- The majority of self-poisoning episodes involve prescribed or over-the-counter medication, and a minority involve illicit drugs, other household substances, or plant material.
- The majority of self-injury episodes involve cutting.
Self-harm includes suicide attempts as well as acts involving little or no suicidal intent.
For all people presenting following an act of self-harm initial assessment should include:
- Physical risk
- Psychological state - risk of further self-harm or suicide and presence of any mental health conditions
- Any safeguarding concerns relating to the person, and people dependant on them for care
Management:
- If there is physical or psychological risk — urgent referral to the nearest emergency department.
- If the person has a minor self-injury and no significant risk of psychological harm — treatment in primary care.
- If the person has self-poisoned — urgent referral to the nearest emergency department for most people.
- If there is doubt or uncertainty about the seriousness of an act of self-harm — seeking advice from a consultant in emergency medicine.
Following an act of self harm a primary care review should be given within 48 hours
Review prescribed medications
If stopping self-harm is unrealistic in the short term provide information about distraction/coping techniques with wound hygiene and after care.
If appropriate provide psychological interventions CBT, etc. Tailored to the persons needs and preferences
Long term -
- Make referral to mental health team when things are trending in the wrong direction - distress is increasing, frequency increasing, person asks for further support from mental health services
- Draw up an individual care plan
- Making a crisis plan