Isle of Man SCB Logo


Top of page

Size: View this website with small text View this website with medium text View this website with large text View this website with high visibility

4.20 Self-harm and Suicidal Behaviour

RELATED GUIDANCE

Suicide Among Children and Young People (Mental Health Foundation 2003)

Truth Hurts: Report of the National Inquiry into Self-harm among Young People (Mental Health Foundation 2006)

AMENDMENT

Please note: in December 2012 changes have been made to the wording regarding professional judgement in disclosing information to other agencies.


Contents

  1. Introduction
  2. Definitions of Deliberate Self-harm and Suicide
  3. Information Sharing and Consent
  4. Responding to the Child or Young Person
  5. Child or Young Person Requiring Hospital Treatment for Physical Harm
  6. Multi-agency Response
  7. Family Court Proceedings


1. Introduction

1.1 Self-harm and suicide threats and gestures by a child put the child at risk of Significant Harm, and should always be taken seriously. They may also be indicative of psychological or emotional disturbance triggered by physical, sexual and / or emotional abuse or of chronic neglect which may also constitute Significant Harm.
1.2 Professionals should also consider the circumstances of a serious eating disorder or extreme risk-taking as a threat or attempt at self-harm or suicide by a child.
1.3 Children can be particularly vulnerable at times of transition, when any emotional difficulties they may be experiencing are compounded by changes which they may find stressful or frightening (e.g. leaving home or care, transferring to adult services, facing or being in custody, experiencing a family break-up).
1.4 Professionals may be able to reduce or prevent self-harming behaviours by planning for transitional support for children already receiving care services, and being alert to children becoming stressed and isolated in universal settings.
1.5 Professionals in all agencies who become aware, through disclosure or otherwise, that a child has self-harmed or threatened or attempted suicide, should use their professional judgement to make a proportionate decision whether or not to discuss this with their line manager and their agency's nominated safeguarding lead. Decision rationale should be clearly documented.


2. Definitions of Deliberate Self-harm and Suicide

2.1 Any child or young person who self-harms or expresses thoughts about this or about suicide has to be taken seriously and appropriate help and intervention offered at that point.
2.2

Definitions from the Mental Health Foundation (2003) are:

  • Deliberate self-harm is self-harm without suicidal intent, resulting in non-fatal injury;
  • Attempted suicide is self-harm with intent to take life, resulting in non-fatal injury;
  • Suicide is self-harm, resulting in death.
2.3 The difference between suicide and deliberate self-harm is not always so clear. For example, deliberate self-harm may be a precursor to suicide, also children and young people who deliberately self-harm may kill themselves by accident. Whilst most cases of self-harm do not lead to suicide, most cases of completed suicide will have had previous episodes of deliberate self-harm.
2.4

Self-harm has been defined as an act with a non-fatal outcome in which an individual deliberately did one or more of the following:

  • Initiated behaviour (for example, self-cutting, jumping from a height), which they intended to cause self-harm;
  • Ingested a substance in excess of the prescribed or generally recognised therapeutic dose;
  • Ingested a recreational or illicit drug that was an act that the person regarded as self-harm;
  • Ingested a non-ingestible substance or object (Hawton et al 2002).
2.5

In a  broader sense, self-harm describes a wide range of things that people do to themselves in a deliberate and usually hidden way, which are damaging:

  • Cutting behaviours;
  • Other forms of self-harm, such as burning, scalding, banging, hair pulling;
  • Self-poisoning.
2.6

In its widest sense self-harm is used as a broad term for many acts that cause personal harm, ranging from someone:

  • Not looking after their needs properly emotionally or physically;
  • Direct injury such as scratching, cutting, burning, hitting themselves, swallowing or putting things inside themselves;
  • Staying in an abusive relationship;
  • Taking risks too easily;
  • Eating distress (anorexia and bulimia);
  • Addiction (for example, to alcohol or drugs).
2.7 The different definitions above affect research results, as studies use different parameters. They also have implications in terms of the breadth of services set up locally for children and young people, in relation to self-harm.


3. Information Sharing and Consent

3.1 See the Isle of Man SCB website - Information Sharing and Confidentiality
3.2

Informed consent to share information should be sought if the child or young person is competent unless:

  • The situation is urgent and there is not time to seek consent;
  • Seeking consent is likely to cause serious harm to someone or prejudice the prevention or detection of serious crime.
3.3

If consent to information sharing is refused, or can/should not be sought, information should still be shared in the following circumstances:

  • There is reason to believe that not sharing information is likely to result in serious harm to the young person or someone else or is likely to prejudice the prevention or detection of serious crime; and
  • The risk is sufficiently great to outweigh the harm or the prejudice to anyone which may be caused by the sharing; and
  • There is a pressing need to share the information.
3.4 Parents should be kept informed and involved in decisions about sharing information even if the child is competent or over 16. However if the competent young person wishes to limit the information given to his parents or does not want them to know it at all, the young person’s wishes should be respected unless the conditions for sharing without consent apply. Where a child or young person is not deemed competent, a person with parental responsibility should give consent unless the circumstances for sharing without consent apply.


4. Responding to the Child or Young Person

4.1

In every case, the practitioner who is made aware that a child or young person has self-harmed, or is contemplating this or suicide, should talk with them without delay and: 

  • Ascertain if they have taken any substances, including tablets, or injured themselves (if so, the child or young person should receive urgent medical attention, even if they appear well, as harmful effects can sometimes be delayed);
  • Try to find out what may be troubling them;
  • Explore to what extent self-harm is likely or imminent or planned;
  • Ascertain what help or support the child or young person would wish.
4.2 A supportive attitude, respect and understanding of the child or young person, along with a non-judgmental stance, are of prime importance. Note also that a child or young person who has a learning disability will find it more difficult to express their thoughts.


5. Child or Young Person Requiring Hospital Treatment for Physical Harm

Where a child or young person requires hospital treatment in relation to physical self-harm, practice should be as follows, in line with the Self-harm: The short-term physical and  psychological management and secondary prevention of self-harm in primary and secondary care (NICE 2004) guidance:

  • Triage, assessment and treatment for under 16s should take place in a separate area of the Emergency Department;
  • There should be overnight admission to a Paediatric or Adolescent ward with detailed assessment the following day, with input from the CAMHS service;
  • 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, family history and child protection issues;
  • Initial management should include advising carers of the need to remove all medications or other means of self-harm available to the child or young person who has self-harmed.
5.1 Any child or young person who refuses 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.


6. Multi-agency Response

6.1 Where a young person, who is a carer for a child or is pregnant, self-harms, or threatens this, a Referral to Social Services must be made in respect of the child/unborn baby.
6.2

Wherever there is a serious concern for a child or young person, a multi-agency planning meeting is to take place, without delay. The purpose of the meeting is to:

  • Consider the concerns;
  • Devise a care plan to support the young person in the community;
  • Consider support services for the family;
  • Agree plans for an inter-agency assessment and management of risk.
6.3

Where child protection procedures are applied:

  • The focus on the needs of the child or young person must be maintained;
  • Close liaison must be maintained with health professionals and others who have a role in providing help and support for the child or young person;
  • Measures are to be put in place to minimise the risk of further self-harm which may arise from the distress of any investigation;
  • A support worker, who is not part of the investigation, should be identified for the child or young person.
6.4 Where a young person, who is a carer for a child or is pregnant, self-harms, or threatens this, a referral must be made to Social Services in respect of the child/unborn baby. See Child Protection Conferences Procedure, Pre-Birth conferences.


7. Family Court Proceedings

7.1 Where the child or young person is currently the subject of Family Court Proceedings, whether public or private law, the Court must be informed of any self-harm or attempted suicide incident.

End