New clinical practice guidelines for suicide and self-harm in children

Presentations of suicidal behaviours and non-suicidal self-injury (NSSI) are becoming more common in young people, revealing a complex and urgent challenge for clinicians caring for them. Nationally, suicide is the leading cause of death for young people aged 15-24, and compared to other developed nations, Australia has one of the highest hospitalisation rates due to self-harm, second only to France.

Yet, despite the prevalence and clinical significance of these presentations, guidance for professionals working with young people has historically been limited. The recent publication of the Suicide and NSSI in Children and Adolescents: Evidence-Based Clinical Practice Guideline, accepted as a resource by the Royal Australian College of General Practitioners (RACGP), represents an important step toward addressing this gap.

Balancing evidence and experience in clinical guidance

Systematic reviews undertaken to inform the guidance identified limited evidence to guide clinical practice. Research related to suicide and self-harm, specifically involving young people, is ethically and socially complex and requires significant safety and planning considerations. 

This reveals a fundamental tension in modern medicine.

Evidence-based practice is the gold standard, supporting clinical decision-making with empirical data and scientific rigour. Broader public health interventions, services, and policymakers also rely on evidence to guide their work, yet are contingent on clinical consensus and a shared understanding of best practice to facilitate change.

But what happens when the evidence base is inconclusive, impractical, or non-existent? In the context of paediatric mental health, clinicians and services are often faced with precisely this dilemma.

The guideline addresses this challenge through a comprehensive, collaborative development process. It was developed in partnership with people with lived and living experience of suicide and NSSI alongside clinicians, researchers, and policymakers.

Using an internationally recognised evidence-based methodology, supported by the National Health and Medical Research Council (NHMRC), the development team conducted four systematic literature reviews to identify evidence and guide where consensus was needed. In the absence of evidence, clinical experience and the experiences of young people and families were used to write practical recommendations to support young people and their recovery.

This process offers a balance between evidence, what is scientifically proven and studied, and feasibility, what is practical, in a real-world setting.

For example, evidence suggests that dialectical behaviour therapy (DBT) is the most effective treatment for young people experiencing suicidal behaviour. However, the experts consulted in development noted the limited accessibility of DBT in certain settings due to cost and the specialised training required to deliver the therapy. In addition to DBT, the guideline also recommends other evidence-based therapies including cognitive behavioural therapy (CBT).

Challenging the status quo

Though the guideline is developed using evidence and informed by lived experience, some have described the guideline as ‘aspirational.’ Yes, the guideline is ambitious. It outlines a standard of care that may not yet be feasible within current systems or settings.

Extensive discussions between young people, clinicians, and researchers highlighted where systems and services have failed and where they can improve. Australia’s mental health services are under significant strain, with long wait times, workforce shortages, and fragmented care pathways. Reports from the Australian Government Productivity Commission have consistently highlighted that the current system is not equipped to meet the needs of those seeking support, particularly young people experiencing acute distress and their families. 

In a system that is struggling to provide adequate care, maintaining the status quo risks perpetuating harm and trauma to our most vulnerable. This guideline challenges clinicians, services, and policymakers to do better.

Guidance within the national suicide prevention landscape

The introduction of the National Suicide Prevention Strategy 2025-2035 represents a critical and welcome step toward more coordinated national action. It signals growing recognition that suicide prevention requires a whole-of-system response, extending beyond crisis care into prevention, early intervention, and community-based supports.

Unfortunately, the recent announcement of the Federal Budget 2026-27 does not include dedicated funding to implement the National Suicide Prevention Strategy. Instead, offering a 12-month extension and short-term funding of the National Mental Health and Suicide Prevention Agreement which outlines an intention for coordinated care across states and territories.

This momentum must now be sustained and built upon with continued prioritisation of services and programs that support clinicians, communities, and researchers' to better care for young people who experience mental health concerns.

Clinical guidance and reform must be situated within this wider political agenda. Guidelines like this one can serve as a foundation for a shared language and understanding about suicide and NSSI. Supporting not only patient care but communication between clinicians and services. This sets the groundwork for more structured professional development and pathways to support clinician confidence and competence.

Importantly, this guideline does not claim to solve the complicated social, economic, and systemic issues that contribute to youth suicide or service provision. The challenges are too complex and deeply embedded for any single document or strategy to address. What it does offer is a practical framework to support clinicians in navigating some of the most difficult clinical presentations they will encounter. It provides clarity where possible and guidance where certainty is lacking.

Sydney Stevens is a PhD student and researcher at the University of Melbourne and Murdoch Children’s Research Institute. With a background in public health and health services, her research is focused on suicide and self-harm in neurodivergent young people.

Calvin Truong is the Advocacy Lead for the Melbourne’s Children’s Campus Mental Health Strategy and an honorary policy researcher at the Murdoch Children's Research Institute.