Self-harm - Treatment
This section gives information on:
What professional help should I get?
If you would like professional help to manage and recover from self-harm you should make an appointment to speak to your GP. Be honest about why you self-harm. People self-harm for different reasons. This will help professionals to find the right support for you.
Don’t give up if the first thing you try doesn’t work. Other treatments might be better for you. You may find it difficult to ask for more help.
The National Institute for Care and Excellence (NICE) produces best practice recommendations for health care providers to follow. The NHS don’t have to follow them, but there should be good reason why they choose not to. NICE recommend the following care and treatment for:
- Long term management of self-harm, and
- Hospital management of self-harm
Long-term management of self-harm
Who should help?
Mental health services will usually be responsible for your treatment and care. They may put you under the ‘Care Programme Approach’ (CPA).
Some people will get support from their GP instead. But a GP should think about referring you to a specialist mental health team if:
- your levels of distress are getting worse or are high all of the time,
- things that the GP has tried doesn’t work for you,
- your self-harm risk is getting worse, or
- you ask for help from them.
Your GP should still monitor your physical health.
What is the Care Programme Approach (CPA)?
If you are under the care of specialist health services and have ‘complex needs’ you may be put under the Care Programme Approach (CPA). Someone who self-harms a lot might have complex needs. Under CPA you will have a care plan. The plan explains what support you need to manage and recover from your self-harm. Such as:
- how to stop your self-harm from getting worse,
- how to reduce or stop harm caused by your-self harm,
- how to lessen risky behaviours,
- how to improve your ability to function, and
- how to improve your quality of life.
Your care plan should also:
- identify goals that you would like to achieve in life, such as employment goals,
- identify team members and what they should be doing for you,
- include a risk management plan,
- identify short term goals linked to your-self harm, and
- be shared with your GP.
You should have a say about what is written into your care plan. Your family or carers should also be involved if you agree. Your care plan should be reviewed every year.
What is a risk management plan?
Risk management should be part of your care plan. It should look at:
- current risk,
- long term risk,
- things that increase your risk of self-harm, and
- a crisis plan.
A crisis plan gives you steps to take in a crisis such as a number to call or distraction techniques to try.
What treatment should I be offered?
Your mental health team should think about giving you 3 – 12 sessions of therapy to help you to stop self-harming. They may start by helping you to find different ways of coping with painful emotions. Your therapist should work with you to find the reasons why you self-harm. Your therapy should be tailored to your needs. You may be offered:
- cognitive behavioural therapy,
- dialectical behavioural therapy,
- psychodynamic therapy, or
- problem solving therapy.
Your therapist should be trained in the therapy that they are delivering. They should work with you to help you understand the reasons for your self-harm.
Therapy may make you feel worse to start with because you may be talking about things that are difficult for you. This doesn’t mean it isn’t working. But you may need extra support while you have therapy. Such as through the Care Programme Approach.
Medication should not be offered to you to reduce your self-harm. But medication may be offered to you if you have another mental health condition, such as depression. Doctors will think about risk of overdose when prescribing medication.
If you can’t stop self-harming in the short term, you and your healthcare team should talk about harm reduction such as:
- talking about new ways that could help you, and
- talking about coping strategies that could help you.
Remember that there is no safe way to self-poison.
When your treatment and care is due to end professionals should:
- tell you what is likely to happen when your care ends
- tell you ahead of time so that you can get used to the change
- give you extra support if you need it,
- make sure you have a clear crisis plan in place,
- share your care plan with any other professionals who are taking over your care,
- give you a copy of your plan and what has been agreed, and
- give your family or carer a copy of the plan if you agree
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What will happen if I need to go to hospital?
Emergency healthcare staff should assess you urgently if you are in hospital through self-harm. The assessment is to understand your:
- physical risk of harm
- your mental state,your mental capacity,
- your willingness to stay in hospital for further assessments,
- your distress level, and
- any possible mental health issues
Everyone who self-harms should:
- have treatment for serious injuries,
- have a risk assessment, and
- be offered a needs assessment.
Can I just get treatment for my injuries?
The NHS should offer you treatment for any serious injuries, even if you don’t want mental health support.
What is a risk assessment?
A risk assessment should be completed with you to think about any risks. Healthcare professionals will look at different things to work out risk such as the following:
- Have you been drinking or taking illegal drugs?
- Why did you self-harm?
- Do you have a history of self-harm?
- Do you have a mental health condition?
- Do you have mental capacity?
- Do you have a plan to kill yourself?
- Are you feeling hopeless or depressed?
You may have a risk assessment and needs assessment at the same time.
What is a needs assessment?
A needs assessment is a detailed assessment of your needs. It will be completed with a mental health specialist. The assessment will outline what support you need to manage and recover from self-harm. Look at your needs assessment and say if you don’t agree with anything. You won’t have a needs assessment if you don’t want ongoing support. The assessment will have information about:
- your risk assessment,
- a mental health assessment, and
- a social needs assessment.
I don’t want to be in hospital. Can I leave?
You should be able to leave if you are assessed as having mental capacity to make the decision. And you haven’t self-harmed because of a severe mental illness.
A Mental Health Act assessment may be carried out if you try to leave but staff don’t think that you are safe to leave.
If you meet the criteria for the Mental Health Act you can be kept in hospital, even if you don’t want to be there.
What will happen after my assessments?
The NHS has different options depending on your risk.
Discharge. You may be discharged without a follow up appointment. This decision will be based on your needs assessment and risk. The assessment should be written in your medical notes and passed to your GP and any other relevant mental health services.
Stay in hospital. You may be kept in hospital overnight. You may be kept in hospital if you were going to go back to an unsafe place or you weren’t able to be assessed. This may be because you were too distressed or drunk. An assessment of your needs should be done with you as soon as possible.
Referral. You may be referred for further assessment and treatment. For example you may be referred to the community mental health team. This will be a joint decision between you and
health care professionals. The decision to refer you should be based on the assessment of your needs and risk.
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