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Assessing Self-Harm Risk

When working with children/young people, it is essential to develop an understanding of the level of risk that they present to themselves and to remember that this can change over time. It is okay to talk with young people about these issues; it will not make things worse.

Factors that increase the risk

  • The use of alcohol or drugs when self-harming (this can increase recklessness and impulsiveness).
  • Feelings of hopelessness about life (whether it be not caring about themselves or actively wanting to die).
  • Methods of self-harm where there is a higher risk of accidental or unanticipated severe harm (e.g. frequent small overdoses may cause long-term harm).
  • An increase in the frequency of self-harm or a feeling of having to do more to feel what they perceive to be the benefits.

Unless the child or young person is in obvious emotional crisis, kind and calm attention to ensuring that any immediate physical wounds are treated (by an appropriate member or staff) should precede additional conversation with them about the nonphysical aspects of self-harm.

The Self-Harm Pathway applies to all children under 18 years who present with self-harm behaviour in the community including those who are actively suicidal (i.e. continues to state that they will commit suicide and needs to be prevented from doing so).

Questions of value in assessing severity of the injury

  • Where on your body do you typically self-harm?
  • What do you typically use to self-harm?
  • What do you do to care for your wounds?
  • Have your wounds ever become infected?
  • Have you ever seen a doctor because you were worried about a wound?

Where in doubt or if concerned, seek medical attention as appropriate.

In general, children and young people are likely to fall into a spectrum of risk:

  • Lower risk: Little history of self-harm, a generally manageable amount of stress and at least some positive coping skills and external support.
  • Higher risk: More complicated profiles, report frequent or long-standing self-harm practices, use of high lethality methods, younger age, parental mental health problems and/or students who are experiencing chronic internal or external stress with few positive supports of coping skills.

These risk factors and questions serve only as a guide to support staff and are by no means exhaustive. Assessing risk should be in collaboration with the young person and your organisation’s safeguarding lead.

Next Steps

  • Where a child or parent is unwilling to engage with support services, a referral to Children’s Services should be considered, as refusal to engage may constitute a safeguarding issue.
  • After assessing immediate risk, gaining further information from the child or young person may take place over a number of conversations and should occur at a pace comfortable for them.
  • Remember, if you a concerned that the child or young person has experienced or is at risk of experiencing significant harm then it is necessary to follow your organisation’s child protection procedures.
  • Establish if any other adult is aware of the self-harm.