Mental Health
Assessment following self-harm in adults
By Ashwin, UK Correspondent
Sep 30, 2004, 21:03

Assessment following self-harm in adults is a new report from the Council of the Royal College of Psychiatrists. It updates the College's 1994 report, The General Hospital Management of Adult Deliberate Self-Harm, modifying its recommendations in the light of developments that have occurred over the last ten years in national policies and research.

Mental illness is an important contributing factor to suicide and self-harm, and age and substance misuse also have an influence. Self-harm is a significant problem and requires the co-ordinated input of a number of agencies, including acute medical and psychiatric care. It is a common cause of admission to hospital.

Services for patients who have self-harmed have changed in the past decade. Fewer people are now admitted to hospital, and specialist mental health nurses increasingly have a primary role in assessment and management.

Good services for the treatment of self-harm potentially have an important role in suicide prevention. However, there are gaps between existing services and recommendations for best practice, despite a range of policy initiatives.

The new report identifies consensus standards for assessment following self-harm, as well as competencies that are expected of both generalist and specialist staff.

Standards are described for the organisation and planning of self-harm services, for procedures and facilities, and for training and supervision. These are specified for the accident and emergency department, the general hospital, the community setting and the psychiatric in-patient unit.

Detailed advice is given for particular patient groups: the intoxicated patient, the 'repeater', and the patient who is reluctant, or appearing, to refuse intervention. The specific risks associated with older people are also highlighted.

The report suggests managerial standards for a self-harm services planning group or co-ordinator. It is recommended that these standards, like the clinical standards, are used as a basis for audit and quality monitoring.

Suggested standard assessment tools, and an algorithm describing consent and capacity issues, are also included in the report.

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