Suicidal and self-harm behaviors in emergency psychiatry: bridging risk assessment and clinical decision-making.

Background: Suicidal behavior and non-suicidal self-injury (NSSI) represent major clinical challenges in psychiatric emergency settings. Despite extensive research on risk factors, the prediction and management of suicidal behavior remain complex, often requiring rapid decision-making under conditions of uncertainty. Objective: To provide a practical, clinically grounded framework for the assessment and management of suicidal and self-harm behaviors in emergency settings, integrating current evidence with real-world clinical practice. Methods: This narrative review synthesizes key findings from the literature alongside clinical experience in psychiatric emergency care. Core domains include conceptual definitions, functions of self-harm, suicide risk assessment, and acute management strategies. Results: Self-harm behaviors frequently serve multiple intrapersonal and interpersonal functions, including emotional regulation, anti-dissociative mechanisms, and crisis communication. Suicide risk assessment should move beyond static risk factor models and incorporate dynamic elements such as intent, planning, ambivalence, and protective factors, including reasons for living. In emergency settings, management should prioritize therapeutic engagement, emotional validation, and collaborative decision-making. The distinction between acute and chronic risk is critical for appropriate disposition, including hospitalization versus outpatient management. Conclusions: Effective management of suicidal and self-harm behaviors in emergency contexts requires an integrative, patient-centered approach that combines structured assessment with clinical judgment. Emphasis on therapeutic alliance and individualized care planning may improve outcomes beyond traditional risk stratification models.