This report is a revision and expansion of a previous Council
Report: The General Hospital Management of Adult Deliberate
Self-Harm (CR32).
Self-harm is a significant problem and requires the
co-ordinated input of a number of agencies, including acute medical
and psychiatric care. It is a complex psychosocial phenomenon as
well as being a common cause of admission to hospital. Services for
patients who have harmed themselves have changed in the last
decade. Fewer are admitted to hospital and nurses have increasingly
played a primary role in assessment and management. It is logical
that good services for people who harm themselves may play a role
in suicide prevention. There are gaps between existing services and
recommendations despite a plethora of policy initiatives.
This report identifies consensus standards for assessment
following self-harm. Competencies expected of both generalist and
specialist staff are identified. Standards are then described for:
the organisation and planning of deliberate self-harm
services;
procedures and facilities; training; and for supervision.
These are specifically described for: the A&E; the general
hospital; the community setting; and the psychiatric in-patient
unit. More detailed advice is given regarding particular patient
groups: the intoxicated patient, the repeater and the patient who
is reluctant or appearing to refuse intervention. The specific
risks associated with the older adults are highlighted.
Managerial standards are suggested for a self-harm planning
group or coordinator. It is recommended that these standards, like
the clinical standards, can be used as the subject of audit and
quality monitoring. Useful appendices include a suggested standard
assessment tool and an algorithm describing consent and capacity
issues.
This publication should be of interest and use to all those
involved in the commissioning and provision of services to people
who have harmed themselves.