Self harm

Question 1

What do you understand by the term ‘Deliberate self-harm’?

Answer 1

intentional act of self poisoning or self injury, irrespective of the motivation or apparent purpose of the act.
*expression of emotional distress

Question 2

What are some methods of self injury and self poisoning?

Answer 2

injury - cutting, turning, hangings stabbing, swallowing objects, jumping from heights or onto vehicles

poisoning - medication, illicit drugs, household substances like bleach, plant materials

Question 3

How prevalent is self harm?

Answer 3

2 in 1000 in UK

common in women, adolescents and young adults

peak incidence 15-19 years in women and 20-24 in males

20 to 30 times more common than suicide

those who self harm 50-100 times higher rate of suicide

Question 4

What are some risk factors for self harm?

Answer 4

divorced or living alone
severe life stressors
harmful drug and alcohol use
less than 35
chronic health problems
violence or childhood maltreatment
socio-economic disadvantage
psychiatric illness eg: depression, psychosis

Question 5

What are the most common methods of self harm in the UK?

Answer 5

90% drug overdose, commonly non-opioid analgesics

10% self injury

Question 6

What are the most common complications on self harm?

Answer 6

permanent scarring of skin
damage to tendons and nerves
acute liver failure

Question 7

What might be the motive behind self harm?

Answer 7

wishing to die
temporary relief
influenced by others
to punish oneself
seeking attention
trying to get help

Question 8

How might you immediately manage someone who presents with self harm?

Answer 8

risk assessment
assess need for hospitalisation with MHA section 2
involvement of crisis team as an alt.
assess mental capacity
manage immediate risks to physical health
treat underlying psychiatric disorder, optimise
refer to help services, manage psychosocial
ensure follow up 48h after discharge!

Question 9

What is suicide?

Answer 9

fatal act of self harm initiated with the intention of ending one’s own life

Question 10

What are some risk factors for suicide?

Answer 10

institutionalised
psychiatric disorders
lack of social support
male, middle aged
depression
previous attempts
alcohol use
loss of rational thinking
occupation or lack of
recent life crisis

Question 11

What might be protective factors against suicide?

Answer 11

children home
pregnancy
religious beliefs
social support
positive coping skills
fear of suicide
responsibility for others

Question 12

What is the prevalence of suicide?

Answer 12

13th leading cause of death worldwide

18.2 male and 5.2 female per 100k UK

most common hanging, strangulation, suffocation, then poisoning

Question 13

What are some clinical risk factors of suicide?

Answer 13

history of self harm or attempted suicide
psychiatric illness
childhood abuse
family history
medical illness

Question 14

How might suicidal patients present?

Answer 14

preoccupation with death
sense of isolation and withdrawal
emotional distance
distraction and lack of pleasure
focus on the past
feelings of hopelessness and helplessness

Question 15

What factors might you consider in assessing suicide risk following self harm?

Answer 15

any note left behind
planned attempts
attempts to avoid discovery
was help sought out after
violent methods?
any final acts like finances, will

Question 16

What topics should you cover in assessing risk post self harm?

Answer 16

• explore suicidal ideation
• explore suicide intent and any plans they made before act
• explore risk factors
• MSE
• explore protective factors
• explore risk to others and from others
• formulate management plan

Question 17

How might you manage someone that is suicidal?

Answer 17

ensure safety
ensure medical stability
assess risk
consider admission to hospital, use MHA
refer to secondary care
involve crisis team for support (following discharge)
outpatient an community treatment
prevention strategies by providing services, decreasing stressors, reducing substance misuse