Conflict of interest statement: ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The 
self-harm monitoring system in Oxford was approved by South Central – Berkshire 
National Research Ethics Service and Derbyshire Research Ethics Committee 
approved the study in Derby. Both were granted ethical approval to collect data 
for both local and multicentre projects. South Manchester Research Ethics 
Committee reviewed the project in Manchester. The project was deemed not to 
require approval as the monitoring is conducted as part of a clinical audit 
system. The Bristol Self-Harm Surveillance Centre received ethical approval from 
University Hospitals Bristol NHS Foundation Trust and Southmead Research Ethics 
Committee approved the research database. All centres have approval under 
section 251 of the NHS Act (2006) to collect patient identifiable data without 
patient consent and Oxford, Derby and Manchester have consent to send patient 
details to the Data Linkage Service. COMPETING INTERESTS: D.G., K.H. and N.K. 
are members of the Department of Health’s (England) National Suicide Prevention 
Advisory Group. N.K. chaired the NICE guideline development group for the 
longer-term management of self-harm and the NICE Topic Expert Group (which 
developed the quality standards for self-harm services). He is currently chair 
of the updated NICE guideline for depression. R.O.C. was a member of the NICE 
guideline development group for the longer-term management of self-harm and is a 
member of the Scottish Government’s suicide prevention implementation and 
monitoring group. All other authors declare no conflict of interest. PUBLISHER’S 
NOTE: Springer Nature remains neutral with regard to jurisdictional claims in 
published maps and institutional affiliations.