Practitioners’ attitudes to self-injury vary widely. While some healthcare professionals are comfortable providing advice about safe self-injury in the inpatient setting, others believe they have a duty of care to protect patients from harming themselves, including removing all potentially sharp implements and increasing observation levels. This article describes work undertaken at South Staffordshire and Shropshire Healthcare NHS Foundation Trust to explore self-injurious behaviour in inpatient settings, including staff knowledge and perceptions and service users’ experiences. Development of clinical guidelines for safe self-injury is also discussed.