Dr Dennis Ougrin Hello, my name is Dennis Ougrin.  I’m a Professor of Child Psychiatry based at Queen   Mary University of London. I would like to say  a few words about self-harm in young people.   Self-harm, especially the type that results  in the presentation to Emergency Room,   as far as we could say, is the strongest  known predictor of death by suicide. We   have recently published NICE guidelines,  which, essentially, is a way of thinking   about assessing and treating self-harm in  young people, and I wanted to highlight a few   new things in these guidelines,  especially about assessment and treatment. When it comes to assessment, it is now clear  that a timely and multidisciplinary assessment   is of great importance. I should also add  that adding a therapeutic component to it,   trying to understand self-harm, trying to make  sense of what has happened, and thinking about the   way forward, could be a very useful addition to  the assessment. We know from a number of research   studies that therapeutic assessment improves  engagement of young people with treatment. In terms of treatment, then, for the first time,  our NICE guidelines recommended a particular   psychological therapy for those young people  with severe and multiple self-harm. That therapy   is called DBT for Adolescents, which stands  for dialectical behaviour therapy. There is   a good amount of evidence from adults that that  psychological therapy works to reduce self-harm   in adults, and we now have relatively good  evidence base to say that DBT for Adolescents   seems to reduce self-harm in adolescents too,  at least in the short-term. DBT, however, is a   fairly expensive psychological therapy, and we are  not certain about the long-term benefits of it. Another important consideration when  thinking about treatment is whether   to focus on self-harm as such, or whether to  focus on other psychological or psychiatric   difficulties that the young person has. The  decision is not straightforward. In some cases,   it is clear that self-harm and all  of the symptoms that go with it,   like emotional dysregulation, needs to be  the primary target of psychological therapy.   But there are some young people in whom we  should really be thinking about targeting other   psychiatric disorders that they might have, such  as, depression, anxiety, ADHD, autism and others. The decision is often clinical and needs  to be driven by a number of factors   the severity of self-harm, the severity of other  disorders that the young person has, the impacts   of self-harm and other disorders on the young  person’s life. By life, I mean their function at   home with their families, at school, with after  school activities, and friendships, and, also,   perhaps the availability of psychological  therapies and other types of treatment. Final – the final thing I wanted to say about  both assessment and treatment is that it is very   important to offer timely interventions. We used  to be thinking about seeing a young person within   seven days, after they present with self-harm  to the Emergency Rooms. The new guidelines   talk about providing some sort of follow-up  within 48 hours in those young people where   there is significant concern. Now, that type  of follow-up could be with specialist teams,   or it could be with other professionals,  like GPs or primary care professionals. Now, that is a very sensible recommendation, in  the sense that we know that the period immediately   after an episode of significant self-harm  which results in hospital presentation,   is the period of the greatest risk  of completing suicide. And so,   thinking about configuring services in  such a way that could provide timely,   immediate follow-up for young people who come with  self-harm to Emergency Rooms is very important. So, to summarise, self-harm is of great importance  as a predictor of suicide. Assessments need to be   timely, done by the right mix of people and need  to be therapeutic. We need to offer relatively   immediate follow-up for young people who come  to hospital with self-harm, and the decision   needs to be taken whether to treat self-harm or  other psychiatric disorders. And then, if the   decision is to treat self-harm and it’s severe  and repetitive, then DBT, which is dialectical   behaviour therapy for adolescents, is probably the  best psychological therapy we have at the moment.