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Self-harm HAI

About

What is covered

This pathway covers the assessment and physical and psychological management of self-harm in primary and secondary care for children (8 years and older), young people and adults.
The term self-harm is used in this pathway to refer to any act of self-poisoning or self-injury carried out by an individual irrespective of motivation. It does not include harm to the self arising from excessive consumption of alcohol or recreational drugs, or from starvation arising from anorexia nervosa, or accidental harm to oneself.
Self-harm is common, especially among younger people, and is associated with a wide range of psychiatric problems. For all age groups, annual prevalence is approximately 0.5%. Self-harm increases the likelihood that the person will eventually die by suicide by between 50- and 100-fold above the rest of the population in a 12-month period.
Self-harm is often managed in secondary care – this includes hospital medical care and mental health services. About half of the people who present to an emergency department after an incident of self-harm are assessed by a mental health professional.
People who self-harm also have contact with primary care. About half of the people who attend an emergency department after an incident of self-harm will have visited their GP in the previous month. A similar proportion will visit their GP within 2 months of attending an emergency department after an incident of self-harm.
The pathway is relevant to all people aged 8 years and older who self-harm.

Updates

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.
NICE has also written information for the public explaining its quality standard on self-harm.

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Updates to this pathway

21 February 2014 Minor maintenance update
31 July 2013 Minor maintenance update.
28 June 2013 Self-harm quality standard added
8 February 2013 Minor maintenance updates
2 March 2012 Clinical case scenarios added.

Short Text

This pathway covers the assessment, and the short- and longer-term management of self-harm.

What is covered

This pathway covers the assessment and physical and psychological management of self-harm in primary and secondary care for children (8 years and older), young people and adults.
The term self-harm is used in this pathway to refer to any act of self-poisoning or self-injury carried out by an individual irrespective of motivation. It does not include harm to the self arising from excessive consumption of alcohol or recreational drugs, or from starvation arising from anorexia nervosa, or accidental harm to oneself.
Self-harm is common, especially among younger people, and is associated with a wide range of psychiatric problems. For all age groups, annual prevalence is approximately 0.5%. Self-harm increases the likelihood that the person will eventually die by suicide by between 50- and 100-fold above the rest of the population in a 12-month period.
Self-harm is often managed in secondary care – this includes hospital medical care and mental health services. About half of the people who present to an emergency department after an incident of self-harm are assessed by a mental health professional.
People who self-harm also have contact with primary care. About half of the people who attend an emergency department after an incident of self-harm will have visited their GP in the previous month. A similar proportion will visit their GP within 2 months of attending an emergency department after an incident of self-harm.
The pathway is relevant to all people aged 8 years and older who self-harm.

Sources

The NICE guidance that was used to create the pathway.
Self-harm: longer-term management. NICE clinical guideline 133 (2011)
Self-harm. NICE clinical guideline 16 (2004)

Quality standards

Self-harm quality standard

These quality statements are taken from the self-harm quality standard. The quality standard defines clinical best practice in the care of people who self-harm and should be read in full.

Quality statements

Compassion, respect and dignity

This quality statement is taken from the self-harm quality standard. The quality standard defines clinical best practice in care for people who have self-harmed and should be read in full.

Quality statement

People who have self-harmed are cared for with compassion and the same respect and dignity as any service user.

Rationale

Everyone who uses healthcare services should be treated with compassion, respect and dignity. For people who have self-harmed, however, staff attitudes are often reported as contributing to poor experiences of care. Punitive or judgemental staff attitudes can be distressing for people who have self-harmed and may lead to further self-harm or avoidance of medical attention.

Quality measure

Structure
Evidence of local arrangements to provide staff training on treating people with compassion, respect and dignity that includes specific reference to people who self-harm.
Process
Proportion of staff in contact with people who have self-harmed who have received training on treating people with compassion, respect and dignity that includes specific reference to people who self-harm.
Numerator: the number of staff in the denominator who have received training on treating people with compassion, respect and dignity that includes specific reference to people who self-harm.
Denominator: the number of staff in contact with people who have self-harmed.
Outcome
Evidence from feedback that people who have self-harmed feel treated with compassion and the same respect and dignity as any service user.

Description of what the quality statement means for each audience

Service providers ensure that training is provided on treating people with compassion, respect and dignity that includes specific reference to people who self-harm.
All staff ensure that they treat people who have self-harmed with compassion and the same respect and dignity as any service user.
Commissioners ensure that they commission services in which all staff who come into contact with people who have self-harmed are trained in treating people with compassion, respect and dignity that includes specific reference to people who self-harm.
People who have self-harmed are cared for with compassion and the same respect and dignity as any service user.

Source guidance

NICE clinical guideline 16 recommendations 1.1.1.1 and 1.1.2.1
NICE clinical guideline 133 recommendations 1.1.1, 1.1.9 and 1.1.10

Data source

Structure
Local data collection.
Process
Local data collection.
Outcome
Local data collection. NHS surveys ask questions about dignity when using services; however, data on diagnosis are not collected.

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.
Staff
Everyone employed by or working in a service that provides care and support for people who have self-harmed. It is not restricted to qualified healthcare professionals, and could include reception staff, administrative staff and others. It applies to primary care, ambulance services, emergency departments, community services and inpatient settings.

Initial assessments

This quality statement is taken from the self-harm quality standard. The quality standard defines clinical best practice in care for people who have self-harmed and should be read in full.

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.

Description of 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

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.

Comprehensive psychosocial assessments

This quality statement is taken from the self-harm quality standard. The quality standard defines clinical best practice in care for people who have self-harmed and should be read in full.

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 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.

Description of 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 and 1.7.3.1
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 guideline 16 and NICE clinical guideline 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) 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.

Monitoring

This quality statement is taken from the self-harm quality standard. The quality standard defines clinical best practice in care for people who have self-harmed and should be read in full.

Quality statement

People who have self-harmed receive the monitoring they need while in the healthcare setting, in order to reduce the risk of further self-harm.

Rationale

Monitoring people who have self-harmed when they are in a healthcare setting can reduce distress, ensure that the person feels supported and help reduce the risk of further self-harm while in the healthcare setting.

Quality measure

Structure
Evidence of local arrangements to ensure that people who have self-harmed receive the monitoring they need while in the healthcare setting, in order to reduce the risk of further self-harm while in the healthcare setting.
Process
Proportion of people who have self-harmed who have a record of monitoring arrangements while in the healthcare setting, in order to reduce the risk of further self-harm.
Numerator: the number of people in the denominator with a record of monitoring arrangements while in the healthcare setting, in order to reduce the risk of further self-harm.
Denominator: the number of people with a new episode of self-harm.
Outcome
Number of episodes of self-harm occurring in healthcare settings.

Description of what the quality statement means for each audience

Service providers ensure that staff carry out monitoring in the healthcare setting according to the needs of people who have self-harmed, in order to reduce the risk of further self-harm.
Healthcare professionals ensure that people who have self-harmed receive the monitoring they need while in the healthcare setting, in order to reduce the risk of further self-harm.
Commissioners ensure that they commission services that monitor people who have self-harmed according to their needs while in the healthcare setting, in order to reduce the risk of further self-harm.
People who have self-harmed are checked regularly by healthcare staff, and are accompanied when required, when they are in hospital or another part of the health service, to make sure they are safe.

Source guidance

NICE clinical guideline 16 recommendation 1.4.2.3

Data source

Structure
Local data collection. NHS Litigation Authority risk management standards assess the process for managing the risks associated with the observation and engagement of patients.
Process
Local data collection.
Outcome
Local data collection. The National Reporting and Learning System contains national and local figures on patient safety incidents including self-harm.

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.
Monitoring
Includes observation and accompaniment of people who have self-harmed, either by healthcare professionals or by their families or carers with support from healthcare professionals.
Monitoring applies to people being treated in primary care, ambulance services, emergency departments and inpatient settings.

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 should be assessed and treated by appropriately trained children's nurses and doctors in a separate children's area of the emergency department.

Safe physical environments

This quality statement is taken from the self-harm quality standard. The quality standard defines clinical best practice in care for people who have self-harmed and should be read in full.

Quality statement

People who have self-harmed are cared for in a safe physical environment while in the healthcare setting, in order to reduce the risk of further self-harm.

Rationale

Caring for people who have self-harmed in a safe physical environment within the healthcare setting can reduce distress, help them to feel supported and reduce the risk of further self-harm in the healthcare setting.

Quality measure

Structure
Evidence of local arrangements to undertake environmental assessments of healthcare settings, including assessing the risks to people who have self-harmed.
Outcome
Number of episodes of self-harm occurring in healthcare settings.

Description of what the quality statement means for each audience

Service providers ensure that they undertake environmental assessments to ensure healthcare settings are safe for people who have self-harmed and to reduce the risk of further self-harm while in the healthcare setting.
Healthcare professionals ensure that people who have self-harmed are cared for in a safe physical environment while in the healthcare setting to reduce the risk of further self-harm.
Commissioners ensure that they commission services that provide safe physical environments in healthcare settings for people who have self-harmed to reduce the risk of self-harm.
People who have self-harmed are cared for in a safe physical environment that reduces the risk of harming themselves further while in hospital or another part of the healthcare service.

Source guidance

NICE clinical guideline 16 recommendation 1.4.2.3

Data source

Structure
Local data collection. NHS Litigation Authority risk management standards assess the process for managing the risks associated with the physical security of premises and assets.
Outcome
Local data collection. NHS surveys ask questions about the environment of services; however, data on diagnosis are not collected. The National Reporting and Learning System contains national and local figures on patient safety incidents, including self-harm.

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.
Safe physical environment
People who have self-harmed should be offered an environment that is safe, supportive and minimises any distress.
Examples of environmental risks to people who self-harm include, but are not limited to:
  • ligature points
  • open windows
  • access to sharps
  • access to medication.
Consideration should be given to the individual needs and safety requirements of each service user.
A safe physical environment refers to primary care settings, ambulance services, emergency departments and inpatient settings where people who have self-harmed are being cared for.

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 should be assessed and treated by appropriately trained children's nurses and doctors in a separate children's area of the emergency department.

Risk management plans

This quality statement is taken from the self-harm quality standard. The quality standard defines clinical best practice in care for people who have self-harmed and should be read in full.

Quality statement

People receiving continuing support for self-harm have a collaboratively developed risk management plan.

Rationale

A risk management plan can help people who self-harm reduce their risk of self-harming again. It should be based on a risk assessment and developed with the person who has self-harmed, who should have joint ownership of the plan. They should fully understand the content of the plan, including what can be done if they are at risk of self-harming again and who to contact in a crisis.

Quality measure

Structure
Evidence of local arrangements to ensure that people receiving continuing support for self-harm have a collaboratively developed risk management plan.
Process
Proportion of people receiving continuing support for self-harm who have a collaboratively developed risk management plan.
Numerator: the number of people in the denominator who have a collaboratively developed risk management plan.
Denominator: the number of people receiving continuing support for self-harm.

Description of what the quality statement means for each audience

Service providers ensure that collaboratively developed risk management plans are in place for people receiving continuing support for self-harm.
Healthcare professionals ensure that people receiving continuing support for self-harm have a collaboratively developed risk management plan.
Commissioners ensure that they commission services that have collaboratively developed risk management plans in place for people receiving continuing support for self-harm.
People who are having long-term support after self-harming have a risk management plan developed with their healthcare professional that helps them reduce their risk of harming themselves again.

Source guidance

NICE clinical guideline 133 recommendations 1.4.3 and 1.4.4

Data source

Structure
Local data collection.
Process
Local data collection.

Definitions

People receiving continuing support for self-harm
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, and are receiving longer-term psychological treatment and management. It includes people with both single and recurrent episodes of self-harm. It does not include people having immediate physical treatment or management for self-harm in emergency departments.
Risk management plan
NICE clinical guideline 133 recommendation 1.4.4 states that a risk management plan should:
  • address each of the long-term and more immediate risks identified in the risk assessment
  • address the specific factors (psychological, pharmacological, social and relational) identified in the assessment as associated with increased risk, with the agreed aim of reducing the risk of repetition of self-harm and/or the risk of suicide
  • include a crisis plan outlining self-management strategies and how to access services during a crisis when self-management strategies fail
  • ensure that the risk management plan is consistent with the long-term treatment strategy.

Equality and diversity considerations

NICE clinical guideline 133 recommendation 1.3.3 highlights the higher risks of suicide following self-harm in people aged over 65 years. These risks should be reflected in risk management plans.

Psychological interventions

This quality statement is taken from the self-harm quality standard. The quality standard defines clinical best practice in care for people who have self-harmed and should be read in full.

Quality statement

People receiving continuing support for self-harm have a discussion with their lead healthcare professional about the potential benefits of psychological interventions specifically structured for people who self-harm.

Rationale

There is some evidence that psychological therapies specifically structured for people who self-harm can be effective in reducing repetition of self-harm. The decision to refer for psychological therapy should be based on a discussion between the service user and healthcare professional about the likely benefits.

Quality measure

Structure
Evidence of local arrangements to provide psychological interventions specifically structured for people who self-harm.
Process
a) Proportion of people receiving continuing support for self-harm who have a record of a discussion with their lead healthcare professional about the potential benefits of psychological interventions specifically structured for people who self-harm.
Numerator: the number of people in the denominator who have a record of a discussion with their lead healthcare professional about the potential benefits of psychological interventions specifically structured for people who self-harm.
Denominator: the number of people receiving continuing support for self-harm.
b) Proportion of people who self-harm who accept referral for psychological intervention and receive at least 3 sessions of a psychological intervention specifically structured for people who self-harm.
Numerator: the number of people in the denominator receiving at least 3 sessions of a psychological intervention specifically structured for people who self-harm.
Denominator: the number of people who self-harm who accept referral for psychological intervention.

Description of what the quality statement means for each audience

Service providers ensure that systems are in place for healthcare professionals to refer people receiving continuing support for self-harm for 3 to 12 sessions of a psychological intervention specifically structured for people who self-harm.
Healthcare professionals ensure that they discuss with people receiving continuing support for self-harm the potential benefits of psychological interventions specifically structured for people who self-harm.
Commissioners ensure that they commission services that discuss potential benefits of psychological interventions specifically structured for people who self-harm with people receiving continuing support for self-harm and can refer them for 3 to 12 sessions.
People who are having long-term support after self-harming discuss the possible benefits of psychological treatments for self-harm with their healthcare professional.

Source guidance

NICE clinical guideline 133 recommendation 1.4.8

Data source

Structure
Local data collection.
Process
a) and b) Local data collection.

Definitions

People receiving continuing support for self-harm
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, and who are receiving longer-term psychological treatment and management. It includes people with both single and recurrent episodes of self-harm. It does not include people having immediate physical treatment or management for self-harm in emergency departments.
Lead healthcare professional
The professional with overall responsibility for the care and support of a person who has self-harmed. This could include, but is not limited to, professionals from primary care and community mental health services.
Psychological interventions
NICE clinical guideline 133 recommendation 1.4.8 states:
Consider offering 3 to 12 sessions of a psychological intervention that is specifically structured for people who self-harm, with the aim of reducing self-harm. In addition:
  • the intervention should be tailored to individual need, and could include cognitive-behavioural, psychodynamic or problem-solving elements
  • therapists should be trained and supervised in the therapy they are offering to people who self-harm
  • therapists should also be able to work collaboratively with the person to identify the problems causing distress or leading to self-harm.

Moving between services

This quality statement is taken from the self-harm quality standard. The quality standard defines clinical best practice in care for people who have self-harmed and should be read in full.

Quality statement

People receiving continuing support for self-harm and moving between mental health services have a collaboratively developed plan describing how support will be provided during the transition.

Rationale

Moving to different mental health services (for example, from services for young people to services for adults) can be a difficult period for people who self-harm. Unless there are plans to manage these transitions, service users can feel isolated and unsupported, and be at increased risk of further self-harm. It is important that service users are involved in agreeing how their support will be managed and understand who they can contact in a crisis.

Quality measure

Structure
Evidence of local arrangements to ensure that providers collaboratively plan in advance and coordinate effectively when people who have self-harmed move between mental health services.
Process
Proportion of people receiving continuing support for self-harm and moving between mental health services who have a collaboratively developed plan describing how support will be provided during the transition.
Numerator: the number of people in the denominator with a collaboratively developed plan describing how support will be provided during the transition.
Denominator: the number of people receiving continuing support for self-harm and moving between mental health services.

Description of what the quality statement means for each audience

Service providers ensure that systems are in place to coordinate effectively with other providers when people who have self-harmed move between mental health services.
Healthcare professionals ensure that people receiving continuing support for self-harm and moving between mental health services have a collaboratively developed plan describing how support will be provided during the transition.
Commissioners ensure that they commission services that provide people receiving continuing support for self-harm and moving between mental health services with a collaboratively developed plan describing how support will be provided during the transition.
People who are having long-term support after self-harming and are moving between mental health services agree a plan with their healthcare professionals that describes how they will be supported while they move from one service to another.

Source guidance

NICE clinical guideline 133 recommendation 1.1.25

Data source

Structure
Local data collection.
Process
Local data collection.

Definition

People moving between mental health services for continuing support for self-harm
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, who are receiving longer-term psychological treatment and are moving from child and adolescent to adult mental health services, or from one adult mental health service to another. Continuing support refers to longer-term psychological treatment and management. It includes people with both single and recurrent episodes of self-harm. It does not include people having immediate physical treatment or management for self-harm in emergency departments.

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Commissioning

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.

Pathway information

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.
NICE has also written information for the public explaining its quality standard on self-harm.

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Updates to this pathway

21 February 2014 Minor maintenance update
31 July 2013 Minor maintenance update.
28 June 2013 Self-harm quality standard added
8 February 2013 Minor maintenance updates
2 March 2012 Clinical case scenarios added.

Supporting information

Glossary

Child and adolescent mental health services
National Poisons Information Service
'Significant other' refers not just to a partner but also to friends and any person the service user considers to be important to them.

Paths in this pathway

Pathway created: November 2011 Last updated: February 2014

Copyright © 2014 National Institute for Health and Care Excellence. All Rights Reserved.

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