Abstract
There is an urgent need for development of practice-based and theoretically grounded model of care for immediate and short-term risk assessment and management by front-line staff (nurses and doctors) for women with severe personality disorders and high-risk repetitive self-harm. This is particularly necessary for forensic in-patients as available guidelines do not address the needs of and risks associated of this group. An algorithm of a hierarchical model of risk assessment and management and care for high-risk repetitive self-harmers within medium secure care is developed and tested for model effectiveness and fidelity. The model was found to be effective in reducing frequency of self-harm and assessment of staff practice revealed adequate model fidelity.