July 29, 2004

Professionals should treat people who self harm with the same respect as they would any other patient, a new national guideline has urged.

Around 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)

The 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.

It also urges that psychosocial assessments of people who self harm should be carried out at the first opportunity.

Other 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 times.

The guideline makes 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.

It 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.

The recommendations include:
* 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.

Dr 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.

"Self-harm 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.

"There 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."

The 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 (pdf)

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