Quality statement 3: Comprehensive psychosocial assessments

Quality statement

People who have self‑harmed receive a comprehensive psychosocial assessment.

Rationale

A comprehensive 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 can start a therapeutic relationship with the healthcare professional and be used to form an effective management plan.

Quality measure

Structure: Evidence of local arrangements to ensure that healthcare professionals either undertake comprehensive psychosocial assessments with people who have self‑harmed or refer them to a specialist mental health professional for the assessment.

Process:

a) Proportion of people who have self‑harmed who either receive a comprehensive psychosocial assessment or are referred to a specialist mental health professional for the assessment.

Numerator – the number of people in the denominator receiving a comprehensive psychosocial assessment or referred to a specialist mental health professional for the assessment.

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

b) Proportion of people who have self‑harmed and are referred to a specialist mental health professional for a comprehensive psychosocial assessment who receive a comprehensive psychosocial assessment.

Numerator – the number of people in the denominator receiving a comprehensive psychosocial assessment.

Denominator – the number of people who have self‑harmed and are referred to a specialist mental health professional for a comprehensive psychosocial assessment.

What the quality statement means for each audience

Service providers ensure that systems are in place for healthcare professionals to undertake comprehensive psychosocial assessments for people who have self‑harmed or refer them to a specialist mental health professional for the assessment.

Healthcare professionals ensure that people are offered a comprehensive psychosocial assessment or are referred to a specialist mental health professional for the assessment after an episode of self‑harm.

Commissioners ensure that they commission services that provide comprehensive psychosocial assessments for people after an episode of self‑harm.

People who have self‑harmed are offered a comprehensive psychosocial assessment that considers their needs, social situation, psychological state, reasons for harming themselves, feelings of hopelessness, depression or other mental health problems and any thoughts of suicide.

Source guidance

NICE clinical guideline 16 recommendations 1.7.2.1 (key priority for implementation) and 1.7.3.1 (key priority for implementation).

NICE clinical guideline 133 recommendations 1.3.1 to 1.3.6.

Data source

Structure: Local data collection.

Process: a) and b) 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.

Specialist mental health professional

A health professional employed to provide expertise in mental healthcare.

Comprehensive psychosocial assessment

NICE clinical guidelines 16 and 133 state that a psychosocial assessment is the assessment of needs and risks to understand and engage people who self‑harm and initiate a therapeutic relationship. Recommendations 1.3.1 to 1.3.6 in NICE clinical guideline 133 give further details on undertaking comprehensive psychosocial assessments. The comprehensive psychosocial assessment should be offered to people being treated in primary care, emergency departments and inpatient settings, and may require referral to a specialist mental health professional.

Equality and diversity considerations

NICE clinical guideline 16 recommendation 1.9.1.10 states that children and young people should be assessed by professionals experienced in the assessment of children and young people who self‑harm.

NICE clinical guideline 16 recommendation 1.9.1.10 and NICE clinical guideline 133 recommendation 1.3.4 state that assessment of children and young people should follow the same principles as for adults, but should also include a full assessment of the family, their social situation and child protection issues.

NICE clinical guideline 16 recommendation 1.10.1.1 and NICE clinical guideline 133 recommendation 1.3.3 state that older people (over 65 years) should be assessed by professionals experienced in the assessment of older people who self‑harm.

NICE clinical guideline 16 recommendation 1.10.1.1 states that assessment of older people should follow the same principles as for adults, but should also pay attention to the potential presence of depression, cognitive impairment or physical ill health, and include a full assessment of their home and social situation.