Self Harming

1. Planning and Prevention

Deliberate self harm is more common amongst looked after children than the general population. Children's services professionals are advised to incorporate the Nice guidelines on the management of self harm into protocols for the health of looked after children

It should be noted that:

• Self harm can range from occasional self harm with no associated intent to cause serious harm which may be a one off, infrequent or repeated;
• That external appearances of the self harm are insufficient to establish intent, or risk or indeed allow understanding of motives;
• That in the absence of other coping strategies some self harm may be a form of coping rather than an intention to commit suicide or seriously harm the self.

Self-harming or self-injurious behaviour is the deliberate act of causing harm to one-self, with or without an intention to die.

It can take many forms from scratching to the swallowing of harmful substances and taking overdoses. It can include under-eating or over-eating.

Mental health needs will be assessed alongside all their needs, no matter where the need is initially identified.

If a child is suspected or found to be self-harming, the strategies that should be taken are those determined by any existing plan, for example, in the child's Placement Plan.

CAMHs services provide targeted and dedicated services to looked after children and the referral pathways should be followed.

If no plan or strategy exists, all reasonable measures should be taken to reduce or prevent continuation of the behaviour.

This may include providing additional supervision, confiscation of materials that may be used to self-harm or, as a last resort, using Physical Intervention or calling for assistance from the emergency services.

If there is any suspicion that the child may be involved in self-harming, the social worker must be informed and a risk assessment undertaken with a view to deciding whether a strategy should be adopted to reduce or prevent the behaviour.

That strategy should then be included in the child's Placement Plan.

If necessary, specialist advice or support should be sought.

2. Notifications

There are different notifications procedures, depending on the seriousness of the self-harming.

2.1 Notifications of Minor or Non Persistent Self-Harming

Minor or non persistent self-harming should be notified to the residential manager/foster carers' supervising social worker at the first opportunity; the manager/supervising social worker will inform the relevant social worker. A decision about whether to notify the parents will be taken by the social worker.

2.2 Notifications of Serious or Persistent Self-Harming

Serious or persistent self-harming is deemed to be an Incident and must be notified to the manager/ supervising social worker and the child's social worker as soon as possible but within 24 hours.

The social worker should decide whether to inform the child's parent(s) and, if so, who should do so.

Depending on the seriousness of the self-harming, other people/agencies may have to be notified.

3. Recording

There are different recording procedures, depending on the seriousness of the self-harming.

3.1 Recording of Minor or Non Persistent Self Harming

Minor or non-persistent self-harming should be recorded in the child's Daily Record, including if first aid or medical treatment is provided.

3.2 Recording of Serious or Persistent Self Harming

Incidents of persistent or serious self-harming are deemed to be Incidents, and must be recorded as such.

Please see Incidents Guidance for details of the records that must be completed in the event of an Incident.

All Incidents must be subject to a Management Review.  See Incidents Guidance for details of conducting Management Reviews.

If first aid or medical treatment is provided, it must also be recorded in the child's Daily Record.