On the basis of the De Leo definition, the primary focus needs to be a description of what the individual is doing, without attempting to attribute level of suicidal intent.

At the most basic level, for an individual presenting at the hospital, the questions to ask are the following:

• Was this injury, drug overdose or poisoning self-inflicted?
• If yes, was it intentional or accidental?

If the injury or poisoning is identified as intentionally self-inflicted on the basis of the exclusion and inclusion criteria (see Figure 3.1), the individual involved will require a psychological and/or psychiatric assessment. It is only at this stage that motivation and intent associated with the intentional self-harm could be explored.

Inclusion Criteria

 On the basis of the De Leo et al 2004 definition, the inclusion criteria are as follows (i.e. the following are considered to be cases of intentional self-harm):

• All methods of intentional self-harm (as per ICD-10 coding, see Table 3.1) (e.g. alcohol overdose, illicit drug overdose, ingestion of pesticides, laceration, attempted drowning, attempted hanging, gunshot wound) where it is clear that the self-harm was intentionally inflicted.
• All individuals who are alive presenting or referred to the hospital following an act of intentional self-harm.

Some individuals may use a combination of methods, such as overdose of medication together with self-cutting. If the individual has engaged in multiple methods of intentional self-harm at the time of presentation, all methods should be recorded.

Exclusion Criteria

On the basis of the De Leo et al 2004 definition, the exclusion criteria are as follows (i.e. the following are not considered to be cases of intentional self-harm):

• Accidental overdose of alcohol: An individual who drinks alcohol to excess requiring hospital treatment, but without any intention to self-harm, and who does not combine alcohol with other methods of self-harm.
• Accidental overdose of illicit drugs: An individual who takes illicit drugs (e.g. cocaine, heroin, ecstasy) on a regular basis without any intention to self-harm.
• Accidental overdose of prescription or over-the-counter medications: An individual who incorrectly follows a prescribed dosage, or who takes additional medication in the case of illness, or who takes an excess of over-the-counter medication without any intention to self-harm.
• Individuals who are dead on arrival at the hospital.

Examples of Exclusion (Not Cases of Intentional Self-Harm)

• Individual put his/her foot through the door in anger.
• Heavy intake of alcohol and medication (e.g. person withdrawing from heroin took a mixture of alcohol and medication hoping for relief)
• Person took usual medication twice by accident or to relieve chronic back pain.
• Insomnia-related incidents where medications are taken to help induce sleep.
• Medication taken to induce abortion for the purpose of terminating pregnancy.
• Alcohol-induced coma as a result of excessive alcohol intake by a young person experimenting with alcohol.
• Alcohol-induced coma as a result of excessive alcohol intake by a person suffering from alcohol dependence.
• Person had thoughts of drowning by jumping off a bridge, but took no action.
• Person is feeling unable to cope with suicidal thoughts