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'Referral advice' recommendation details

Self-harm

Guidance ID NICE 'referral advice' recommendation 'Referral advice' category
CG16 Following psychosocial assessment for people who have self-harmed, the decision about referral for further treatment and help should be based upon a comprehensive psychiatric, psychological and social assessment, including an assessment of risk, and should not be determined solely on the basis of having self-harmed. Time frame not specified
CG16 With regard to the management of self-harm in primary care, all people who have self-harmed should be assessed for risk, which should include identification of the main clinical and demographic features and psychological characteristics known to be associated with risk, in particular depression, hopelessness and continuing suicidal intent. The outcome of the assessment should be communicated to other staff and organisations who become involved in the care of the service user. In the assessment and management of self-injury in primary care, healthcare professionals should refer service users for urgent treatment in an emergency department, if assessment suggests there is a significant risk to the individual who has self-injured. In most circumstances, people who have self-poisoned and present to primary care should be urgently referred to the nearest emergency department, because the nature and quantity of the ingested substances may not be clearly known to the person who has self-poisoned, making accurate risk assessment difficult. If there is any doubt about the seriousness of an episode of self-harm, the general practitioner should discuss the case with the nearest emergency department consultant, as management in secondary care may be necessary. Consideration should be given to the service user's welfare during transportation to any referral organisation and, if necessary, this should be supervised by an appropriate person where there is a risk of further self-harm or reluctance to attend other care centres, or the service user is very distressed. In remote areas at considerable distance from an emergency department or where access is likely to be delayed, consideration should be given to initiating assessment and treatment of self-harm in the primary care setting, following discussion with the nearest emergency department consultant. This should include taking samples to test for paracetamol and other drugs, as indicated in TOXBASE. Immediate
CG16 If urgent referral to an emergency department is not considered necessary for people who have self-injured in primary care, a risk and needs assessment should be undertaken to assess the case for urgent referral to secondary mental health services. Assessment of the service user's needs should be comprehensive and should include evaluation of the social, psychological and motivational factors specific to the act of self-harm, current intent and hopelessness, as well as a full mental health and social needs assessment. Following assessment and treatment of self-harm in primary care, the outcome of the risk and needs assessment, and full details of the treatment provided, should be forwarded to the appropriate secondary mental health team at the earliest opportunity. Healthcare professionals who may have to assess and/or treat people who have self-harmed should ensure that they are properly trained and competent to undertake assessment and treatment as necessary. Urgent
CG16 When ambulance staff attend a person who has self-harmed, they should urgently establish the likely physical risk, and the person's emotional and mental state. In cases where the service user does not require emergency treatment in the emergency department, ambulance staff should consider, (having taken full account of the service user's preferences), taking the service user to an alternative appropriate service, such as a specialist mental health service. The decision to do so should be taken jointly between the ambulance staff, the service user and the receiving service. The ambulance services should ensure that there is rapid access to TOXBASE and the NPIS so that their crew can gain additional information on substances and/or drugs ingested in cases of self-poisoning in order to assist in decisions regarding urgent treatment and the transfer of patients to the most appropriate facilities. When transporting people who have self-harmed to an emergency department, wherever possible, ambulance staff should take into account the service user's preferences when more than one emergency department facility exists within a reasonable distance, unless doing so significantly increases the risk to the service user, or when one department has specialised in the treatment of people who have self-harmed. Urgent
CG16 All people older than 65 years of age who have self-harmed should be assessed by mental healthcare practitioners experienced in the assessment of older people who self-harm. Given the high risks amongst older adults who have self-harmed, consideration should be given to admission for mental health risk and needs assessment, and time given to monitor changes in mental state and levels of risk. Time frame not specified
CG16 If a person is assessed as being mentally incapable, staff have a responsibility, under common law, to act in that person's best interests. If necessary, this can include taking the person to hospital, and detaining them to allow assessment and treatment against the person's stated wishes. Time frame not specified
CG16 In the event of self injury, if there is significant risk to the service user, refer to an emergency department urgently. If in doubt about whether to refer, discuss with an emergency consultant. If the service user lives in a remote area and cannot get to an emergency department quickly, discuss with an emergency consultant. Consider initiating treatment. Arrange for an appropriate chaperone when the service user is going in the ambulance to an emergency department if there is risk of further self-harm, the person is reluctant to attend, and/or the service user is very distressed. Urgent
CG16 In the event of self poisoning, refer to an emergency department urgently unless you are sure this isn't necessary. If in doubt about whether to refer, discuss with an emergency consultant. If the service user lives in a remote area and can't get to an emergency department quickly, discuss with an emergency consultant. Consider initiating treatment and collect samples to test for paracetamol and other drugs, as indicated in TOXBASE. Urgent
CG16 In the event of self harm. If a person wishes to leave before a psychosocial assessment, assess for mental capacity/mental illness and record assessment in the notes. If mental capacity is diminished and/or the person has a significant mental illness, refer for urgent mental health assessment and prevent the person leaving. Urgent
CG16 In patients who have self harmed, discuss treatment options and the service user's preference. Provide the service user with relevant written information about treatments and services. Do not refer only on the basis that the patient has self-harmed. Time frame not specified

This page was last updated: 22 August 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.