The recurrent nature of non-suicidal self-injury (NSSI) and its frequent association with multiple psychopathological conditions makes it a challenge for assessment and treatment. While the behavior can often be effectively addressed in a hospital setting, the short term stays that are typical in the current environment make it unlikely that therapeutic gains will be maintained following discharge. The result is often therapeutic nihilism, and a revolving door phenomenon, which can become a pathway to chronic psychiatric disability. However, if the hospital can be viewed as part of a continuum of community-based care, rather than a retreat from the community, it can play a valuable role in stabilization and improvement in adaptive functioning. The authors describe a hypothetical yet typical case of an adolescent admitted to the hospital for NSSI and review the clinical decision-making process that led to the development and implementation of an appropriate treatment plan.