All letters are subject to editing and may be shortened. General letters can be sent to bjgpdisc@rcgp.org.uk (please include your postal address for publication), and letters responding directly to BJGP articles can be submitted online via eLetters. We regret we cannot notify authors regarding publication.

For submission instructions visit: bjgp.org/letters

I am a patient no clinician wants in the room. I have self-harmed by cutting on and off for 30 years and my entire body is covered in scars. Referrals to the Community Mental Health Team are rejected or end in a one-off appointment where I am told I have the capacity to make poor decisions. There is no treatment pathway for self-harm apart from referral to secondary care, which is unlikely to take the patient on for the long-term, intensive psychotherapy they often need. The National Institute for Health and Care Excellence (NICE) guidelines on assessment, management and preventing recurrence have no bearing on my ongoing experiences of the NHS.1

Psychosocial assessment, recommended in the guidelines and provided in Accident and Emergency (A&E), is often a means to no end since there are no new services …