Self-mutilation is a prevalent concern, particularly for adolescents. School counseling programs can play an important role in the recognition, prevention, and intervention of self-mutilation. This study reviews current literature on adolescent self-mutilation, prevention, and treatment suggestions offered school counseling program personnel. Also included is a brief review of school counseling program accountability literature followed by suggestions for school counseling program implementation of prevention and intervention strategies which incorporate accountability components in order to further the research on school counseling programmatic best practices for adolescent self-mutilation.