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Self harm is common but its prevalence may be underestimated because many studies rely on self report. In a study of 17 countries an average of 2.7% of adults reported self harm.1 A survey in the United Kingdom of 15-16 year olds estimated that more than 10% of girls and 3% of boys had self harmed in the previous year.2 Self harm and psychiatric disorder are strongly associated.3 4 Importantly, once a person has self harmed, the likelihood that he or she will die by suicide increases 50 to 100 times,5 6 with 1 in 15 dying by suicide within nine years of the index episode.7 The UK suicide rate is 17.5 for males and 5.2 for females per 100 000 population,8 which is nearly 10 times the homicide rate. Understanding and helping people who self harm is therefore likely to be an important part of an effective suicide prevention strategy. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the longer term management of self harm.9 This guideline is intended to complement the earlier NICE guideline on the short term management of self harm (treatment within the first 48 hours after an episode of self harm).10 NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group's experience and opinion of what constitutes good practice. ### General principles of care