self-harm

Question 1

what does it involve?

Answer 1

Self-harm involves intentional self-injury, most commonly by cutting or self-poisoning with medications. Other methods include burning, swallowing objects or household substances, drowning, stabbing or jumping from heights or in front of vehicles.

Self-harm encompasses both acts which have suicidal intent as well as those where there are different intentions. These may include seeking relief from unpleasant or overwhelming feelings or communicating distress to others.

Question 2

what are the RF?

Answer 2

Stressful life events
Socio-economic disadvantage
Young age for self-harm (peak in women is 16-24 year olds, peak in men in 25-34s)
Middle age for suicide
Social isolation
Chronic physical health conditions
Mental health conditions
Alcohol and/or drug misuse
Criminal justice system involvement

Question 3

what is the mx?

Answer 3

Immediate medical and/or surgical management may be required for injuries or overdoses
Ensure adequate analgesia is offered including local anaesthetic when suturing wounds
A mental health professional should carry out a psychosocial assessment
Some patients at high risk of suicide or serious self-harm may require admission to a psychiatric hospital
Ask about safeguarding concerns (e.g. domestic violence) when the patient is alone and follow local protocols if concerns raised
Provide information and support including:
- How the patient will be followed up
- Self-care advice
- Details of local and national support services and how to access these
- Advice on harm minimisation if appropriate e.g. wound aftercare, distraction techniques
Make a safety plan including what to do in an emergency
Involve family members or carers if the patient agrees
Consider referral for follow up interventions to address self-harm and comorbid mental health conditions e.g. cognitive behavioural therapy, dialectical behavioural therapy
Consider other harm minimisation techniques e.g. reducing quantities of toxic medications prescribed to patients at risk of overdose

Question 4

what are complications?

Answer 4

Repeated self-harm is common especially if contributing factors are not addressed
Scarring and injuries from cutting e.g. to tendons or nerves
Complications of drug overdoses e.g. liver failure secondary to paracetamol overdose
Increased suicide risk especially in the following cases:
- Stated suicidal intent
- Repeated self-harm
- Physical comorbidities
- Male patients