Quality standard
Quality statement 3: Psychosocial assessments
Quality statement 3: Psychosocial assessments
Rationale
A psychosocial assessment is aimed at identifying personal factors that might explain an act of self‑harm. It should be carried out each time a person presents with an episode of self‑harm. It should start a collaborative therapeutic relationship and be used to form an effective management plan.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that mental health professionals undertake psychosocial assessments with people who have self‑harmed.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
Process
Proportion of people who have self‑harmed who receive a psychosocial assessment.
Numerator – the number of people in the denominator who receive a psychosocial assessment.
Denominator – the number of people with a new episode of self‑harm.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
What the quality statement means for different audiences
Service providers ensure that systems are in place for mental health professionals to undertake psychosocial assessments for people who have self‑harmed.
Mental health professionals ensure that people are offered a psychosocial assessment after an episode of self‑harm.
Commissioners ensure that they commission services that provide psychosocial assessments for people after an episode of self‑harm.
People who have self‑harmed are offered a psychosocial assessment that considers their strengths, vulnerabilties and needs, and reasons for harming themselves.
Source guidance
Self-harm: assessment, management and preventing recurrence. NICE guideline NG225 (2022), recommendations 1.5.1, 1.5.9 to 1.5.12, 1.5.15 and 1.6.6
Definitions of terms used in this quality statement
People who have self‑harmed
People who have carried out intentional self‑poisoning or injury, irrespective of the apparent purpose of the act. [Adapted from NICE's guideline on self-harm, terms used in this guideline; self-harm]
Psychosocial assessment
A psychosocial assessment explores the functions of self-harm for the person and identifies the person's strengths, vulnerabilities and needs. This includes:
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historic factors
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changeable and current factors
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future factors, including specific upcoming events or circumstances
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protective or mitigating factors.
The psychosocial assessment should take into account:
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the person's values, wishes and what matters to them
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the need for psychological interventions, social care and support or occupational or vocational rehabilitation
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any learning disabilities, neurodevelopmental conditions or mental health problems
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the person's treatment preferences
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that each person who self-harms does so for their own reasons
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that each episode of self-harm should be treated in its own right, and a person's reasons for self-harm may vary from episode to episode
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whether it is appropriate to involve their family and carers.
[Adapted from NICE's guideline on self-harm, recommendations 1.5.9 and 1.5.10]
Equality and diversity considerations
Children and young people, people with a learning disability and older people who have self-harmed should have a psychosocial assessment by a mental health professional experienced in assessing people in those groups who self-harm. A psychosocial assessment in children and young people should additionally ask about their social, peer group, education and home situations, any caring responsibilities, the use of social media or the internet and the effects of these on mental health and wellbeing and any child protection or safeguarding issues.
In older people a psychosocial assessment should pay particular attention to the potential presence of depression, cognitive impairment and physical ill health and frailty; include an assessment of the person's social and home situation, including any role they have as a carer; recognise the increased potential for loneliness and isolation and that there are higher rates of suicide after an episode of self-harm for older people. [NICE's guideline on self-harm, recommendations 1.5.11 to 1.5.13]