1.4.20 Self-Harm and Suicidal Behaviour
This chapter was updated in April 2015, when Section 4, Further Information was added containing links to Guidance for Developing a Local Suicide Prevention Action Plan: Information for Public Health Staff in Local Authorities and a report from the Royal College of Psychiatrists: Managing Self harm in Young People (2014).
Self-harm, self-mutilation, suicide threats and gestures by a child must always be taken seriously and may be indicative of a serious mental or emotional disturbance.
All reports of self harm, attempted self-harm or threats of self harm, including threats of suicide must be taken seriously by all professionals. In most cases of deliberate 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.
The possibility that self-harm, including a serious eating disorder, has been caused or triggered by any form of abuse or chronic neglect should not be overlooked and this may justify a referral to Children's Social Care for an assessment as a child in need and/or in need of 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 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 Self Harm
It is good practice, whenever a child/young person is known to have either made a suicide attempt or been involved in self-harming behaviour, to undertake a multi-disciplinary assessment of the strengths, needs and risks to the child. This assessment must include listening carefully to the child, giving them opportunity to express themselves, observing them carefully and talking to parents and carers and others who know them well, including school. Such assessment needs to be carried out by a professional with appropriate skills, in a child centred way. Information sharing about concerns about a child by all professionals is very important. Self-harming or talking about suicide must be seen as a cry for help and responded to actively and sensitively, even when there are no abuse or neglect indicated. The assessment may need to involve CAMHS. Any child self-harming should be considered for a referral to CAMHS.
Child presented at school
All school personnel who come into contact with a child who is self harming should inform the school's named designated teacher. Information should also be passed to the school nurse and GP.
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.
Child referred to social care
Children's Social Care assessment should consider the views, wishes and feelings of the child and their relationship with their parents carers; any difficulties the child has at school, in the community or with wider family members; sex and relationship issues, and any other stresses on the child.
The assessment should consider whether the parents/carers are failing to protect the child from harm; the child is exhibiting behaviour beyond the control of their parent/carer and their self harming behaviour is beyond parental control; 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 bullying by other children for example.
Each social care, CAMHS or multi-disciplinary assessment must produce a plan which addresses the child's needs, seeks to alleviate the child's distress, and where appropriate seeks to support the parents/ carers in their parenting of the child.
Child presented at hospital
Where the child has presented at hospital the doctor should undertake a preliminary examination and can seek further advice from the 24 hour on-call CAMHS emergency service.
Where the child has presented at hospital, a mental health professional should undertake a preliminary examination and decide what further assessment is required.
In cases of attempted suicide a hospital admission will usually be arranged to enable a psycho-social assessment, which should consider whether or not the child is at risk of significant harm and the need to refer to CAMHS and / or Children's Social Care for assessment.
Where a child has been hospitalised as a result of self-harm, any discharge should involve co-ordinated planning with community services, including Children's Social Care and CAMHS.