The Role of the Hand Surgeon in the Management of Self-Injurious Behavior: A Guideline for Comprehensive Care and Patient Safety.

Abstract

Deliberate self-harm (DSH), including self-injurious behavior and nonsuicidal self-injury, presents substantial challenges to health care providers because of its prevalence, association with psychiatric conditions, and potential progression to suicide.^1,2 Hand surgeons are often among the first subspecialists to encounter these patients, particularly in emergency and outpatient settings, where upper-extremity injuries are common. This article explores the critical role of hand surgeons in identifying, managing, and preventing DSH-related injuries, emphasizing a multidisciplinary approach. Early recognition of DSH is vital, as many patients display subtle signs, such as scars on the upper extremities or discrepancies in reported injury mechanisms. Suicide screening tools, such as the Ask Suicide Screening Questions toolkit, enable rapid and effective identification of at risk individuals to guide subsequent care. In the emergency setting, hand surgeons must balance surgical intervention with the need for psychiatric evaluation, leveraging a multidisciplinary team to address underlying mental health conditions. Similarly, in outpatient clinics, hand surgeons have a unique opportunity to screen for DSH, initiate mental health referrals, and establish follow-up care with the help of existing clinical staff and social workers. Addressing misconceptions, such as the belief that discussing suicide may "implant" the idea or that surgical intervention reinforces self-harm for the average patient, is essential to improving care pathways. These misconceptions also deter hand surgeons from asking about DSH and suicidal thoughts. By expanding their role to include mental health considerations, hand surgeons can reduce recurrence rates, improve functional outcomes, and potentially save lives. We provide a comprehensive framework for integrating suicide prevention strategies and mental health resources into hand surgery practice, underscoring the critical impact of hand surgeons in managing this vulnerable patient population.