Transcript Document

Non fatal deliberate self harm ( DSH)
• ‘A deliberate non-fatal act, whether physical,
drug over dosage or poisoning, done in the
knowledge that it was potentially harmful, and in
the case of drug over dosage, that the amount
taken was excessive’( Morgan 1979)
Synonyms
• Parasuicide: ‘any act deliberately undertaken by
a patient which mimics the act of suicide but
which does not result in a fatal outcome’ (
Kreitman 1988)
• Attempted suicide : ‘an act of self damage
inflicted with the intention of self destruction’
• The management of DSH in young people is a
joint endeavour between A and E, Paediatrics
and CAMHS
• Joint Royal College ( Paediatrics and Psychiatry)
recommendations
• Admit all cases overnight irrespective of
apparent seriousness of attempt
• Next working day assessment
• Local joint working protocols
• Protocols to be NICE compliant
• NICE
2004
• Guidelines re Deliberate Self Harm
• Focussed on respect, understanding, privacy
• Choice in their care
• Triage screening for and identifying physical and
mental health needs
• Offering comprehensive psychosocial
assessment to all
Special issues for those under 16
• Triage, assess and treat in
separate area
• Nurses trained in assessment
and early management of
young people who have self
harmed
• All should be admitted
overnight to Paediatric ward
and assessed the next day
• Admit to a ward for
adolescents if over 14
• Paediatrician should have
overall responsibility for
those admitted
• Obtain parental consent for
mental health assessment
• Staff to be trained in the
particular issues related to
consent and capacity in this
age group
• Special attention to
confidentiality, consent,
capacity, parental consent,
mental health act and
children act
• CAMHS should undertake
assessment and provide
consultation to family and
other agencies/staff groups
as appropriate
Special issues for those under 16
• CAMH professionals should
– Be trained specifically to work with children
and YP after self harm
– Be skilled in the assessment of risk
– Have regular supervision
– Have access to consultation with senior
colleagues
Special issues for those under 16
• Initial Management should include advising
carers about removal of all means of self harm
including medication.
• If repeated self harm consider developmental
group psychotherapy for at least 6 sessions
• Risk factors for repeat attempt and for suicide
completion
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Male gender
Increasing age
Living alone
Steps to avoid detection
Past attempts
Mood disorder
Substance Misuse (particularly males over 16)
Depression, hopelessness
• Particular focus on adolescence
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Untreated depression
Limited repertoire of strategies of coping
Impulsive traits
Substance Misuse
Access to irreversible methods
• Together these factors are a potent and risky
combination
Adolescence associated psychosocial problems
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Conduct Disorder
Depressive Disorder
Psychosis
Multi-impulsive Bulimia
Incipient family breakdown
Undisclosed abuse of all types
Reaction to parental mental illness
• In young people think about it as an event with
meaning
• Particularly social or relational meaning
• Usually people who use DSH remain in contact
with others, and there is an element of warning,
or appeal for help from another
• Whether taken in context around others or not,
there is always symbolic meaning to be made:
‘cutting the bad out of me’
• Assessment
• Screening history and mental state for known
factors associated with risk of repetition and
completion
• At the same time asking the salient
question…what is the significance of this person
presenting to me, in this way, at this point in their
life
• Intent
• In the context of the assessment you have just
made, what is your assessment of intention
• Assessment of intention in young people
particularly important.
• It informs risk assessment
• Intention around the original act and ongoing
intention
• What do they say about intention and what do