To provide a practical, clinically grounded framework for the assessment and management of suicidal and self-harm behaviors in emergency settings, integrating current evidence with real-world clinical practice.
Approach:
Methods: This narrative review synthesizes key findings from the literature alongside clinical experience in psychiatric emergency care, focusing on definitions, functions of self-harm, suicide risk assessment, and management strategies.
Key Findings:
Self-harm behaviors frequently serve multiple intrapersonal and interpersonal functions, including emotional regulation, anti-dissociative mechanisms, and crisis communication.
Suicide risk assessment should move beyond static risk factor models and incorporate dynamic elements such as intent, planning, ambivalence, and protective factors, including reasons for living.
Management in emergency settings should prioritize therapeutic engagement, emotional validation, and collaborative decision-making.
The distinction between acute and chronic risk is critical for appropriate disposition, including hospitalization versus outpatient management.
Interpretation:
Effective management of suicidal and self-harm behaviors in emergency contexts requires an integrative, patient-centered approach that combines structured assessment with clinical judgment.
Limitations:
The review does not provide exhaustive systematic coverage of the literature.
Variability in definitions of suicidal and self-harm behaviors may lead to confusion, and traditional models based on static risk factors have demonstrated insufficient predictive validity.
Conclusion:
An integrative approach emphasizing therapeutic alliance and individualized care planning may improve outcomes in emergency settings.
