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2.2.48 Self Harming and Suicidal Behaviour

RELEVANT LINKS

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

Links to Managing Self Harm in Young People (Royal College of Psychiatrists) and Guidance for Developing a Local Suicide Prevention Action Plan: Information for Public Health Staff in Local Authorities were added to this chapter (above) in March 2015.


Contents

  1. Definition
  2. Response
  3. Responding to Incidents of Deliberate Self Harm


1. Definition

Deliberate self harm is an acute non fatal act of self harm carried out deliberately in the form of an acute episode of behaviour by an individual with variable motivation (Gelder et al 2001).

The young person may have intentionally poisoned themselves through, for example, taking an overdose of medicines or injured themselves through self cutting and the damage caused is intentional.

Deliberate self harm acts can be extremely serious and dangerous, sometimes characterised by intention to end life, or, there may be no intent to commit suicide.

Self harm is a significant event and should form part of the Chronology of events in that child’s life, best practice would be for practitioners to record on the Summary of the child’s record.


2. Response

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 psychological or emotional disturbance. The need for a referral made to specialist services for further assessment must always be considered.

The possibility that deliberate self-harm has been caused or triggered by any form of abuse or chronic neglect should not be overlooked and may justify a referral to Local Authority Children’s Services for an assessment as a Child in Need and / or in need of protection. A staff member who is in doubt about the required response should seek advice from he r /his named Child Protection co-ordinator or designated person.

Consideration must also be given to protecting 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 e.g. running in front of cars etc (all of which may indicate underlying behavioural or emotional difficulties or abuse).


3. Responding to Incidents of Deliberate Self Harm

All Agencies

If self harm has caused physical injury or attempted suicide is suspected or known, urgent medical advice should be sought from the local hospital A&E.

In all cases, it is good practice, whenever a child / young person is known to have deliberately harmed themselves, to undertake a multi-disciplinary risk assessment which includes the family or carers where possible, along with an assessment of need.

In addition to the normal Child Protection procedures the following procedures may apply to specific situations.

Child at School

All school personnel who come into contact with a deliberately self harming child should inform the school’s designated senior person for Child Protection. 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.

Appropriate circumstances for referral include:

  • There is evidence parents / carers are failing to protect the child from harm or failing to diminish risks of further attempts at harm;
  • The child is exhibiting behaviour beyond the control of her / his parent / carer and continues 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 when the child is a witness to or the subject of domestic abuse;
  • There is significant concern that the child’s family circumstances would continue to place them at risk of Significant Harm.

Child Presenting to another Agency (e.g. Connexions, Youth Service, Voluntary Organisations)

Any practitioner or professional not identified in the previous section who identifies or suspects that a child or young person is deliberately self-harming should follow CAF procedures and protocols, undertaking an assessment and sharing information with the relevant agencies immediately. 

They should identify themselves as the Lead Professional and take responsibility for brokering access to appropriate services unless it is clear that another professional (e.g. a social worker) already has that responsibility and / or until the CAF process identifies an alternative Lead Professional. Referral to counselling provision should be offered where it is available.

When the assessment creates serious cause for concern an immediate referral should be made to CAMHS and / or Local Authority Children’s Services.

When the assessment does not indicate immediate danger the CAF should be completed and consideration given to whether to refer to CAMHS and / or Local Authority Children’s Services.

Child Referred to a Social Work Team

For cases when deliberate 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 / or whether a Section 47 Enquiry should be initiated.

It is essential to be clear and prioritise the need for an urgent specialist assessment in young people who are an acute suicide risk. In all cases consideration should also be given to the factors above.

Child Referred to CAMHS

For cases where deliberate self harm has been reported but the child is not in immediate danger, consideration must be given to the need for a multi-agency assessment and specifically for a:

  • Paediatric assessment;
  • Referral to Local Authority Children’s Services if any concerns about the welfare of the child exist.

Child Presenting to Hospital

Any child presenting to hospital with deliberate self harm must be assessed by a paediatrician who will decide on treatment, admission and referral to CAMHS and Local Authority Children’s Services in consultation with the health care team.

A comprehensive discharge plan should be made which includes follow up appointments with relevant professionals.

If there are concerns about the welfare or safety of a child prior to discharge home a referral must be made to Local Authority Children’s Services who must be involved in the discharge planning arrangements (see Hospital Pre-discharge Arrangements Procedure).

In the event that the child refuses to remain in hospital, relevant services should be notified on a case by case basis. The involvement of the parent or carer in assessing need and providing support where possible is paramount.

End