Quality statement 2: Initial assessments

Quality statement

People who have self‑harmed have an initial assessment of physical health, mental state, safeguarding concerns, social circumstances and risks of repetition or suicide.

Rationale

An initial assessment can identify whether a person who has self‑harmed is at immediate physical risk so that steps can be taken to reduce this risk, including referral for more urgent care if indicated.

Quality measure

Structure: Evidence of local arrangements to ensure that initial assessments of people who have self‑harmed include physical health, mental state, safeguarding concerns, social circumstances and risks of repetition or suicide.

Process: Proportion of people who have self‑harmed who have an initial assessment of physical health, mental state, safeguarding concerns, social circumstances and risks of repetition or suicide.

Numerator – the number of people in the denominator with an initial assessment of physical health, mental state, safeguarding concerns, social circumstances and risks of repetition or suicide.

Denominator – the number of people with a new episode of self‑harm.

What the quality statement means for each audience

Service providers ensure that people who have self‑harmed have an initial assessment after an episode of self‑harm that includes physical health, mental state, safeguarding concerns, social circumstances and risk of further self‑harm or suicide.

Healthcare professionals ensure that people who have self‑harmed have an initial assessment after an episode of self‑harm that includes physical health, mental state, safeguarding concerns, social circumstances and risk of further self‑harm or suicide.

Commissioners ensure that they commission services that undertake an initial assessment of physical health, mental state, safeguarding concerns, social circumstances and risk of further self‑harm or suicide for people after an episode of self‑harm.

People who have self‑harmed have their physical health, mental state, social circumstances and risks of repetition or suicide assessed after an episode of self‑harm.

Source guidance

NICE clinical guideline 16 recommendations 1.2.1.1, 1.2.1.2, 1.3.1.1 and 1.4.1.1.

Data source

Structure: Local data collection.

Process: Local data collection.

Definitions

People who have self‑harmed

Children or young people (aged 8 years and older) and adults who have carried out an act of self‑poisoning or self‑injury, irrespective of motivation.

Initial assessment

The first assessment by a healthcare professional after an episode of self‑harm. It applies to people first seen in primary care, ambulance services or emergency departments. It also applies to the first assessment of episodes of self‑harm in inpatient settings. An initial assessment should be undertaken each time a person presents with an episode of self‑harm.

Physical health

Factors that should be recorded in an initial assessment of physical health include, but are not limited to:

  • level of consciousness

  • physical injuries

  • level of pain

  • details of the nature and quantity of any overdose.

Mental state

Factors that should be recorded in an initial assessment of mental state include, but are not limited to:

  • mental capacity

  • level of distress

  • presence of mental health problems

  • willingness to remain for further psychosocial assessment.

Safeguarding

The protection of vulnerable people from harm. It can apply to people of all ages, including adults, older people, children and young people. It includes consideration of risks to the person who has self‑harmed, any children or adults in the person's care and to other family members or significant others.

Social circumstances

Factors that should be recorded in an initial assessment of social circumstances include, but are not limited to:

  • family members, significant others or carers who can provide support

  • dependants

  • housing

  • personal or financial problems.

Equality and diversity considerations

NICE clinical guideline 16 recommendation 1.9.1.1 states that children and young people under 16 years who have self‑harmed and present at the emergency department should be triaged, assessed and treated by appropriately trained children's nurses and doctors in a separate children's area of the emergency department.