Professionals working across the health and social care system have a role to play in supporting people who self-harm, NICE has said in a draft guideline.
The first new guideline for 11 years looking at self-harm, which is out for consultation until 11 March, sets out responsibilities for non-mental health specialists – including those working in primary care and social care – when caring for people who self-harm.
Although it emphasises the importance of primary care clinicians referring patients to specialist mental health services to ensure people ‘are in the most appropriate setting’, it also stressed that continuity is crucial for patients who are treated in primary care.
The committee agreed that ‘if people are being cared for in primary care following an episode of self-harm, there should be continuity of care and regular reviews of factors relating to their self-harm to ensure that the person who has self-harmed feels supported and engaged with services’.
The guidance also recommends a CBT-based psychological intervention that is ‘specifically structured for adults’. For children and young people who often self-harm and have emotional dysregulation difficulties, dialectical behaviour therapy adapted for adolescents (DBT-A) should be considered.
Non-specialists should arrange for self-harm patients to undergo a psychosocial assessment by a mental health professional as soon as possible after an episode, to evaluate the person’s needs and recognise factors which might explain the self-harm.
The aim of the comprehensive psychosocial assessment is to:
- develop a relationship with the person
- begin to understand why the person has self-harmed
- ensure that the person receives the care they need
- gives the person and their family members or carers information about their condition and diagnosis
It also says ambulance staff should suggest self-harming patients see their GP to maximise the chance of engagement with services.
It states: ‘When attending a person who has self-harmed but who does not need urgent physical care, ambulance staff and paramedics should discuss with the person (and any relevant services) if it is possible for the person to be assessed or treated by an appropriate alternative service, such as a specialist mental health service or their GP.’
It notes that ‘ambulance staff often felt that the emergency department was not the preferred place that the person who had self-harmed wanted to be taken. They agreed that referral to alternative services could facilitate the person’s engagement with services’.
Meanwhile, reiterating existing guidance, the draft guideline adds: ‘Do not offer drug treatment as a specific intervention to reduce self-harm.’
Self-harm is defined as intentional self-poisoning or injury irrespective of the apparent purpose of the act. It can occur at any age, but there is evidence that there has been a recent increase in self-harm among young people in England, NICE said.
Dr Paul Chrisp, director of the centre for guidelines at NICE, said: ‘Self-harm is a growing problem and should be everyone’s business to tackle – not just those working in the mental health sector.
‘These guidelines set out a way for every person who self-harms to be able to get the support and treatment they need.’
Professor Nav Kapur, topic advisor for the self-harm guideline and professor of psychiatry and population health at the University of Manchester said: ‘Self-harm can occur at any age and present to any setting. Historically, people who have harmed themselves have had a highly variable experience of services.
‘This new guideline is an opportunity to make things better, particularly from the point of view of assessment and aftercare.’
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