Self-harm management

Existing self-harm management plans (follow as closely as possible). 

Chapter SI Self-harm Preparation Assessment Management What if... ... 

Chapter 71 Self-harm on the ward Preparation Assessment Management What If... ... 

Ensure she s been screened by the ED doctors for overt organic causes and undisclosed self-harm Focus on assessment and initial management, containing risks and alleviating distress (Table 21.21. 

CBT/CAT - may help specific problems (e.g. self-harm, anger management) and comorbid synptoms (e.g. depression, anxiety)... 

Community risk management, e.g. self-harm, violence, vulnerability... 

Expertise in assessing and managing self-harm risk... 

If discharging, always write the person a sinple summary of your management plan, so they know what they need to do, and what you ll do for them Include a crisis plan, should they feel worse, or become more rislq (e.g. considering self-harm), e.g. 

NICE (2004) CG16 Self-harm The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. NICE, England. 

Kelly may need this if her risks can t be managed on a paediatric ward, e.g. actively self-harming severe depression with pervasive suicidal thoughts underlying psychosis. 

There may still be safeguarding issues if staff have ignored - or not taken steps to address - the self-harm the manager didn t mention it to you, after all. 

Self-harm on psychiatric wards is fairly common, raiding from tiny scratches to life-threatenii injuries. Address both medical and psychological management. 

Past self-harm triggers, planned/in5)ulsive, methods, severity management. 

Don t make management decisions alone. A team response is essential, especially when working with people who have personality difficulties or who recurrendy self-harm consider a formal MDT meeting. Actively involve Catriona wherever possible, and explain the plan to her in the presence of her named nurse/ward manager to ensure everyone hears the same message. 

However, close observation won t help her develop self-management skills, and may increase self-harming risks through positive reinforcement/raising stress and frustration levels... 

David, A.S., Hotopf, M., Moran, P. et al. (2010) Mentally disordered or lacking capacity Lessons for management of serious deliberate self-harm. British Medical Journal, 341, c4489. 

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