How to Deliver Aftercare After Hospital Presentation for Self-Harm
How should clinicians structure follow-up after a hospital presentation for self-harm?
Patients who present to hospital after self-harm remain at high risk for both repeat self-harm and suicide over the following months and years. This guide applies to hospital-presenting self-harm episodes and summarizes the aftercare workflow described in the national program evaluated in the study.
-
Identify the patient as needing structured aftercare
Use this workflow for patients presenting to hospital with nonfatal self-harm, defined in the study as intentional self-poisoning or self-injury regardless of motivation or degree of suicidal intent. The program evaluated in the article was designed specifically for hospital-presenting self-harm episodes, which the authors considered the most comprehensively registered setting.
-
Make first follow-up contact as early as possible
According to the national aftercare guideline described in the study, the first contact should occur within 3 days after the self-harm episode. In practice, many contacts occurred later, with a median interval of 12 days among all who received aftercare, so the article supports prioritizing earlier outreach to better match intended program delivery.
-
Provide active outreach by telephone or in person
Deliver follow-up care mainly by telephone, with supplementary in-person contact when needed, as in the national program. The aftercare workers in the study contacted patients directly rather than relying only on passive referral.
-
Perform brief risk assessment and support at each contact
At follow-up contacts, provide brief suicide risk assessments and psychological support, consistent with the intervention described in the study. The program also included referral to health or social services when appropriate, so the contact should be used to identify needs that require further linkage.
-
Continue contact over a 3-month period
The aftercare guideline specified that the service should last for 3 months, or about 90 days. The study used first contact within 90 days as the main definition of valid aftercare exposure because that period matched the intended duration of the intervention.
-
Maintain at least twice-monthly follow-up
Over the 3-month aftercare period, the guideline required a minimum of 2 contacts per month. This means the program was not a single check-in but a sustained series of contacts intended to support monitoring, engagement, and referral.
-
Use referrals as part of the intervention
When needs are identified, refer patients to health or social services, as this was one of the core components of the aftercare model studied. The article does not separate which component drove outcomes, so risk assessment, support, and referral should be understood as a combined package.
Clinical Considerations
- This was an observational study, so the findings show association rather than proving that aftercare caused lower suicide risk.
- The intervention bundled brief risk assessment, psychological support, and referral, so the study could not determine which specific component was responsible for the observed outcomes.
- The findings were based on registered self-harm episodes presenting to hospitals and may not generalize to self-harm in the community that never comes to medical attention.
- Program delivery often lagged behind the intended timeline, with a median 12-day delay to first contact despite a 3-day guideline target.
Bottom Line
After hospital-presenting self-harm, provide active follow-up quickly and continue structured contact for 3 months with repeated outreach, because this real-world aftercare model was associated with lower subsequent suicide risk.