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Deliberate Self-Harm
Document Type
Guideline
Function
Clinical Practice, Patient Care
Directorate(s)
Mental Health
Department(s) affected
Child and Family Unit (CFU)
Applicable for which patients,
Children and young people
clients or residents?
Applicable for which staff
All clinical staff
members?
Key words (not part of title)
n/a
Author - role only
Charge Nurse Manager
Owner (see
ownership structure)
Service Clinical Director – Child & Family Unit
Edited by
Clinical Policy Facilitator
Date first published
1 March 2008
Date this version published
20 July 2018 - reviewed
Review frequency
3 yearly
Unique Identifier
PP3011/RBP/028 – v04.00
Contents
1.
Purpose of guideline 2.
Guideline management principles and goals
3.
Recommended best practice
4.
Developing a documented individual treatment/management plan
5.
Self-harming behaviour
6.
Threatened self-harm
7.
Talking to others about self-harming
8.
Legislation 9.
Associated Auckland DHB documents 10.
Disclaimer 11.
Corrections and amendments
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1. Purpose of guideline
To assist staff in the Child & Family Unit (CFU) to provide consistent, safe evidence based care for
patients with a repetitive pattern who threaten to deliberately self-harm; or discuss self-harm with
other patients.
2. Guideline management, principles and goals
These guidelines should only be used after a comprehensive Psychiatric Assessment and
current Risk Assessment have been completed, and taken into account in the development
of a treatment/management plan.
At all times, any scars wounds or dressings associated with deliberate self-harm are to be
covered by clothing eg long sleeved tops.
3. Recommended best practice
The actions to be taken by CFU staff in the event of threatened self-harm or self-harming
behaviour in order to assess:
Risk of deliberate self-harm
Context of risk assessment
Then to formulate personal plan in association with colleagues and patient/family.
4. Developing a documented individual treatment/management plan
In the development of the management plan, assist the patient to identify a safety plan that is
detailed and specific:
Encourage patient to use identified distraction techniques
Encourage patient to access 1:1 time with designated nurse on duty for help with
distraction techniques if unable to engage independently
Encourage patient to inform designated nurse on duty to clinically assess wound if required
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5. Self-harming behaviour
When a patient is distressed, it becomes difficult for them to cope, so they self-harm. The table
below describes the actions to be taken:
Stage
Description
Superficial self-
If a patient self-harms and does not require any medical attention:
harm:
1. ask the patient to hand over the self-harm object
2. redirect patient as per Treatment/Management Plan
(see above),
Complete the above
without mentioning the self-harming.
Ensure that the patient’s allocated nurse is informed so that they can
allocate time to discuss this incident later in the shift.
If the patient refuses to hand over the self-harm object, follow the
procedures outlined in the individual management plan.
If procedures are not in place in the management plan, determine the level
of risk, act to ensure patient safety.
Injury Requires
If the injury requires covering, ask the patient to hand over the self-harm
Covering
object,
give the patient appropriate dressings to be completed by them self.
Provide
minimal necessary attention.
Redirect patient as per treatment/management plan.
Ensure patient’s allocated nurse is informed, so they can allocate time to
discuss this incident with the patient later in the shift.
Injury Requires
If the injury requires medical attention, ask the patient to hand over the
Medical
self-harm object.
Attention
Inform patient's nurse.
Be matter of fact about what is happening.
Nurse contacts medical registrar after discussion with team.
Do not leave patient alone until satisfied patient is safe.
Note
Update risk assessment in association with co-worker, if care is to be
altered. Document all changes/interventions in file.
Complete Significant Event Form if this is indicated.
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6. Threatened self-harm
When a patient talks about self-harm and is able to ask for help. The table below describes the
actions to be taken:
Stage
Description
Talking About
If a patient is talking about self-harm with other patients, remind patient
Self-harm
about their responsibility not to discuss this with, or distress other patients.
Staff
Acknowledge that the patient is having difficulty coping.
Responsibility
Ask them what they would like help with.
Be calm and reassuring with responses; remain objective and matter of
fact.
Work with the patient to refocus on distraction strategies, or a positive
activity as per treatment/management plan.
If the patient continues to be distressed, get assistance. Do not leave
the patient alone. Continue to work with the patient. This may include
moving the patient to a safe area.
Patient’s
The patient is responsible for their behaviour and safety.
Responsibility
The patient is not to discuss self-harm with other patients on the Unit.
The patient is responsible for telling staff when things are difficult, and
to ask for help or support. This may include asking for encouragement
to use their distraction techniques (as per Treatment/Management
Plan).
Patient is responsible for making safe choices.
Note:
Update risk assessment in association with co-worker if care is to be
altered. Document all changes/interventions in file.
Complete Significant Event Form if this is indicated
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7. Talking to others about self-harming
When a patient is talking to other patients about self-harming. The table below describes the
actions to be taken:
Stage
Description
Talking About
If the patient is talking about self-harm with other patients:
Self-harm With
Remind patient about their responsibility not to discuss this with, or
Other Patients
distress other patients.
If discussion continues, remove from company of other patients.
Remind and encourage patient that if they want help or support, there
are staff available.
Note:
Update risk assessment in association with co-worker if care is to be
altered. Document all changes/interventions in file.
Complete Significant Event Form, if this is indicated.
8. Legislation
Mental Health (Compulsory Assessment and Treatment) Act 1992
9. Associated Auckland DHB documents
Bicultural Policy
Code of Rights
Critical Incident Stress Management
Informed Consent
Incident Management Policy
Restraint Minimisation & Safe Practice
Risk Management
Observation - Increased - in Mental Health & Addictions
Restraint Minimisation and Safe Practice in Mental Health (MH&A)
NZ Standard
8141:2001 Restraint Minimisation and Safe Practice
Ministry of Health Guidelines
Guidelines for Clinical Risk Assessment and Management in Mental Health Services (1998)
Location manual
Searching Property
Risk Assessment
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10. Disclaimer
No guideline can cover all variations required for specific circumstances. It is the responsibility of
the health care practitioners using this Auckland DHB guideline to adapt it for safe use within their
own institution, recognise the need for specialist help, and call for it without delay, when an
individual patient falls outside of the boundaries of this guideline.
11. Corrections and amendments
The next scheduled review of this document is as per the document classification table (page 1).
However, if the reader notices any errors or believes that the document should be reviewed
before the scheduled date, they should contact the owner or th
e Clinical Policy Facilitator without
delay.
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