Acute management of the self-cutter.

'Self-cutting' is a specific type of emergency presenting to accident and emergency departments. All cases presenting in Sheffield in a 6-month period were studied. The self-cutter is most often a young, unemployed man: this is the group most likely to cut repeatedly. At least 45% of all cutters had a past psychiatric history, and a quarter of them were judged a high suicidal risk. The seriousness of the physical injury and the suicidal risk cannot be simply correlated. The crucial part of acute management is the decision about psychiatric referral. As with a complex physical injury, formal assessment must be performed and specialist referral made on that basis.