Self-Harm: Independent Evidence on Assessment, DBT, CBT & Safety

Table of contents

• Evidence summary
• What self-harm is, and who is affected
• Signs, assessment and when to get urgent help
• Causes and risk factors
• Treatments that work, and what does not
• Medicines
• Supplements, apps and lifestyle claims
• Risks and limits of common treatments
• Wound care and safety planning
• Supporting someone who self-harms
• Who to see
• Follow the money: who funds the research and the treatment
• Related research
• Frequently asked questions
• Sources and funding notes

Evidence summary

Independent evidence and credibility scorecard

Independence tiers: 1 = regulator, government body or government-commissioned national data; 2 = academic or Cochrane team with no declared commercial funding for the work; 3 = independent authors with declared commercial ties, including royalties or training income from the therapy being tested, or industry research funding; 4 = funded or authored by a company selling the treatment. Credibility runs from A (highest) to D.

Seven of the twelve sources are wholly or partly UK-based, and much of the UK research comes from a small group of academic centres whose members also sat on NICE committees. That makes the evidence base coherent, but it also means the same people's judgement runs through the guideline and the studies behind it. The US and Norwegian DBT trials, run by different teams and funders, reached similar conclusions about DBT-A, which strengthens confidence in that finding.

What self-harm is, and who is affected

NICE defines self-harm as intentional self-poisoning or self-injury, whatever the apparent purpose of the act (NICE NG225). That definition deliberately includes both acts with suicidal intent and acts without it, because intent is often mixed, changes over time and is hard to judge from outside. The Cochrane reviews use the same definition, "regardless of degree of suicidal intent" (Witt 2021).

The NHS describes self-harm most often as a way to express or cope with emotional distress. People also describe it as a way to feel in control, to punish themselves, to relieve unbearable feelings or to respond to intrusive thoughts. Some people say it is a way of staying alive through severe distress, and not everyone who self-harms wants to end their life (NHS: why people self-harm).

How common is it? In England, adults reporting non-suicidal self-harm at some point in their lives rose from 2.4% in 2000 to 6.4% in 2014. Among women and girls aged 16 to 24 it rose from 6.5% to 19.7%, about one in five. In 2014, 59% of people who had self-harmed said they had no medical or psychological contact afterwards (McManus et al. 2019). NICE cites a national study in which 7.3% of girls and 3.6% of boys aged 11 to 16 had self-harmed or attempted suicide, rising to 21.5% of girls and 9.7% of boys aged 17 to 19. It estimates more than 200,000 hospital presentations in England each year (NICE).

Why it matters. Self-harm is the strongest known risk factor for later suicide. A systematic review of 177 studies found that 1.6% of people who went to hospital after self-harm died by suicide within a year and 3.9% within five years. About 16% had another non-fatal episode within a year (Carroll et al. 2014). Worldwide, more than 720,000 people die by suicide each year; it is the third leading cause of death among 15 to 29-year-olds, and a prior suicide attempt is an important risk factor (WHO). These numbers describe groups, not individuals. Most people who self-harm do not die by suicide, and many stop.

Self-harm is not a diagnosis in itself. It occurs alongside many conditions, including depression, anxiety, trauma-related disorders, eating disorders and substance use, and sometimes with no diagnosed condition at all.

Signs, assessment and when to get urgent help

Signs others may notice

Self-harm is often kept secret. The NHS lists physical signs such as unexplained injuries or blood on clothing, or covering up even in hot weather. Emotional signs include withdrawing from others, low mood, low self-esteem and talking about ending things or not wanting to go on (NHS: how to help someone else).

For less urgent situations, the NHS advises seeing a GP if you are harming yourself, having thoughts of harming yourself, or worried about minor injuries, which can become infected without treatment. NHS 111 (online or phone, mental health option) can direct you to the right service (NHS: getting help; NHS urgent help).

What a good assessment looks like

NICE NG225 sets out what should happen when someone attends after self-harm:

• Physical and mental care together. Staff should establish how serious the injury is, the person's emotional state and level of distress, any immediate safety or safeguarding concerns, and whether a care plan already exists (NICE 1.7.2).
• A psychosocial assessment, early. A mental health professional should carry this out at the earliest opportunity, to build a relationship, understand why the person self-harmed and plan care. It should not be delayed until medical treatment is finished, and breath or blood alcohol levels should not be used to delay it (NICE 1.5.1–1.5.4).
• No risk scores to ration care. NICE says not to use risk-assessment tools and scales, or global "low/medium/high" risk labels, to predict future suicide or repeat self-harm, or to decide who is offered treatment or discharged. Assessment should focus on the person's needs and their immediate and long-term safety (NICE 1.6.1–1.6.5).
• Follow-up. If there are ongoing safety concerns, initial aftercare should be provided within 48 hours of the psychosocial assessment (NICE 1.10.2).

Why no risk scores? In a study of 4,000 hospital episodes in England, two scales caught most people who went on to self-harm again but wrongly flagged most of those who did not (specificity 15% and 23%). Two others missed most repeat episodes (sensitivity 9% to 29%). Area under the curve, where 50% is no better than chance, ranged from 49% to 71%, and all four scales were worse at predicting suicide than repeat self-harm (Steeg et al. 2018). In plain terms, a "low risk" score offers little reassurance.

NICE also notes that only about half of people who attend emergency departments after self-harm are assessed by a mental health professional, and that about half saw their GP in the previous month (NICE). A systematic review of 74 studies found general hospital staff, especially doctors, often held negative attitudes towards people who self-harm, and that active training consistently improved attitudes and knowledge (Saunders et al. 2012). If you have had a poor experience before, you are still entitled to respectful care.

Causes and risk factors

There is rarely a single cause. A Lancet review of self-harm and suicide in adolescents described contributions from genetic vulnerability and from psychiatric, psychological, family, social and cultural factors. It also flagged media and "contagion" effects, with the internet playing a growing role (Hawton, Saunders & O'Connor 2012).

The NHS lists common sources of distress that can build up before self-harm: bullying, pressure at school or work, family or relationship problems, money worries, low self-esteem, stress, anxiety or depression, confusion about sexuality, bereavement, physical or sexual abuse, contact with the criminal justice system, and difficulty controlling emotions, often linked to past trauma. It also notes links with ADHD and autism (NHS). NICE asks all staff to ask about safeguarding concerns such as domestic abuse, violence or exploitation, when possible while the person is alone (NICE 1.3.1).

In the English surveys, women and girls aged 16 to 24 had the highest rates, while men and people aged 16 to 34 were less likely to have had any health service contact afterwards (McManus et al. 2019). Lower contact among men matters, because men who self-harm may be missed.

Treatments that work, and what does not

Adults: CBT-informed therapy

NICE recommends offering adults a structured, person-centred, CBT-informed psychological intervention, such as CBT or problem-solving therapy, tailored to people who self-harm. It should start as soon as possible and typically run for 4 to 10 sessions, with more if needed (NICE 1.11.3). NICE also says diagnosis, age, substance misuse or other conditions should not be used as reasons to withhold psychological help (1.11.9).

The evidence behind this is weaker than the confident wording might suggest. The 2021 Cochrane review included 76 trials with 21,414 adults. At the end of treatment, individual CBT-based therapy produced an odds ratio of 0.35 for repeat self-harm, but the confidence interval ran from 0.12 to 1.02. That means the true effect could be large or close to nothing. It was based on only four trials (238 people) and rated low certainty. There was "some evidence" of fewer repeat episodes at 6 and 12 months (Witt et al. 2021). The authors concluded that, because of the quality of the trials, the evidence for most psychosocial interventions in adults remains uncertain.

Adults: other therapies

In the same review, a single trial of mentalisation-based therapy (134 people) found fewer people repeated self-harm (OR 0.35, 95% CI 0.17 to 0.73). Two trials of a group-based emotion-regulation therapy, both from the same team, also suggested benefit (OR 0.34, 95% CI 0.13 to 0.88; 83 people). For adult DBT, the proportions repeating self-harm were similar (66.0% vs 68.2%), although DBT may reduce how often self-harm happens. Psychodynamic therapy, case management, GP management, remote contact and brief emergency department interventions showed no evidence of a difference (Witt et al. 2021). "No evidence of a difference" usually reflects small, low-quality trials. It is not proof these approaches are useless.

Young people: DBT-A

Dialectical behaviour therapy for adolescents, as tested in the largest US trial, combined weekly individual therapy, group skills training, consultation meetings for therapists and parent contact as needed (McCauley et al. 2018). In the Cochrane review of 17 trials (2,280 young people, mean age 14.7), DBT-A was the one intervention with high-certainty evidence: 30% repeated self-harm vs 43% with usual or alternative care (OR 0.46, 95% CI 0.26 to 0.82; four trials, 270 participants) (Witt et al. 2021). Put simply, for roughly every eight young people treated with DBT-A rather than comparison care, about one fewer repeated self-harm by the end of treatment. This is our rough reading of the 13-point gap, not a published number needed to treat.

The two key trials came from different countries and funders. In Norway, 77 adolescents with recent, repeated self-harm in community clinics were randomised to 19 weeks of DBT-A or enhanced usual care. DBT-A was better at reducing self-harm, suicidal thoughts and depressive symptoms (Mehlum et al. 2014). In the US, 173 adolescents aged 12 to 18 with a prior suicide attempt and repeated self-harm were randomised to six months of DBT or individual and group supportive therapy. After treatment, 54.2% of the DBT group had no self-harm compared with 36.9% of the comparison group (OR 0.33, 95% CI 0.14 to 0.78). Suicide attempts were also less common (OR 0.30). The advantage faded between 6 and 12 months, when the difference was no longer significant (McCauley et al. 2018). A separate meta-analysis found small to moderate effects of DBT-A compared with control groups on self-harm (Hedges' g −0.44, 95% CI −0.81 to −0.07) and suicidal thoughts (g −0.31) (Kothgassner et al. 2021).

NICE recommends that clinicians consider DBT-A for children and young people who self-harm frequently and have significant difficulty regulating emotions (NICE 1.11.4). In young people, individual CBT (OR 0.93, 95% CI 0.12 to 7.24) and mentalisation-based therapy (OR 0.70) did not show clear benefit in small trials. Family therapy showed none (OR 1.00), nor did emergency cards or group therapy (Witt et al. 2021).

Medicines

No medicine is licensed or proven to reduce self-harm itself. NICE says do not offer drug treatment as a specific intervention to reduce self-harm (NICE 1.11.10). The Cochrane review of medicines in adults found only seven trials with 574 people:

• Newer antidepressants vs placebo: OR 0.59 (95% CI 0.29 to 1.19; 2 trials, 129 people), very low certainty.
• Antipsychotics vs placebo: fewer repeat episodes (21% vs 75%) in one trial of just 30 people, low certainty. There was no difference when compared with another drug or dose.
• Mood stabilisers vs placebo: OR 0.99 (one trial, 167 people).

The authors concluded the evidence is uncertain and larger trials are needed (Witt et al. 2021). In children and adolescents, no trial of any medicine for self-harm met the review's criteria (Witt et al. 2021).

Medicines still have a place when someone also has a condition that responds to them, such as depression, bipolar disorder or psychosis. The NHS notes that a care team may suggest medicine alongside talking therapy in those cases (NHS: assessment and treatments). For lithium's specific evidence on suicide, see our lithium review.

Supplements, apps and lifestyle claims

Be cautious about any product or programme sold as a cure for self-harm. The independent evidence points to skilled human therapy and continuity of care, not to supplements.

Risks and limits of common treatments

• Talking therapies are demanding. In the US trial, 75.6% completed DBT and 55.2% completed supportive therapy (McCauley et al. 2018). Benefits faded after treatment ended, which suggests some people need continued support.
• Medicines for linked conditions can be dangerous in excess. NICE asks prescribers to weigh how toxic a medicine is for someone at risk of overdose, to consider smaller supplies (for example weekly prescriptions) through shared decisions, to ask for unused medicines to be returned, and to review medicines after an episode of self-harm (NICE 1.13.1–1.13.3).
• Poor care itself can cause harm. NICE warns against using staff untrained in clinical observation, such as security staff, to watch people who have self-harmed, and asks for continuity of staff (NICE 1.12.1–1.12.2). Negative staff attitudes can discourage people from coming back (Saunders et al. 2012).
• Harm minimisation has limits. NICE makes no recommendation on "safer self-harm". It says harm-minimisation strategies should only be considered for people already in ongoing care who cannot yet resist the urge, and that they will not suit everyone (NICE 1.11.11–1.11.13).
• Hospital admission is not automatic. NICE suggests considering general hospital admission mainly when safety or safeguarding cannot otherwise be managed, or when someone is too distressed or intoxicated to be assessed (NICE 1.9.1).

Wound care and safety planning

Wound care

Physical care matters, and nobody should be refused treatment for an injury because it was self-inflicted. For minor wounds, the NHS describes stopping bleeding with firm pressure, cleaning with tap or bottled water, and covering with a clean dressing. It advises calling 111 if you feel generally unwell or have a high temperature after a cut (NHS: cuts and grazes). A GP can advise on and treat minor injuries (NHS: getting help). Emergency care is needed for bleeding that will not stop or spurts, loss of feeling or movement near the wound, or large or deep wounds (NHS: cuts and grazes). Some wounds need closing, a tetanus injection or antibiotics (NHS). NICE asks clinicians to give people information on how to deal with injuries and manage scars (NICE 1.1.1).

Safety planning

A safety plan is a short, personal, written plan for getting through a crisis. NICE recommends considering one, developed with the person and, where they agree, their family or carers. It should cover triggers and warning signs, personal coping strategies, people and places that help distract, friends or family who can help, professional contacts, and steps to keep the surroundings safer. The person should hold it and decide who it is shared with (NICE 1.11.7–1.11.8). The NHS points to the Staying Safe website for templates and video guides (NHS).

The evidence is encouraging but not definitive. A meta-analysis of six studies (3,536 people) found safety-planning-type interventions reduced suicidal behaviour (relative risk 0.57, 95% CI 0.41 to 0.80; number needed to treat 16) but did not reduce suicidal thoughts (Nuij et al. 2021). In plain terms, about 16 people would need a safety plan for one fewer to have suicidal behaviour during follow-up. The largest single study, in US veterans' emergency departments, was not randomised. Suicidal behaviour over six months was 3.0% with a safety plan plus phone follow-up vs 5.3% with usual care (OR 0.56, 95% CI 0.33 to 0.95), and the safety-plan group had more than double the odds of attending outpatient mental health care (Stanley et al. 2018). Most of these studies measured suicidal behaviour rather than self-harm specifically.

Supporting someone who self-harms

Finding out that someone you care about is self-harming can be frightening. NHS advice for friends and family is practical and consistent with NICE:

• Do: let them know you are there; ask how they would like to be supported; try to understand their feelings without judging, rather than focusing only on the injuries; treat any self-harm as a sign of serious distress; encourage them to talk to a GP or a listening service; get medical attention when needed (NHS).
• Don't: try to force them to stop, threaten to take away their control, or call them attention-seeking (NHS).
• Look after yourself. Carers of adults can ask their local authority for a carer's assessment in England (NHS). NICE says families and carers should be given information on the emotional impact, how to cope and what to do in an emergency (NICE 1.1.2).

NICE notes that even when a person has not agreed to involve their family, relatives can still give information to clinicians. It also encourages alternative ways to communicate distress, such as letters, agreed safe words or emojis (NICE 1.4.1–1.4.2). Teachers and other non-health staff should respond with respect and compassion, deal with immediate physical needs and help the person reach appropriate care (NICE 1.8.1).

Who to see

• Emergency services or emergency department: serious injury, any overdose, or if you cannot stay safe (NHS). In hospital, a liaison psychiatry or mental health team should carry out the psychosocial assessment (NICE 1.5.1).
• GP or family doctor: the usual first step for ongoing self-harm, minor injuries and referral. The GP may refer to a community mental health team, or to children and young people's mental health services for under-18s (NHS).
• Psychological therapist: a clinical psychologist or therapist trained and supervised in the specific therapy (CBT-informed therapy for adults, DBT-A for young people), as NICE requires (NICE 1.11.5).
• Listening services (any time): Samaritans (116 123, UK), Shout (text SHOUT to 85258, UK) and Childline (0800 1111, under-19s) (NHS); 988 in the US (988 Lifeline).

Follow the money: who funds the research and the treatment

Who profits either way

Self-harm care has no blockbuster drug, so the usual pharmaceutical money trail is short. The financial interests sit elsewhere: in therapy training, certification and books; in health systems that must pay for staff time; and, less visibly, in the reputations of academic groups whose research shapes national guidance. If NICE recommends a named therapy, demand for training in it rises. If risk scales are dropped, services need more skilled staff time for full assessments, which costs more.

Who funded the key evidence

• NICE is an executive non-departmental public body sponsored by the Department of Health and Social Care (GOV.UK). NG225 replaced the older guidelines CG16 (2004) and CG133 (2011) (NICE).
• Cochrane reviews cannot be funded or conducted by commercial sponsors with a vested interest in the findings (Cochrane policy). In the three self-harm reviews, the lead author edits Cochrane's self-harm and suicide reviews, and another author is a co-ordinating editor and a clinical adviser to New Zealand's Ministry of Health suicide prevention office. She also declared a fellowship from the Auckland Medical Research Foundation to develop and test a digital intervention for young people who self-harm, a non-commercial but relevant interest. The other authors declared no interests (Witt 2021).
• DBT-A trials. The US trial was funded by two NIMH grants. NIMH monitored recruitment but the investigators decided on publication (McCauley 2018). The Norwegian trial's lead sponsor was Oslo University Hospital (ClinicalTrials.gov).
• Safety planning. The veterans' study was supported by the US Department of Veterans Affairs, which helped design and run it but had no role in analysis or publication (Stanley 2018).
• UK epidemiology and risk-scale research was funded by the National Institute for Health and Care Research (NIHR), NHS Digital and the Department of Health and Social Care (Steeg 2018; McManus 2019; Carroll 2014).

Guideline committee interests

NICE publishes a register of interests for the NG225 committee (NICE register). Documented entries include:

• The committee chair, a consultant neurologist, declared private practice, industry-sponsored Alzheimer's disease trials (including Roche and Merck) and a paid Biogen advisory board. NICE judged these "not specific to the topic" and he took part.
• The topic adviser, a professor of psychiatry, declared royalties from a co-authored suicide prevention textbook. In its first year, £1,200 of £1,400.60 in royalties came from a bulk order by the Lundbeck Institute. NICE recorded this as a specific interest but judged that he did not need to withdraw.
• Other members declared NIHR research grants, charity trusteeships (including national Mind) and paid training work.

We found nothing in the register suggesting any member had a financial stake in a particular self-harm therapy. Several committee members are leading self-harm researchers: the topic adviser and a committee psychologist both co-authored the risk-scale study discussed above, whose authors also declared earlier NICE self-harm guideline roles (Steeg 2018, competing interests; NICE committee list). That is normal for specialist guidelines, but it means the committee partly weighed its own members' research.

The treatment industry

Marsha Linehan, of the University of Washington, led the DBT trial registration (ClinicalTrials.gov). Behavioral Tech, which describes itself as the training company she founded, trains clinicians in DBT, alongside the non-profit Behavioral Tech Institute (formerly the Linehan Institute) and a separate certification board (Behavioral Tech). In the key US DBT-A trial, Linehan declared royalties from Guilford Press for DBT books, royalties for training materials from Behavioral Tech, and payment for DBT workshops and online programmes. A co-author declared grant support and personal fees from Behavioral Tech outside the trial (McCauley 2018). That is why we rate the trial tier 3, even though its funding was public. The Norwegian trial, run by a different team, reached a similar conclusion, which reduces concern that developer involvement drove the result.

On the pharmaceutical side, one author of the DBT-A meta-analysis declared research funding from Lundbeck and Servier and a speaker's fee from Shire, unrelated to DBT (Kothgassner 2021). We found no drug-company-funded trial of a medicine for self-harm in the Cochrane reviews' summaries, and no licensed medicine for this purpose. We found no reliable market-size figure for self-harm treatment and have not estimated one.

What this means: Unusually for a mental health topic, the evidence on self-harm is almost entirely publicly funded, and no company sells a product that the main guideline recommends. The remaining conflicts are intellectual and professional: therapy developers testing their own approaches, and a small group of UK academics whose research informs the guideline they helped write. The guideline's clearest message, that risk scores should not decide who gets care, is backed by independent data from several English hospitals and does not benefit any seller.

Related research

For wider, evidence-graded context, see these Pure City Research guides:

• Mental health crisis warning signs
• Depression in children and adolescents
• Major depressive disorder
• Cognitive behavioural therapy (CBT)
• Mental health assessment and diagnosis
• Complex PTSD
• Trauma-focused therapy
• Lithium: bipolar, suicide and kidney risk
• Digital CBT and mental health apps
• Exercise and social support for mental health

Frequently asked questions

Sources and funding notes

What we could not verify: the "sources of support" (funders) of the three 2021 Cochrane reviews, because the Cochrane Library full text was blocked to us; we report the authors' declared interests from PubMed. We could not confirm the grant funders of the Norwegian DBT-A trial beyond its registry sponsor, or the funding of the Nuij 2021 safety-planning meta-analysis and the Hawton 2012 Lancet review. We did not read NICE's full evidence reviews (J and K), so the guideline's own effect estimates are not reported here. We did not identify which natural product was tested in the single Cochrane-included trial. We found no reliable market-size data for self-harm treatment or DBT training, and no US federal guideline equivalent to NG225 was reviewed. The longer-term (6 and 12-month) CBT results in adults are described only in general terms because we could not open the full Cochrane analysis tables.

1. NICE NG225. Self-harm: assessment, management and preventing recurrence. Recommendations (published 7 September 2022) — UK guideline; NICE, sponsored by DHSC.
2. NICE NG225: Context — definition and prevalence; NICE.
3. NICE NG225: Update information — replaced CG16 and CG133; NICE.
4. NICE NG225 committee register of interests — declared interests of committee members; NICE.
5. GOV.UK: National Institute for Health and Care Excellence — NICE status and sponsor; UK government.
6. Witt KG et al. Psychosocial interventions for self-harm in adults. Cochrane 2021, CD013668 — systematic review; funders not verified; authors' declared interests are Cochrane editorial roles.
7. Witt KG et al. Interventions for self-harm in children and adolescents. Cochrane 2021, CD013667 — systematic review; as above.
8. Witt KG et al. Pharmacological interventions for self-harm in adults. Cochrane 2021, CD013669 — systematic review; as above.
9. Cochrane commercial sponsorship policy — Cochrane (UK-registered charity).
10. McCauley E et al. Efficacy of DBT for adolescents at high risk for suicide. JAMA Psychiatry 2018 (full text) — RCT; funded by NIMH; developer royalties declared.
11. ClinicalTrials.gov NCT01528020 — registry for the McCauley trial; University of Washington, with NIMH.
12. Mehlum L et al. DBT for adolescents with repeated suicidal and self-harming behaviour: a randomized trial. JAACAP 2014 — RCT; funders not verified.
13. ClinicalTrials.gov NCT00675129 — registry for the Mehlum trial; lead sponsor Oslo University Hospital.
14. Kothgassner OD et al. Efficacy of DBT for adolescent self-harm and suicidal ideation: meta-analysis. Psychol Med 2021 (full text) — meta-analysis; no specific grant; one author with Lundbeck/Servier research funding.
15. Stanley B et al. Safety Planning Intervention with follow-up vs usual care in the emergency department. JAMA Psychiatry 2018 (full text) — cohort comparison; US Department of Veterans Affairs.
16. Nuij C et al. Safety planning-type interventions for suicide prevention: meta-analysis. Br J Psychiatry 2021 — meta-analysis; funding not verified.
17. Steeg S et al. Accuracy of risk scales for predicting repeat self-harm and suicide. BMC Psychiatry 2018 (full text) — cohort study; NIHR Programme Grant.
18. Carroll R, Metcalfe C, Gunnell D. Hospital presenting self-harm and risk of fatal and non-fatal repetition. PLoS One 2014 (full text) — meta-analysis; NIHR fellowship.
19. McManus S et al. Prevalence of non-suicidal self-harm and service contact in England, 2000–14. Lancet Psychiatry 2019 (full text) — national surveys; NHS Digital, DHSC, NIHR.
20. Hawton K, Saunders KE, O'Connor RC. Self-harm and suicide in adolescents. Lancet 2012 — narrative review; funding not verified.
21. Saunders KE et al. Attitudes and knowledge of clinical staff regarding people who self-harm. J Affect Disord 2012 — systematic review; funding not verified.
22. WHO fact sheet: Suicide — global statistics; WHO.
23. NHS: Self-harm, including getting help, why people self-harm, assessment and treatments and how to help someone else — UK government patient information.
24. NHS: Where to get urgent help for mental health — UK government.
25. NHS: Cuts and grazes — wound care and emergency signs; UK government.
26. Behavioral Tech: About us — DBT training company and related non-profit; self-description.
27. 988 Suicide & Crisis Lifeline and Samaritans — crisis services.

Educational research reviewed 7 October 2026. This article is not medical advice; talk to a qualified clinician or pharmacist before starting, stopping or combining treatments.