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8.33 Self-Harm and Suicidal Behaviour

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RELATED GUIDANCE

Royal College of Psychiatrists Managing Self-harm in Young People

Guidance for Developing a Local Suicide Prevention Action Plan: Information for Public Health Staff in Local Authorities

AMENDMENT

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.

Contents

Introduction

8.33.1

Self-harm is common. A survey of young people aged 15-16 years estimated that more than 10% of girls and more than 3% of boys had self-harmed in the previous year. Self-harm increases the likelihood that the person will eventually die by suicide by between 50- and 100- fold above the average for the rest of the population. 

8.33.2

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.

8.33.3

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.

8.33.4

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.

8.33.5

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

8.33.6

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.This will involve a referral to MASH.

8.33.7

Any child aged under 10 reported to be self harming must be the subject of a comprehensive mental health assessment and a referral to CAMHS. A paediatric assessment may be needed as part of this process. The mental helath assessment is the priority.

8.33.8

This must be undertaken as a matter of urgency for any child aged under 5.

8.33.9

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

8.33.10

Information should also be passed to the school nurse who can liaise with the child's GP where necessary.

8.33.11

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 10, a comprehensive paediatric assessment should be sought after seeking advice from acute mental health services (CAMHS) - see Responding to Incidents of Self-Harm above.

8.33.12

All school personnel who come into contact with a child who is self harming should inform the school's designated member of staff.

Child referred to Children's Social Care

8.33.13

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.

8.33.14

In all cases an assessment should consider whether:

  • There is evidence the parents / carers are failing to protect the child from harm or are failing to diminish the risks of further attempts at harm;
  • The child is exhibiting behaviour beyond the control of their parent / carer and they continue to self harm or attempt suicide;
  • The child is too young or has learning difficulties and is unable or does not give an explanation that is consistent with self harming;
  • The child is being harmed or suspected of being harmed by another adult or child - this may include injury from a sibling or severe bullying by other children or situations where the child is a witness to or the subject of domestic violence;
  • Following an assessment there is significant concern that the child's family circumstances would continue to place them at risk of Significant Harm.
  • Consider child sexual abuse / child sexual exploitation and other harmful practices.
8.33.15

In all cases where self harm or attempted suicide is suspected or known the child should be seen by an appropriately trained clinician/physician at the local A&E department or an acute mental health service (CAMHS).

Child Presented at Hospital

8.33.16

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.

8.33.17

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.

8.33.18

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.

8.33.19

Area self-harm pathways:

West Sussex: Acute hospital trusts in West Sussex should follow their internal trust pathway for self-harm and contact the Named Professionals within the trust for advice as required.

East Sussex:  East Sussex referral guidance

Brighton & Hove: Pathway for Paediatric team at Royal Alexandra Children's Hospital

Definition

Self-harm can be broadly grouped into self-poisoning (with prescription medication and other chemicals) and self-injury (Horrocks et al 2003). The latter most commonly includes self-cutting, but can also involve behaviours such as stabbing, jumping or hanging. Ligatures may also be used.  

Some young people are self-harming as a coping mechanism, but not all. There are other reasons e.g. copycat behaviour, cry for help or occasionally a genuine belief at the time that they can kill themselves this way.

There are other causes of deliberate self-harm including autism, learning disability and functional behaviour. 

8.33.20

Self-harm* describes a wide range of things that people to do themselves in a deliberate and usually hidden way. In the vast majority of cases self-harm remains a secretive behaviour that can go on for a signficant time without being discovered. 

Examples of self-harm are:

  • overdosing of tablets or medicines
  • inhaling or sniffing harmful subtances
  • cutting, often to arms using razor blades, broken glass or knives
  • burning using cigarettes or caustic agents
  • Punching and bruising
  • Inserting or swallowing objects
  • Head banging

*The term self-harm is often used as an all-encompassing term referring to suicidal thoughts and attempted suicide (Mental Health Foundation 2006)

8.33.21

Self injury is any act which involves deliberately inflicting pain and/or injury on the body, but without suicidal intent. Self injury is seen as a coping mechanism with the aim of relieving emotional distress.

NB Although self-harming behaviour is relied on as an attempt to cope and manage and may not be intentionally suicidal, it must be recognised that the emotional distress that leads to self-harm can also lead to suicidal thoughts and actions.

  

8.33.22

Suicide is an intentional, self-inflicted, life-threatening act resulting in death from a number of means. 

8.33.23

Suicidal-intent is indicated by evidence of premeditation (such as saving up tablets), taking care to avoid discovery, failing to alert potential helpers, carrying out final acts (such as writing a suicide note) and choosing a violent or aggressive means of deliberate self-harm allowing little chance of survival.

8.33.24

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, after a risk assessment, via the school counselling service, the GP, child and adolescent mental health service (CAMHS) or other therapeutic services e.g. paediatric or psychiatric services.     

8.33.25

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.

8.33.26

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.

8.33.27

Consideration must also be given to protect children who engage in high rks behaviour which may cause serious self-injury such as drug or substance misuse, running away, child sexual exploitation, partaking in daring behaviour i.e. running in front of cars etc. All of which may indicate underlying behavioural or emotional difficulties or abuse.


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This page is correct as printed on Monday 11th of December 2017 06:00:11 AM please refer back to this website (https://sussexchildprotection.procedures.org.uk) for updates.
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