Issues around confidentiality, competence and safe guarding important here.

Involvement of family members and other carers can be really useful, if the young person agrees. Should be collaborative, of course, giving them opportunities to contribute to planning. But not just about minimising self harm behaviour – empowering and supporting (during acute distress and also in recovery) vital too.

Assessment

• “How is your mood?”
• “Sometimes people who feel down can start to feel hopeless about the future. Has this happened to you?”
• “Have you ever had any thoughts about life not being worth living?” [Hurting yourself different??]
• “Have you thought about how you might do that? Have you done anything towards that plan?”
• Risk is then on a spectrum – engaging with treatment? Loss of protective factors eg family support?
• Discuss removing the method of self harm – with therapeutic collaboration or negotiation, to keep the person safe
• Discuss current support network, any safety plan (see below) or coping strategies
• Problem solve around dynamic risk factors

Refer

 Refer to mental health professionals urgently where:

• the person’s levels of concern or distress are rising, high or sustained
• the frequency or degree of self-harm or suicidal intent is increasing
• the person asks for further support from mental health services
• levels of distress in family members or carers of children, young people and adults are rising, high or sustained, despite attempts to help.

Treatment

Work collaboratively with the person, using a strengths-based approach to identify solutions to reduce their distress that leads to self-harm.

Consider developing a safety plan:

• recognise the triggers and warning signs
• individualised coping strategies, including problem solving any barriers to those strategies
• social contacts and settings that can distract from suicidal thoughts or escalating crisis
• family members or friends to provide support and/or help resolve the crisis
• contact details for the mental health service, including out-of-hours services and emergency contact details
• keep the environment safe by working collaboratively to remove or restrict lethal means of suicide.

Underlying depression, anxiety, learning disabilities, autism, eating disorders should all be addressed.

For children and young people with significant emotional dysregulation difficulties who have frequent episodes of self-harm, consider dialectical behaviour therapy adapted for adolescents (DBT-A).

[NICE guidance NG225][BMJ 2017]