Guidelines prepared in the UK by the Royal College of Psychiatrists regarding the management of deliberate self-harm (DSH) in children and adolescents have existed for around 20 years. Although recently revised, they remain largely unchanged. They recommend admission to a suitable ward and assessment by Child and Adolescent Mental Health Services (CAMHS) in all cases. This article examines the disparity between recommendations and practice in an Accident and Emergency (A&E) department. In two-thirds of cases the young person was not admitted and one third were discharged without any discussion with or assessment by CAMHS. This may be avoided by the development of a locally agreed policy of admission complemented by a dedicated DSH service provided by CAMHS. Nationally agreed guidelines prepared in collaboration with all the relevant specialities may be more influential in changing local practice.
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