8.49 Self-Harm and Suicidal Behaviour
Last reviewed in December 2020
Next review in December 2022
- Related guidance(Jump to)
- Definitions(Jump to)
- Introduction(Jump to)
- Child Presented at School(Jump to)
- Child referred to Children's Social Care(Jump to)
- Child Presented at Hospital(Jump to)
- Area self-harm pathways(Jump to)
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, reckless 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 self-harm, including autism, learning disability and functional behaviour.
Self-harm* describes a wide range of things that people to do themselves in a usually hidden way. In the vast majority of cases, self-harm remains a secretive behaviour that can go on for a significant time without being discovered.
Examples of self-harm are:
*The term self-harm is often used as an all-encompassing term referring to suicidal thoughts and attempted suicide (Mental Health Foundation 2006)
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.
Suicide is an intentional, self-inflicted, life-threatening act resulting in death from several means.
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.
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 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.
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 requires 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, 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.
In most cases of 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 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.
When a child or young person is known to have made a suicide attempt a referral should be made to MASH (West Sussex) SPOA (East Sussex), and Front Door For Families (Brighton & Hove).
When a child or young person is known to have been involved in self-harming behaviour, professionals should consider whether a referral to CAMHS is needed and to, undertake a multi-disciplinary risk assessment, along with an assessment of need. This may involve a referral to MASH (West Sussex) SPOA (East Sussex), and Front Door For Families (Brighton & Hove)
Any child aged under 10 reported to be self-harming should be referred to CAHMS. A paediatric assessment may be needed as part of this process. The mental health assessment is the priority.
Child Presented at School
Following attendance at A&E information should be passed to the child’s GP and the school nurse where appropriate
It is good practice for the school to speak to the child and ascertain whether the difficulties presented can be resolved with them and their parents within the school environment or whether outside help from other professionals is required. Schools should consider whether a referral to MASH (West Sussex) SPOA (East Sussex), and Front Door For Families (Brighton & Hove) is required.
It is good practice for 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
For cases where self-harm has been reported, but the child is not in immediate danger, a Child and Family Assessment may 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.
If there are immediate concerns about the child's mental or physical health, the child should be seen by an appropriately trained clinician/physician at the local A&E department or by the local CAMHS service.
In all cases where an assessment is undertaken, this should consider whether:
Child Presented at Hospital
Where the child has presented at hospital, the health practitioner 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/ A&E admission will usually be arranged to enable a psychosocial 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. If a child presents during service hours, they may be assessed by Paediatric Liaison or CAMHS duty teams without the need for hospital admission.
Where a child has been hospitalised as a result of serious self-harm, any discharge should involve coordinated planning with community services, including Children's Social Care and CAMHS.
Area self-harm pathways
Acute hospital trusts in Sussex should follow their internal trust pathway for self-harm and contact the Named Professionals within the trust for advice as required.