Management
The aims of management are:
1.
to make an adequate assessment;
2.
to treat the depressive disorder, and reduce
associated psychosocial impairment;
3.
to manage associated psychiatric disorder and
risk factors;
4.
to prevent further episodes of DSH.
Type of assessment:
This will depend on the con-
text in which the young person is seen [28]. Thus, in
primary care settings the main goal is to ascertain
risk and consider whether self-harm has actually
taken place, as this will often require referral to
the appropriate local hospital accident and emer-
gency service. In the hospital setting paediatric
management is required for physical effects of self-
harm, coordinated with child and adolescent men-
tal health assessment, and social work input. When
the young person is referred to the out-of-hours
hospital accident and emergency service, existing
guidance is that admission is required overnight
with the assessment taking place the following
day [28]. The mental health assessment requires
the identification of a psychiatric disorder and
the range of risk factors. The assessment should
include interviewing the young person alone as
well as with his or her parent(s). The purpose of
this assessment is: (i) to assess the current risk
with regard to suicidality and further deliberate
self-harm; (ii) to understand the young person’s
and the family’s difficulties and how these have
led to self-harm; (iii) to determine whether the
young person is suffering with a psychiatric dis-
order, for example depression (and the level of
hopelessness), or drug or alcohol misuse; and (iv)
to assess the resources of the young person and
the family. It is important to establish whether the
index episode of deliberate self-harm was asso-
ciated with a high degree of suicidal intent (see
Box 30.1); whilst a minority of patients may try
to conceal their true intent, assessment of intent
is best facilitated by obtaining a detailed under-
standing of the circumstances of the attempt and
comparing this information with factors known to
be associated with high intent. The outcome of
this assessment will inform discharge and further
management planning.
Treatment:
This requires that the young person
should be kept safe, which means restricting access
to potentially harmful substances, such as drugs,
used for self-harm, as well as alcohol. Appropri-
ate care and emotional support are needed [29].
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