harm in young people who subsequently died by suicide. Drawing on UK-wide records for 544 young people aged 10–19, the study found that almost half had a recorded history of self-harm. Those who had self-harmed recently frequently experienced several overlapping difficulties and had often been in contact with services before their deaths. The findings highlight the importance of comprehensive assessment and coordinated care, while revealing the limits of prevention approaches that depend on a known history of self-harm. Approximately half of these young people had no such history recorded. Understanding both groups is essential when considering where services need to go next (Aggarwal et al., 2025).
Understanding the wider picture
Self-harm and suicide are related, but they are not interchangeable. Self-harm deserves a compassionate response regardless of whether a young person describes suicidal intent. The “iceberg model” developed by Geulayov et al. (2018) helps explain the wider context. Hospital presentations represent only part of adolescent self-harm; a much larger proportion occurs in the community. Suicide deaths represent a smaller, tragic part of this broader picture. Research based on deaths therefore addresses an important question, but cannot describe the experiences or likely outcomes of all young people who self-harm. Longitudinal research nevertheless demonstrates why clinical attention matters. Following children and adolescents who presented to hospital after non-fatal self-harm, Hawton et al. (2020) identified an elevated subsequent risk of suicide compared with the general population. Most young people who self-harm do not die by suicide, but their distress and support needs require serious consideration.
What did the study examine
Aggarwal et al. (2025) investigated suicide deaths among young people aged 10–19 across the UK between 2014 and 2016. Of 595 deaths identified through national mortality records, information about preceding circumstances was available for 544, representing 91% of the identified deaths. The researchers drew mainly on coroner investigations, alongside other official reports. They examined recorded self-harm, mental health diagnoses, adverse experiences and contact with services. Recent self-harm was defined as occurring within three months before death. This was a retrospective case series. The comparisons were between groups of young people who had all died by suicide, distinguished by their recorded histories of self-harm. There was no comparison group of living young people. Although published in 2025, the study describes deaths from an earlier period. Its findings should therefore inform reflection on care without being presented as a measurement of current service performance.
Self-harm often occurred alongside other difficulties
A recorded history of self-harm was present in 267 young people, or 49% of the sample. Recent self-harm was recorded in 26%. Among those with recent self-harm, 63% had a diagnosed mental illness, compared with 23% of those with no recorded self-harm history. Recent adversity was also common: 95% of the recent self-harm group had experienced difficulties such as relationship problems, bereavement, or accommodation and financial pressures. A history of abuse was recorded in 17%, compared with 3% of those without known self-harm (Aggarwal et al., 2025). These findings describe overlapping needs. They do not establish that any single experience caused a death. For clinical practice, the authors’ interpretation is that assessment must extend beyond the self-harm episode itself. Understanding the young person’s circumstances requires attention to relationships, safety, mental health, substance use and everyday pressures. Several difficulties may need to be addressed together.
Contact with services creates an opportunity
Among young people with recent self-harm, 60% had been in contact with mental health services during the three months before death. In addition, 52% had contact with an emergency department or general practitioner for a mental health concern. These categories could overlap and should not be added together (Aggarwal et al., 2025). The findings indicate that many young people had encountered services during a period of substantial distress. However, contact alone tells us little about the content, continuity or quality of care received. The study lacked consistent information about psychological treatments. It cannot determine whether a particular intervention was offered, whether it was accessible, or whether a different response would have prevented an individual death. Its practical contribution is to direct attention towards what happens during and after contact: how needs are understood, how support is organised, and how services respond when difficulties cross professional or organisational boundaries.
From assessment to a shared plan
The NICE self-harm guideline, cited by Aggarwal et al., recommends early psychosocial assessment by a mental health professional experienced in working with children and young people. This includes exploring home life, education, peer relationships and safeguarding concerns (NICE, 2022). Assessment should lead to an individualised plan. NICE recommends considering a collaboratively developed safety plan that identifies warning signs, coping strategies, supportive contacts and routes to urgent help. Where ongoing safety concerns remain, initial aftercare should be provided within 48 hours of the psychosocial assessment. For young people experiencing several difficulties, a meaningful response may require coordination across services. The clinical task is to connect identified needs with specific support, while involving families or carers when appropriate (NICE, 2022).
The response of professionals matters
The way professionals respond is another relevant part of care. Saunders et al. (2012), in a systematic review cited by the central paper, found that negative staff attitudes towards people who self-harm were common in general hospital settings, particularly towards repeated self-harm. Training was associated with improvements in knowledge and attitudes. That evidence supports attention to staff education, alongside clinical procedures. A technically thorough assessment can still be difficult for a young person if they feel judged or dismissed. Repeated presentations should prompt renewed understanding of unmet needs. Compassionate communication, curiosity about the person’s experience and clear explanations of available support are practical foundations for that work. The evidence on training should not, however, be interpreted as proof that training alone prevents suicide.
What can be said about treatment?
Aggarwal et al. discuss psychological interventions, drawing on the Cochrane review by Witt et al. (2021). That review found evidence favouring dialectical behaviour therapy adapted for adolescents, or DBT-A, for reducing repeated self-harm at the end of treatment. Evidence for several other approaches remained uncertain. In particular, individual cognitive behavioural therapy should not be presented as having equally established effectiveness for adolescent self-harm on the basis of this review. These distinctions matter when translating the paper into practice. Treatment should be matched to the young person’s needs and the available evidence. The case series itself did not test treatment effectiveness, and reducing repeated self-harm is a different outcome from demonstrating a reduction in suicide deaths (Witt et al., 2021).
Prevention must also reach young people without recognised self-harm
Approximately 51% of the sample had no recorded history of self-harm. This finding places an important limit on prevention strategies that rely entirely on identifying previous episodes (Aggarwal et al., 2025). Rodway et al. (2020), analysing the same underlying national case series, found that around 30% had neither known self-harm nor recorded suicidal ideas. This is a related analysis, rather than independent confirmation in another population. An absence of recorded warning signs does not establish that a young person experienced no distress. Difficulties may not have been disclosed, recognised or documented. The findings support the authors’ call for accessible crisis support and prevention approaches that reach beyond those already known to services.
Conclusion
Aggarwal et al. (2025) show that recent self-harm, overlapping adversity and service contact were common among a substantial group of young people who died by suicide. Their findings support careful, individualised assessment and coordinated responses to distress. Each contact offers a chance to listen, understand and organise care. Making that opportunity meaningful—and ensuring support also reaches young people whose distress remains unrecognised—is a central priority for prevention.
Where next?
Join us on 1 December 2026 for the most important conference on self-harm this year, ‘Understanding and Responding to Self-Harm: Latest Evidence and Clinical Practice. Judy Dunn International Online Conference 2026‘, with Professor Nav Kapur, Professor Paul Plener, Professor Rose McCabe, Professor Caroline Richards, Associate Professor Johan Bjureberg and Professor Joan Asarnow.
Bringing together leading international experts, this conference will explore current evidence and key developments in the field, from emerging insights into the neurobiology of self-harm to the role of emotion regulation, assessment and engagement in care.
References
- Aggarwal, S., Tham, S.-G., Ibrahim, S., Turnbull, P., Webb, R. T., Appleby, L., Kapur, N., & Rodway, C. (2025). Self-harm in children and young people who die by suicide: UK-wide consecutive case series. The British Journal of Psychiatry, 227(3), 593–600. https://doi.org/10.1192/bjp.2024.248
- Geulayov, G., Casey, D., McDonald, K. C., Foster, P., Pritchard, K., Wells, C., Clements, C., Kapur, N., Ness, J., Waters, K., & Hawton, K. (2018). Incidence of suicide, hospital-presenting non-fatal self-harm, and community-occurring non-fatal self-harm in adolescents in England (the iceberg model of self-harm): A retrospective study. The Lancet Psychiatry, 5(2), 167–174. https://doi.org/10.1016/S2215-0366(17)30478-9
- Hawton, K., Bale, L., Brand, F., Townsend, E., Ness, J., Waters, K., Clements, C., Kapur, N., & Geulayov, G. (2020). Mortality in children and adolescents following presentation to hospital after non-fatal self-harm in the Multicentre Study of Self-harm: A prospective observational cohort study. The Lancet Child & Adolescent Health, 4(2), 111–120. https://doi.org/10.1016/S2352-4642(19)30373-6
- National Institute for Health and Care Excellence. (2022). Self-harm: Assessment, management and preventing recurrence (NICE Guideline NG225). https://www.nice.org.uk/guidance/ng225
- Rodway, C., Tham, S.-G., Turnbull, P., Kapur, N., & Appleby, L. (2020). Suicide in children and young people: Can it happen without warning? Journal of Affective Disorders, 275, 307–310. https://doi.org/10.1016/j.jad.2020.06.069
- Saunders, K. E. A., Hawton, K., Fortune, S., & Farrell, S. (2012). Attitudes and knowledge of clinical staff regarding people who self-harm: A systematic review. Journal of Affective Disorders, 139(3), 205–216. https://doi.org/10.1016/j.jad.2011.08.024
- Witt, K. G., Hetrick, S. E., Rajaram, G., Hazell, P., Taylor Salisbury, T. L., Townsend, E., & Hawton, K. (2021). Interventions for self-harm in children and adolescents. Cochrane Database of Systematic Reviews, 2021(3), Article CD013667. https://doi.org/10.1002/14651858.CD013667.pub2