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Self Harm:an intentional act of self-poisoning or self-injury,…
Self Harm:an intentional act of self-poisoning or self-injury, irrespective of the motivation or apparent purpose of the act, and is an expression of emotional distress.
Methods
self-injury episodes involve cutting.
self-poisoning episodes involve prescribed or over-the-counter medication, and a minority involve illicit drugs, other household substances, or plant material.
Less common methods include burning, hanging, stabbing, drowning, swallowing objects, insertion, shooting, and jumping from heights or in front of vehicles.
Self-harm includes suicide attempts as well as acts where little or no suicidal intent is involved
Complications
Permanent scarring of skin and damage to tendons and nerves
repetitive incidents of self harm
Acute liver failure
increased risk of suicide (male, repeatedly self harm episodes, physical health issues and expressing suicide intent)
Management
after incident of self harm
sensitive and compassionate approach
assess any risk factors, coping mechanisms in place, risk to others, support measures in place
examine and assess physical injuries and mental health and refer immediately to A&E if injuries unable to be managed within primary care
refer to appropriate teams and inform all MDT members
Arrange follow up for the person who has self-harmed, within 48 hours of discharge from hospital
long term mx following an act
people who have previously self-harmed and are at risk of repetition, ensure that assessments of the person's risk of self-harm, suicide, and psychosocial needs are carried out
referral to appropriate mental health team- individual care plans and crisis management
primary care-Management of any identified psychosocial needs, any mental health or other problems, preventing access to any means of self harm, managing physical health, liaising with secondary care, offering verbal and written support
Risk of self harm
Manage and follow up in primary care people not requiring specialist referral
Local and national sources of support, groups, and voluntary organizations to friends and family
Clinical Judgement used to assess if referral appropriate
DNA followed up
assessment of the persons social, psychosocial and physical factors which may increase the persons risk of self harm. Identify protective factors that may reduce the person's risk or safeguarding concerns to others. Reduce risk of self harm. MDT team approach.
Ensure that any person who presents at risk of self-harm gives informed consent for management, wherever possible.
assess, initially, alone to maintain confidentiality with a sensitive and compassionate approach
Risk Factors
Age — self-harm rates peak in 16 to 24-year-old women and 25 to 34-year-old men. Suicide rates are highest in both men and women aged 45–49 years.
Socio-economic disadvantage.
Social isolation.
Stressful life events, for example relationship difficulties, previous experience in the armed forces, child maltreatment, or domestic violence.
Bereavement by suicide.
Mental health problems, such as depression, psychosis or schizophrenia, bipolar disorder, post-traumatic stress disorder, or a personality disorder.
Chronic physical health problems.
Alcohol and/or drug misuse.
Involvement with the criminal justice system (with people in prison being at particular risk).
Referral
refer to community mental health team if increased risk or distress,
refer to drug and alcohol team if abuse of alcohol or drugs
refer to crisis team if immediate risk,
immediate referral to A&E with physical injuries unable to be managed in primary care
specialist mental health team if previous episodes of self harming