14.1 Self-harm, suicidal behaviour & suicide
Last reviewed in April 2023
Next review in April 2025
For guidance on how to respond to a suspected suicide please see 8.51 Response to a suspected suicide | Sussex Child Protection and Safeguarding Procedures Manual.
For guidance on how to respond to a potential cluster of suicides for those aged under 18 please see 8.50 Responding to a potential cluster of suicides for children and young people aged under 18 | Sussex Child Protection and Safeguarding Procedures Manual
- Introduction(Jump to)
- Definitions(Jump to)
- Indicators(Jump to)
- Where a child presents to a non-health professional(Jump to)
- Where a child presents to a health or social care professional(Jump to)
- Where hospital care is needed(Jump to)
- Psychosocial Assessment(Jump to)
- Children referred to Children's social care(Jump to)
- Information sharing and consent(Jump to)
- Area Self Harm Pathways(Jump to)
- How to respond to a suspected suicide(Jump to)
- How to respond to a potential cluster of suicides for those under 18 years(Jump to)
- Further information and Guidance(Jump to)
Any child or young person, who self-harms or expresses thoughts about this or about suicide, must be taken seriously and appropriate help and intervention should be offered at the earliest point. Any practitioner who is made aware that a child or young person has self-harmed, or is contemplating this or suicide, should talk with the child or young person without delay.
This procedure does not cover self-injurious behaviours which is sometimes present in the context of Learning Disability or Autism and this should be assessed with reference to the learning disability safeguarding procedures (Safeguarding children with disabilities).
Definitions from the Mental Health Foundation (2003) are:
Deliberate self-harm is a common precursor to suicide and children and young people who deliberately self-harm may die by accident.
Self-harm can be described as wide range of behaviours that someone does to 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 long time without being discovered. Many children and young people may struggle to express their feelings and will need a supportive response to assist them to explore their feelings and behaviour and the possible outcomes for them.
The indicators that a child or young person may be at risk of taking actions to harm themselves or attempt suicide can cover a wide range of life events such as bereavement, bullying at school or a variety of forms of cyber bullying, often via mobile phones, bullying (including homophobic, transphobic etc), mental health problems including eating disorders, family problems such as domestic abuse or any form of child abuse as well as conflict between the child and parents.
The signs of the distress the child may be under can take many forms and can include:
Where a child presents to a non-health professional
When a person who has self-harmed presents to a non-health professional, for example, a teacher or a member of staff in the criminal justice system, the non-health professional should:
When a person presents to a non-health professional, for example, a teacher or a member of staff in the criminal justice system, the non-health professional should establish the following as soon as possible:
Where a child presents to a health or social care professional
When a person presents to a healthcare professional or social care practitioner following an episode of self-harm, the professional should:
When a person presents to a healthcare professional or social care practitioner following an episode of self-harm, the professional should establish the following as soon as possible:
Carry out concurrent physical healthcare and the psychosocial assessment as soon as possible after a self-harm episode.
Specific guidance in Primary care, care by ambulance staff and paramedics and social care are available in Overview | Self-harm: assessment, management and preventing recurrence | Guidance | NICE
Where hospital care is needed
Where a child or young person requires hospital treatment in relation to physical self-harm, practice should be as follows, in line with the National Institute of Health and Clinical Excellence NICE Guidance Self-harm: assessment, management and preventing recurrence (NG225) September 2022.
Initial assessment or Triage should establish the following as soon as possible:
Before discharge ensure that:
There should be an age appropriate assessment by a mental health professional as soon as possible after arrival to complete a psychosocial assessment. (See section 7 Psychosocial Assessment, below)
Any child or young person who refuses psychosocial assessment or admission should be reviewed by a senior Paediatrician in Accident and Emergency and, if necessary, their management discussed with the on-call Child and Adolescent Psychiatrist, and CAMHS liaison.
This should be done with reference to the National Institute of Health and Clinical Excellence NICE Guidance Self-harm: assessment, management and preventing recurrence (NG225) September 2022 - Overview | Self-harm: assessment, management and preventing recurrence | Guidance | NICE
Assessment should be undertaken by healthcare practitioners experienced in this field.
Assessment should follow the same principles as for adults who self-harm, but should also include a full assessment of the family, their social situation (including peer group and education), family history, the use of social media and the internet to connect with others and the effects of these on mental health and wellbeing, any caring responsibilities, child protection and issues.
Do not delay the psychosocial assessment until after medical treatment is completed.
The psychosocial assessment should explore the functions of self-harm for the person and the strengths, vulnerabilities and needs. Including adverse childhood experiences.
Mental health professionals should undertake a risk formulation as part of every psychosocial assessment including considering if social care need to be part of this assessment.
If the young person is caring for a child or pregnant, the welfare of the child or unborn baby should also be considered in the assessment as should a consideration if this person is a young carer.
Children referred to Children's social care
The child or young person may be a Child in Need of services (s17 of the Children Act 1989), which could take the form of an early help assessment or a support service or they may be at risk of significant harm, which requires child protection services under s47 of the Children Act 1989.
The referral should include information about the background history and family circumstances, the community context and the specific concerns about the current circumstances, if available.
Information sharing and consent
The best assessment of the child or young person's needs and the risks they may be exposed to, requires useful information to be gathered in order to analyse and plan the support services. In order to share and access information from the relevant professionals, the child or young person's consent will be needed.
Professional judgement must be exercised to determine whether a child or young person in a particular situation is competent to consent or to refuse consent to sharing information. Consideration should include the child's chronological age, mental and emotional maturity, intelligence, vulnerability and comprehension of the issues. A child at serious risk of self-harm may lack emotional understanding and comprehension and the Gillick competence guidelines should be used.
Informed consent to share information should be sought if the child or young person is competent unless:
If consent to information sharing is refused, or can/should not be sought, information should still be shared in the following circumstances:
Professionals should keep parents/carers informed and involve them in the information sharing decision even if a child is competent or over 16 as part of the triangle of care. Care and Safety plans should be shared with schools and social care if possible. However, if a competent child wants to limit the information given to their parents/carers or other does not want them to know it at all; the child's wishes should be respected, unless the conditions for sharing without consent apply.
Where a child is not competent, a parent with parental responsibility should give consent unless the circumstances for sharing without consent apply.
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.
How to respond to a suspected suicide
How to respond to a potential cluster of suicides for those under 18 years