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Summary of practical guidance

Below is a summary of practical advice on how to manage and help people who attend the emergency department after self-harm.

Brief contact in the emergency department

This clip is reproduced with permission from Harmless and is taken from the DVD Harmless: Out of Harm's Way. For more information on Harmless please visit their website.

In the below video, a clinician discusses how positive contact with staff in the emergency department can contribute to improved outcomes and experiences for patients who self-harm. You can also view a transcript (PDF).

Key guidance

The following guidance is drawn from the NICE Clinical guidelines on the; long-term management of self-harm, short-term management and prevention of recurrence and the Quality Standard for Self-Harm.

Assess physical risk and emotional and mental state quickly

The emergency department is often the first point of contact for people who self-harm, and these people are often in crisis. Staff responsible for triage should urgently evaluate physical risk, as well as the patient's mental state.

Emotional distress may not always be obvious, but should be given weight alongside the severity of the self-injury/self-poisoning when making decisions about priority for treatment.

A preliminary psychosocial assessment to determine a patient's mental capacity, the presence of mental illness, level of distress and willingness to receive further psychosocial assessments is recommended. 

Arrange for the patient to have a full psychosocial assessment

A full psychosocial assessment is usually carried out by psychiatric liaison staff or staff from similar local services. This assessment should be carried out as soon as possible, and not delayed until after medical treatments have been received - unless the injury/overdose is life-threatening. 

The needs of people who attend hospital following self-harm will vary widely, but might be related to physical or mental health concerns, or be more social in nature, such as difficulties with relationships, or employment. Therefore the assessment of needs should be broad and comprehensive, including motivational factors specific to the act of self-harm, current suicidal intent, and hopelessness, as well as a full review of mental health and social needs. 

As well as helping to ensure the patient receives appropriate support to tackle the underlying causes of the self-harm behaviour, a good quality, in-depth, and sympathetic assessment is generally beneficial to help engage the patient, and to help them to feel understood and supported.

Assessments should be added to the patient's notes and copies passed to the patient's GP and any other relevant mental health services as soon as possible.

Pay attention to therapeutic engagement

All contact with hospital staff can have a positive impact on a patient who has attended hospital following self-harm. It is important to keep in mind that people who self-harm are often in crisis, and talking openly about self-harm may be new and difficult for them. 

Engaging the patient is essential when carrying out assessments of needs and risks, and helps to initiate therapeutic relationships and increase understanding of the patient and their self-harm behaviour.

Be aware of the impact of negative attitudes

Research has shown that people who self-harm have historically been subject to negative attitudes by hospital staff.

The stigma around self-harm can prevent people from seeking help, and encountering negative attitudes in the emergency department can have a big impact on people who are already in crisis, discouraging them from seeking help in the future and accessing the care they need to resolve the underlying causes of the self-harm behaviour.

The NICE quality standard for self-harm states that service providers should ensure that "training is provided on treating people with compassion, respect and dignity that includes specific reference to people who self-harm", and that "staff ensure that they treat people who have self-harmed with compassion and the same respect and dignity as any service user".

Attend relevant training where possible (and ask for training if not!)

Emergency department staff who have contact with people who self-harm should have appropriate training, in order to better understand and care for self-harm patients.

Caring for patients who self-harm can be challenging, and many people are likely to find training helpful as an opportunity to learn about and understand about this patient group.

For more information on the Manchester Self-Harm Project please visit our website or follow us on Twitter.

*The MaSH Project does not provide treatment, care services or advice. If you are in a crisis please seek help from your general practitioner, your local hospital emergency department, or through a telephone helpline service.