Self-harm risk assessment

what NICE says

  • A mental health professional should see and speak to the person at every attendance after an episode of self-harm.

SAD PERSONS scale

all risk assessment tools have their limitations.

Sex: male
Age: <19 or >45
Depression: or hopelessness
Previous: self harm
Excess: drugs & alcohol
Rational thinking: lost
Separated: divorced or widowed
Organised: Attempt planned and life threatening
No social support: No family, job or religion
Stated future intent: Wants to try again

History taking

  • Context
  • Intent - what were you hoping would happen?
  • Impulsive/planned? Preparations for death? Did you tell anyone about it?
  • Red flags [HARE]
    • Previous self-harm/suicide attempts
    • Alcohol
    • Intent to die (be precise "just want to sleep"; "just to end the pain")
    • Planning
    • Steps to not be found
    • Leaving instructions for people after death
    • ↑ Violence
    • Currently having suicidal thoughts/plans
  • NOT protected by protective factors!
  • Think about immediate risk vs short-term
  • After self harm, ask:
    • Seriousness of attempt; not always objective seriousness ⇒ "did you think that would kill you?"
    • Feelings about survival - regret
    • Whether found by chance
    • Planning further attempt
    • What thoughts do you have that might stop you from taking an overdose?
  • Sources of social support

#mental-health

https://www.nice.org.uk/guidance/ng225/chapter/Recommendations#assessment-and-care-by-healthcare-professionals-and-social-care-practitioners
OSCE Aid, Geeky Medics, BMJ DFTB

The absconding patient