NICE guidelines

See also NICE guidelines on Self Injury

What is it?

Note this section addresses self injury - there is also a section on how to manage Suicide Warnings

Self injury can take many forms:

• Cutting, burning
• Ligaturing (tying things around the neck) - highly risky
• Taking "small" overdoses (dangerous as difficult to know what is a "small" overdose...)
• Deliberately getting into fights (liking being assaulted/hit, etc)
• Using drugs or alcohol excessively
• Some forms of eating disorders (bulimia - forced vomiting, or anorexia - self-starvation) can have much in common with self injury.

What to ask about

Features of the episode

• Events leading to self-harm
• Circumstances—eg, whether alone at the time, whether informed anyone, or whether made arrangements to avoid discovery
• Intentions, especially suicidal intent
• Lethality (but also consider patient’s beliefs about lethality)

Mental health issues

• Previous self injurious behaviour
• Psychiatric illness
• Personality disorder
• SubstanceUseDisorder
• Psychosocial problems

Background

• Physical health
• Past psychiatric history
• Family and personal history

Social circumstances

• Living circumstances
• Social support network
• Coping strategies

The future

Research indicates that a very significant number of completed suicides are preceded by Self Injurious Behaviours. It is essential that the RiskAssessment is kept updated and an appropriate Care Plan is in place. Things to ask about in assessing risk after Self injurious Behaviours:

• Attitude to being alive after self-harm
• Attitude to care and to use of helping agencies
• Hopelessness
• Future-oriented thinking
• Risk of suicide or of repeated self-harm - RISK FACTORS FOR SUICIDE AFTER SELF INJURY:
  
  • Older age
  • Male sex
  • Past psychiatric care
  • Psychiatric disorder
  • Social isolation
  • Repeated self-harm
  • Avoiding discovery at time of self-harm
  • Medically severe self-harm
  • Strong suicidal intent
  • Substance misuse (especially in young people)
  • Hopelessness
  • Poor physical health

Information from others

• Family, friends, family practitioner, or counsellor

What to do

• Avoid raising the level of affect by remaining calm, non-judgmental, and overtly concerned.
• Attend to any Physical Health matters - such as wound care - that require attention.
• It is good practice to try to get the young person at least to help clean wounds, and place dressing - rather than have them in an entirely passive role.
• Ensure your RiskAssessment is up to date, and that this is reflected in the Care Plan
• Cognitive Behavioural approaches may help the young person's underlying mood
• MentalizationBasedWork allows a focus on Affect Regulation
• There may be FamilyWork required to help with the Crisis Contingency Planning, and to establish a robust Care Plan that will keep the RiskAssessment within safe limits.