people who self harm with respect, urges new guideline
should treat people who self harm with the same respect as they
would any other patient, a new national guideline has urged.
170,000 people per year attend accident and emergency (A&E)
departments after self harming, reveals the guideline published
by The National Institute for Clinical Excellence and the National
Collaborating Centre for Mental Health (NCCMH)
guideline, for professionals in England and Wales, recommends that
those staff who treat people within 48 hours of them self harming
should receive appropriate training.
also urges that psychosocial assessments of people who self harm
should be carried out at the first opportunity.
recommendations include that A&E staff involved in the care
of people who have self-poisoned should ensure that activated charcoal,
which absorbs drugs and poison, is immediately available at all
a battery of recommendations for the physical, psychological and
social assessment and treatment by primary and secondary care of
people in the first 48 hours after having self-harmed.
covers acts of self-harm that are an expression of distress and
where the person directly intends to injure him/herself, for example
through cutting or overdosing.
* That people who have self-harmed should be treated with the same
care, respect and privacy as any patient and that healthcare professionals
should take into account the distress associated with self-harm.
Appropriate training should be provided for staff coming into contact
with people who self-harm.
A&E staff who may be involved in the care of people who have
self-poisoned should ensure that activated charcoal is immediately
available at all times.
All people who have self-harmed should be offered a preliminary
psychosocial assessment at triage (or at the initial assessment
in primary or community settings) following an episode of self-harm.
Assessment should determine a person's mental capacity, their willingness
to remain for further (psychosocial) assessment, their level of
distress and possible presence of mental illness.
People who have self-harmed should be offered treatment for the
physical consequences of self-harm, regardless of their willingness
to accept psychosocial assessment or psychiatric treatment.
All people who have self-harmed should be assessed for future risk
of self-harm and/or suicide and the key psychological characteristics
associated with risk, in particular depression, hopelessness and
continuing suicidal intent should be identified.
Tim Kendall, consultant psychiatrist and co-director of the NCCMH,
said: "170,000 people a year attend emergency departments because
they have self-harmed, of those an estimated 80,000 never receive
a psychological assessment or follow up even though the risk of
committing suicide after self-harming one or more times is 100 times
greater than the average risk in the population.
and suicide have now become the third leading cause for life years
lost after cancer and heart disease in all age groups. Few people
providing care in casualty understand why people self-harm and don't
know how to help them effectively.
is no one cause for people self-harming, but very often abusive
experiences in their past are significant factors. One key recommendation
in this guideline is that any staff coming in to contact with people
who self-harm in any setting should be provided with appropriate
training to help them better understand the problem of self-harm,
how best to engage people who have self-harmed and to provide the
right assessment treatment and follow up."
National Institute for Clinical Excellence guideline on the short-term
physical and psychological management and
secondary prevention of self-harm in primary and secondary care
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