8.33 Self-Harm and Suicidal Behaviour
In March 2015, a link was added to Royal College of Psychiatrists Managing Self-harm in Young People and Guidance for Developing a Local Suicide Prevention Action Plan: Information for Public Health Staff in Local Authorities.
- Responding to Incidents of Self-Harm
- Child Presented at School
- Child referred to Children's Social Care
- Child Presented at Hospital
Self harm, self mutilation, eating disorders, suicide threats and gestures by a child must always be taken seriously and may be indicative of a serious mental or emotional disturbance.
In most cases of deliberate self harm the young person should be seen as a Child in Need and offered help via the school counselling service, the GP, child and adolescent mental health service (CAMHS) or other therapeutic services e.g. paediatric or psychiatric services.
The possibility that self-harm, including a serious eating disorder, has been caused or triggered by any form of abuse or chronic neglect should not be overlooked.
The above possibility may justify a referral to Children's Social Care using the Making a Referral Procedure for consideration and assessment of whether the child is in need of services and/or protection.
Consideration must also be given to protect children who engage in high risk behaviour which may cause serious self injury such as drug or substance misuse, running away, partaking in daring behaviour i.e. running in front of cars etc. All of which may indicate underlying behavioural or emotional difficulties or abuse.
Responding to Incidents of Self-Harm
It is good practice, whenever a child or young person is known to have either made a suicide attempt or been involved in self harming behaviour, to undertake a multi-disciplinary risk assessment, along with an assessment of need.
Any child aged under 12 reported to be self harming must be the subject of a comprehensive paediatric assessment leading to a possible referral to CAMHS.
This must be undertaken as a matter of urgency for any child aged under 5.
In addition to the normal child protection procedures in Section 3 of this manual, Recognition and Referral of Abuse and Neglect, the following procedures may apply.
Child Presented at School
All school personnel who come into contact with a child who is self harming should inform the school's designated member of staff.
Information should also be passed to the school nurse who can liaise with the child's GP where necessary.
The school should make arrangements to interview the child and ascertain whether the difficulties presented can be resolved with her/him and their parents within the school environment or whether outside help from other professionals is required. However, if aged under 12, a comprehensive paediatric assessment should be sought - see Responding to Incidents of Self-Harm above.
Child referred to Children's Social Care
In all cases where self harm or attempted suicide is suspected or known the child should be seen by a physician at the local A&E department.
For cases where self harm has been reported but the child is not in immediate danger, a Child and Family Assessment should be undertaken to determine what course of action should follow. This will include consideration as to whether a referral to CAMHS is necessary and if a Section 47 Enquiry should be initiated. For younger children, a comprehensive paediatric assessment should be sought - seeResponding to Incidents of Self-Harm above.
In all cases an assessment should consider whether:
Child Presented at Hospital
Where the child has presented at hospital, the doctor should undertake a preliminary examination and decide what further assessment is required. For younger children, a comprehensive paediatric assessment should be sought - see Responding to Incidents of Self-Harm above.
In cases of attempted suicide a hospital admission will usually be arranged to enable a psycho - social assessment, which should consider whether or not the child is at risk of Significant Harm and the need to refer to Children's Social Care for assessment under the Making a Referral Procedure.
Where a child has been hospitalised as a result of self-harm, any discharge should involve co-ordinated planning with community services, including Children's Social Care and CAMHS.