Before deciding upon the most appropriate treatment for a young person who is self-harming or engaging in suicidal behaviours, the management plan should address the young person’s immediate safety, in the context of establishing a therapeutic relationship (1). As part of the development of a safety plan, a decision needs to be made as to whether hospitalisation is required, or if the young person can utilise existing support networks, such as family and friends, in carrying out their safety plan (1). A comprehensive safety plan should cover the following steps:
- The young person’s early warning signs
- Coping strategies they could try to feel better
- People and social settings that provide a distraction
- People they can contact for help
- Professionals or agencies they can contact for help, and
- How they can make the environment safe.
A template of a safety plan is available here.
Currently, there is insufficient research regarding which interventions are most effective for responding to deliberate self-harm behaviours (2). A systematic review evaluated the evidence for interventions with young people at risk of self-harm or suicide and is the only higher-quality evidence available in this area that is youth-specific. While the evidence is extremely limited, cognitive-behavioural interventions (CBT) appeared to show some promise (3). Given that not much is known about the effectiveness of interventions to reduce self-harm (4), it is recommended that any underlying mental health problems, such as depression, are appropriately treated so that the young person may feel more able to cope and therefore less likely to engage in self-harming behaviours (5).
UK Guidelines for Self-Harm (6) suggest the following aims and objectives in the treatment of self-harm:
- Rapid assessment of physical and psychological need
- Effective measures to minimise pain and discomfort
- Timely initiation of treatment, irrespective of the cause of self-harm\
- Harm reduction (from injury and treatment; short-term and longer-term)
- Rapid and supportive psychosocial assessment (including risk assessment and comordibity)
- Prompt referral for further psychological, social and psychiatric assessment and treatment when necessary
- Prompt and effective psychological and psychiatric treatment when necessary
- An integrated and planned approach to the problems of people who self-harm, involving primary and secondary care, mental and physical healthcare personnel and services, and appropriate voluntary organisations
- Ensuring that the special issues that apply to children and young people who have self-harmed are properly addressed, such as child protection issues, confidentiality, consent and competence.
The evidence map provides reference details for studies of prevention and treatment interventions for self harm and suicide behaviours and risk in young people.