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6.20 Self Harm and Suicidal Behaviour

RELATED CHAPTERS

This chapter should also be read in conjunction with Safeguarding Children Abused Through Sexual Exploitation Procedure.

AMENDMENT

This chapter was updated in March 2015 and is intended for use as guidance and the risk assessment for completion by anyone working with children and young people up to the age of 18 or for those with learning difficulties or disabilities in Hertfordshire up to the age of 25.

New links to two documents were added:


Contents

  1. Introduction
  2. Principles Underpinning the Guidance
  3. The Aims of this Guidance
  4. Training - Safeguarding Children
  5. Definitions to Support the Guidance
  6. The Risk Assessment Process
  7. Baseline Risk Assessment Tool: Questions and Guidance
  8. Levels of Risk and Suggested Actions
  9. Do's and Don'ts
  10. Consent Issues
  11. Child Protection
  12. Further Risk Assessment Stage
  13. Further Assessment of Risk to Determine Referral
  14. Direct Referral Route to Specialist or Emergency Care
  15. Ongoing Support Systems

    Appendix 1: Self Harm Care Pathway

    Appendix 2: Guidance on Sharing Information

    Appendix 3: Legislation and Guidance

    Appendix 4: Useful Organisations/Contacts

    Appendix 5: Key Contacts in Hertfordshire


1. Introduction

Self harm and suicidal behaviour among children and young people has increased dramatically over the past twenty years. Research evidence reviewed by the National Inquiry into Self-harm among Young People suggests one in 12 young people have self-harmed in the UK, and that rates of self-harm are higher than anywhere else in Europe.

This guidance is intended for use and the risk assessment completion by anyone working with children and young people up to the age of 18 or 25 for those with learning difficulties or disabilities in Hertfordshire.

It has been developed via a multi agency working group and aims to offer an informed and systematic approach to addressing the needs of children and young people at risk of self- harm or suicide. It also sets out to ensure that children and young people gain appropriate support, and are assessed and referred appropriately where needed.

This guidance document recognises that children and young people who self-harm are doing so as a coping mechanism, and that telling them to stop does not work. It also seeks to support staff in working with children and young people to reduce the potential harm self-harm can cause to both the young person's physical body and to their mental well-being, e.g. self-esteem.


2. Principles Underpinning the Guidance

  • Recognising self-harm as a real and sensitive issue;
  • Each young person to be respected and listened to;
  • Ensure the implementation of equal opportunities;
  • Young people to be made aware of the local Confidentiality & Information Sharing policy;
  • To work towards minimising harm and give coping strategies where appropriate;
  • Recognising the young person may be part of a family unit;
  • Support to be offered to families;
  • Where staff feel intervention is necessary, this will be achieved through ongoing communication with the young person;
  • Follow local organisation's self harm policy - within Hertfordshire's framework.


3. The Aims of this Guidance

  • To improve the quality of support, advice and guidance offered to young people who self- harm, or maybe at risk of committing suicide;
  • Offer consistent support to children and young people no matter what point of contact, to standardise the response of agencies regardless of what type of agency;
  • To increase knowledge, skills and competence of staff to recognise the signs and respond appropriately when working with a young person who self-harms, and/or knows of someone who self-harms;
  • To meet a locally identified need by service providers & commissioners.


4. Training - Safeguarding Children

Hertfordshire Safeguarding Children Board (HSCB) offers/delivers training on safeguarding that is available to people across the children's and young people's workforce.

Stage 1 training - All staff who are in regular contact with children and young people must, as a minimum, undertake stage 1 introductory training on safeguarding children and promoting their welfare, as per local policy requirements.

Staff in this category are in a position to identify concerns about maltreatment, including concerns, which may arise from implementing the Common Assessment Framework (CAF).

Stage 2 training - Staff who work regularly with children and young people, and who may be asked to contribute to an assessment of a child or young person in need, should also attend stage 2 multi agency training. This training will provide a higher minimum level of expertise and a better understanding of working together to safeguard children effectively.

Operational managers who supervise staff at this level and have strategic responsibility for the provision of services to children and young people should also attend stage 2 training.

Stage 3 training - Is for named and designated safeguarding children leads across all agencies who need to have a thorough understanding of working with complex or serious cases and have a particular responsibility for safeguarding children.


5. Definitions to Support the Guidance

Self-harm*

Self-harm describes a wide range of things that people do to themselves in a deliberate and usually hidden way. In the vast majority of cases self-harm remains a secretive behaviour that can go on for a long time without being discovered. Self-harm can involve:

  • Attempted hanging;
  • Overdosing of tablets or medicines;
  • Cutting, often to the arms using razor blades, broken glass or knives;
  • Burning using cigarettes or caustic agents;
  • Punching and Bruising;
  • Inserting or swallowing objects;
  • Head banging;
  • Pulling out hair or eyelashes.

Self Injury

Self injury is any act which involves deliberately inflicting pain and/or injury on the body, but without suicidal intent. Self injury is seen as a coping mechanism with the aim of relieving emotional distress.

NB Although self-harming behaviour is relied on as an attempt to cope and manage and may not be intentionally suicidal, it must be recognised that the emotional distress that leads to self harm can also lead to suicidal thoughts and actions.

Suicide

Suicide is an intentional, self-inflicted, life-threatening act resulting in death from a number of means.

Suicidal-intent

This is indicated by evidence of premeditation (such as saving up tablets), taking care to avoid discovery, failing to alert potential helpers, carrying out final acts (such as writing a suicide note) and choosing a violent or aggressive means of deliberate self harm allowing little chance of survival.

*The term self-harm is often used as an all encompassing term referring to suicidal thoughts and attempted suicide.


6. The Risk Assessment Process

First Contact - Baseline Risk Assessment Stage A child, a peer or a parent may directly contact a member of staff. Equally a worker may notice a change in the child's behaviour or appearance that leads to a cause for concern, as such any frontline worker should be able to complete the risk assessment. The following table lists behaviours and situations that could indicate risk of deliberate self harm or suicide in young people. This list is offered as a guide and not as a diagnostic tool.

Click here to view The Risk Assessment Process Table.

An early baseline assessment of self harm should take place to ensure that the child or young person gets timely and appropriate support.

All frontline workers need to feel confident to make an early baseline assessment via a number of basic but important questions. See below:

A designated member of staff should also be identified who can provide advice and support to workers, e.g. the school/college nurse.

If the risk assessment is completed, then this should be documented in all records and case files.


7. Baseline Risk Assessment Tool: Questions and Guidance

Setting up the contract with the child or young person
  • Discuss confidentiality child protection if necessary;
  • Discuss Child Protection if necessary;
  • Discuss who knows about this and discuss contacting parents;
  • Discuss who you will contact i.e. the school/college nurse;
  • Discuss contacting the GP.
Initial questions
  • Have you got any injuries or taken anything that needs attention? - (consider emergency action);
  • What has been happening?
  • Who knows about this?
  • Have you thought about taking your own life? - (consider likely or imminent harm);
  • If so, how often have you thought about this?
  • Have you got what you need to harm yourself (means)?
  • Have you thought about when you would do it (timescales)?
  • Are you at risk of harm from others?
  • Is something troubling you? - (family, school, social, consider use of child protection procedures);
  • Are there any problems with inappropriate use of the internet or social networking sites;
  • What would you like to happen next?
Responses
  • If urgent medical response needed call an ambulance;
  • Say who you will have to share this with (e.g. designated person) and when this will happen;
  • Say who and when the right person will speak with them again to help and support them;
  • Check what they can do to ensure they keep themselves safe until they are seen again e.g. stay with friends at break time, go to support staff;
  • Consider carrying out an E-CAF or Family CAF;
  • Give reassurances i.e. its ok to talk about self harm and suicidal thoughts and behaviour.
Further Questions
  • What if any self-harming thoughts and behaviours have you considered or carried out? (Either intentional or unintentional - consider likely / imminent harm)
  • If so, have you thought about when you would do it?
  • How long have you felt like this?
  • Are you at risk of harm from others?
  • Are you worried about something?
  • Ask about the young person's health (use of drugs / alcohol)?
  • What other risk taking behaviour have you been involved in?
  • What have you been doing that helps?
  • What are you doing that stops the self-harming behaviour from getting worse?
  • What can be done in school to help you with this?
  • How are you feeling generally at the moment?
  • What needs to happen for you to feel better?


8. Levels of Risk and Suggested Actions

The following link provides a table/tool to help professionals identify levels of risk and possible actions Click here to view Levels of Risk and Suggested Actions Table The following table also identifies possible support services available for different levels of risk

Risk

Services Available

Low Risk

  • Youth Connexions;
  • School/College Counselling;
  • School/college Nurses;
  • GP's;
  • Educational Psychologist;
  • Children's Centres;
  • Mentors;
  • Parental Drug Awareness Service (PDAS);
  • Family Lives (previously Parentline Plus);
  • Parenting Courses (guidance for parents);
  • Herts Direct;
  • Channel MOGO.

Raised Risk

  • Targeted Advice Service (TAS);
  • Targeted Youth Support Service (TYSS);
  • Adolescent Drug and Alcohol Service (ADASH);
  • Mental Health Workers;
  • Youth Connexions;
  • School/College Counselling;
  • School/college Nurses;
  • GP's;
  • Educational Psychologist;
  • Parental Drug Awareness Service (PDAS);
  • Family Lives (previously Parentline Plus);
  • Parenting Courses;
  • Thriving Families;
  • Herts Direct;
  • Channel MOGO.

High Risk

  • Targeted Advice Service (TAS);
  • Targeted Youth Support Service (TYSS);
  • Adolescent Drug and Alcohol Service (ADASH);
  • Child Protection;
  • Health School Liaison Officers;
  • CAMHS;
  • Mental Health Workers;
  • Educational Psychologist;
  • GP's;
  • A & E Departments;
  • Samaritans;
  • Thriving Families;
  • Herts Direct;
  • Channel MOGO.


9. Do's and Don'ts

Do's
  • Make first line assessment of risk;
  • Take self harm and suicidal behaviour seriously;
  • Be yourself, listen, be non-judgemental, patient, think about what you say;
  • Check associated problems such as bullying, bereavement, relationship difficulties, abuse, and sexuality questions;
  • Check how and when parents will be contacted;
  • Encourage social connection to friends, family, trusted adults;
  • Implement initial care pathway;
  • Implement support/contact with young person;
  • Seek risk assessment from GP and School/college Nurse;
  • Make appropriate referrals;
  • Set up a meeting to plan the care pathway interventions based upon understanding of the risks and difficulties;
  • Provide opportunities for support, strengthen existing support systems;
  • If child makes disclosure of abuse seek further advice;
  • Work with children and young people in small groups or 1-2-1 settings;
  • Consider carrying out an E-CAF or Family CAF;
  • Do discuss your concerns with a supervisor;
  • Liaise with Police Operation Halo specialist if necessary;
  • Do seek advise from the Targeted Advice Service (TAS).
Don'ts
  • Don't panic or jump to quick solutions;
  • Dismiss what the children or young people are saying;
  • Believe that a young person who has threatened to harm themselves in the past will not carry it out in the future;
  • Disempower the child or young person;
  • Ignore or dismiss people who self-harm;
  • See it as attention seeking;
  • Assume it is used to manipulate the system or individuals;
  • Trust appearances;
  • Undervalue your ability to respond in an appropriate was despite your anxieties; a pupil in distress should never be ignored.
  • Ensure language used does not define individuals or groups as ‘self harmers’ but as individuals who self harm

At this stage it is strongly recommended that the professional should ask the young person who else is aware of the young person's circumstances or has been involved to avoid risk assessment duplication.

CAMHS services can be accessed via the Single Point of Access (SPA) – 0300 777 0707.

There is also Step 2 which is Tier 2 early intervention Child and Adolescent Mental Health Service which aims to help children and young people with low level mental health impairments manage their difficulties at the earliest possible stage, so they can look forward to an emotionally healthy future.  Step 2 consists of a small team of mental health professionals (nurses, psychologists, counsellors) trained in using a number of therapeutic talking therapies. They firstly offer an Initial Assessment where they meet with the referred client and their parents and assess their needs.  Sometimes their difficulties can be resolved within the first session, by talking it through, offering some useful advice or by signposting the client to more appropriate organisations for their needs.  In other cases, the Step 2 Advisor in partnership with the client and family may decide that it is appropriate to offer some short term therapeutic treatment.  This can be up to six sessions. 

In addition, Step 2 provides unnamed telephone advice to professionals working within schools and can offer some limited training too. The contact number to Step 2 is 01438 730 570 - Please note, this number is for professionals only, not parents or young people.

If there is also drug and alcohol misuse happening you may also want to make a referral to the Adolescent Drug and Alcohol Service ADASH

Responses to the risk assessment questions together with an assessment of the appearance and behaviour of the child or young person will lead to:

  • An increased awareness of the child's or young person's needs but no further action, or
  • An increased awareness of the child's or young person's needs and an on-going support and potential re-assessment system being put in place locally, or
  • A recognised need for the child or young person to be referred on for a more in-depth assessment and support.


10. Consent Issues

If a young person is deemed to need support from other professionals the worker supporting the individual will:

Sometimes concerns of significant harm may lead to referral being made without consent.

However, it is highly recommended to seek consent where possible.


11. Child Protection

After the baseline risk assessment, or at any stage of the care pathway, if a professional is concerned that the child is in need of protection, they should call the Customer Call Centre on 0300 123 4043 For out of hours service (after 8 pm) calls will automatically be diverted to an agency, who can contact the Children's Services Out of Hours Service (SOOHS) on your behalf (except textphone/minicom, callers need to redial 01992 632150).

The usual child protection procedure should then be followed whereby a section 47 enquiry / core assessment will be carried out by Children's Social Services in consultation with the police and other agencies.

If an urgent referral is required schools can contact CAMHS* via the school nurse, TAS (the Targeted Advice Service) on 01438 737511 or Children's Services on 0300 123 4043. Alternatively, parents/carers can request a referral to CAMHS via their child’s GP. In the case of self inflicted injuries needing treatment, when substances or tablets have been ingested, or a child or young person is at imminent risk of suicide, an emergency referral to A&E would be required, usually via a 999 call for an ambulance.

CAMHS can also be contacted through the Single Point of Access (SPA) contact number 0300 777 0707


12. Further Risk Assessment Stage

At the Further Risk Assessment stage a number of key workers will be in a position to offer a more in-depth risk assessment and thus determine whether the child or young person needs further support.

Assessment at this stage using the proforma in Section 8, Levels of Risk and Suggested Actions will lead to one of the following outcomes:

  • An increased awareness of the child's or young person's needs but no further action;
  • An increased awareness of the child's or young person's needs and an on-going support and potential re-assessment system being put in place;
  • Identification of a high risk of need leading to either emergency admission or referral to any of those stipulated in the Referral Routes box within the Self Harm Care Pathway (Appendix 1: Self Harm Care Pathway). Also refer to questions in Section 7, Baseline Risk Assessment Tool: Questions and Guidance.

This staged risk assessment approach ensures that staff are supported where uncertainty arises, and that children and young people receive timely and appropriate support and assessment.


13. Further Assessment of Risk to Determine Referral

Please remember that risk factors are not, nor can they ever be, tools for prediction. Also, any risk assessment can only be valid for the moment at which it is carried out and so may need to be repeated at suitable intervals according to professional judgement or advice. Risk of self-harm is not the same as risk of mental illness, and one does not need to be mentally ill to self-harm, although there may be links (see list of Risk factors).

Bear in mind that some information can be obtained from the young person, but not all, which may need to come from other sources, such as parents or carers, peers, or other professionals. The order of the factors in the list is not necessarily significant, as they are all worthy of consideration.


14. Direct Referral Route to Specialist or Emergency Care

Some staff at the 'Baseline Assessment Stage' might decide to directly refer to the professionals in the 'referral route' box. For example, a General Practitioner may refer directly to the Child and Adolescent Mental Health Service.

It is also possible that the first time any community health or education professionals learn of a child or young person in need may be after attempted suicide or deliberate self-harm that has resulted in assessment in Accident and Emergency or admission to hospital. Irrespective of the entry point on to the Referral Pathway, where a child or young person's has been deemed to need an assessment it is essential that we do not lose sight of that person post assessment.


15. Ongoing Support Systems

On-going support systems need to be put in place irrespective of the level of risk based on the-going notion that the level of perceived risk could change at any time.

On going support may take many forms and may be offered via numerous sources and will be dependent on the child or young person's needs and wishes (see table below).

Where the baseline assessment does not lead to referral for more in depth assessment it is essential that communication with the young person remains strong and that an appointed professional remains in contact with the young person on a regular basis.

If a young person has been admitted to hospital the locality Child and Adolescent Mental Health Service might continue to offer support, but equally the school/college nurse, the child's GP, or in some cases the child's social worker, may be best placed to offer on going support. One key worker should be named and identified to offer an on going point of contact for that child, with an alternative person stipulated should the key worker not be available. This needs to be agreed locally between key professionals and in consultation with the family and young person. A planning meeting may need to be convened for this purpose, and further review meetings where requires.

It is also acknowledged that parents / carers, staff and other pupils may require support themselves when supporting young people at risk of self harm. Key contact numbers for staff are available within Appendix 5: Key Contacts in Hertfordshire.

Risk Services Available
Low Risk
  • Youth Connexions;
  • School/College Counselling;
  • Cross Herts Community Counselling (CHeCC);
  • School/college Nurses;
  • GP's;
  • Educational Psychologist;
  • Children's Centres;
  • Mentors;
  • Parental Drug Awareness Service (PDAS);
  • Parentline Plus;
  • Parenting Courses (guidance for parents).
Raised Risk
  • Mental Health Workers;
  • Youth Connexions;
  • School/College Counselling;
  • Cross Herts Community Counselling (CHeCC);
  • School/college Nurses;
  • GP's;
  • Educational Psychologist;
  • Parental Drug Awareness Service (PDAS);
  • Parentline Plus;
  • Parenting Courses.
High Risk
  • Child Protection;
  • Health School Liaison Officers;
  • CAMHS;
  • Mental Health Workers;
  • Educational Psychologist;
  • GP's;
  • A & E Departments;
  • Samaritans.


Appendix 1: Self Harm Care Pathway

Click here to view Appendix 1: Self Harm Care Pathway.


Appendix 2: Guidance on Sharing Information

This is concise guidance for sharing recorded information about children or young people who harm themselves or are perceived to be at risk of self-harm including suicide.

1.

Purpose of Sharing Information

The purpose of sharing information is to ensure young people in need and in particular young people who harm themselves or are perceived to be at risk of self harm including suicide are given the help and support they are entitled to.

2.

What will be shared?

Information shared will be no more than is necessary. All information will be handled with respect and care.

Unrecorded observations, which may not at first seem significant, will be freely shared on a need to know basis within statutory agencies and between partners in the interests of meeting the statutory functions of the partners.

Information should be recorded if it is significant.

3.

Consent

Partners will record the competent child's consent to share recorded information. Fresh consent should be sought if the existing consent does not cover the proposed sharing or there has been a break in involvement. The child should be told what information may be shared and why it would be shared and the consequences of sharing.

4.

Sharing without Consent

Informed consent should be sought from the competent child to share recorded information unless;

  • The situation is urgent and there is not time to seek consent; or
  • Seeking consent is likely to cause serious harm to someone or prejudice the prevention, detection of serious crime.

If consent to sharing recorded information is refused by the competent child, or can/should not be sought from the child, information should still be shared in the following circumstances;

  • There is reason to believe that not sharing is likely to result in serious harm to the child or someone else or is likely to prejudice the prevention or detection of serious crime; and
  • The risk is sufficiently great to outweigh the harm or prejudice to anyone that may be caused by the sharing; and
  • There is a pressing need to share the information.

5.

When is a child "competent" to give consent?

Anyone under the age of 18 is a child. A judgement must be made as to whether a particular child in a particular situation is competent to consent or refuse consent to sharing information. Consideration should include the child's chronological age, mental and emotional maturity, intelligence, vulnerability and comprehension of the issues. A child at serious risk of self-harm may lack emotional understanding and comprehension (Fraser guidelines should be used).

NSPCC Fact sheet on Fraser guidelines.

6.

Sharing Information

Partners who request or refer information should state;

  • What the information is and why it should be shared;
  • Whether there is informed consent and any limits to it;
  • If there is no consent, why they believe the information should be shared without consent;
  • The proposed method of sharing and storage of the information;
  • The period of time for responding to the request or referral.
Partners who refuse or cannot comply with a request or referral should say why and what could be done to secure their agreement to share information. Local authorities, education authorities and health authorities/trusts must comply with requests for information from Social workers carrying out an s47 inquiry unless it would be unreasonable to do so.

7.

Families

Partners should keep parents informed and involve them in the information sharing decision even if a child is competent or over 16. However, if a competent child wants to limit the information given to his parents or does not want them to know it at all; the child's wishes should be respected, unless the conditions for sharing without consent apply. Where a child is not competent, a parent with parental responsibility should give consent unless the circumstances for sharing without consent apply.

8.

Partners:

Children's Services
Probation,
Youth Offending Team
Youth Connexions,
Hertfordshire Children's Trust Partnership employees and contractual partners
Hertfordshire Community Health Services
Hertfordshire Partnership Foundation Trust
Further Education Colleges


Appendix 3: Legislation and Guidance

1.

Children Act 1989 Section 17

A child is defined as 'in need' by Section 17 of the Children Act (1989) if:

  • He or she is unlikely to achieve or maintain, or to have the opportunity of achieving or maintaining, a reasonable standard of health or development without the provision for him/her of services; or
  • His/her health or development is likely to be significantly impaired, or further impaired, without the provision for him/her of such services; or
  • (S)he is disabled.

2.

Children Act 1989 Section 47

Where a local authority has reasonable cause to suspect that a child who lives, or is found, in their area is suffering, or is likely to suffer, significant harm, the authority shall make, or cause to be made, such enquiries as they consider necessary to enable them to decide whether they should take any action to safeguard or promote the child's welfare.

'Harm' is defined as Ill treatment, which includes sexual abuse, physical abuse and forms of ill-treatment which are not physical, for example:

  • Emotional abuse; or
  • Impairment of health (physical or mental); or
  • Impairment of development (physical, intellectual, emotional, social or behavioural).
This may include seeing or hearing the ill treatment of another (s120 Adoption and Children Act 2002).

3.

Mental Health Act 1983

The Mental Health Act 1983 is the principal Act governing the treatment of people with mental health problems in England and Wales. The Mental Health Act covers all aspects of compulsory admission and subsequent treatment. Besides these emergency procedures, there are other sections of the Act under which a person can be detained in hospital without their consent.(In November 1999 the Government issued a White Paper called 'Reforming the Mental Health Act', which was intended to act as the basis for a new Act. In June 2002 this was superseded by a draft Mental Health Bill).

The Mental Health Act of 1983 covers the detention of people deemed a risk to themselves or others.It covers four categories of mental illness: severe mental impairment, mental impairment, psychopathic disorder and mental illness.

The first two are generally interpreted as people with learning difficulties who have aggressive tendencies. Psychopathic disorder relates to people who have a "persistent disorder or disability of the mind" which leads to aggression.

Mental illness itself is not defined by the Act. However, it does state what it does not cover, which includes people who may be deemed to be mentally ill "by reason only of promiscuity or other immoral conduct, sexual deviancy or dependence on alcohol or drugs".

The Act allows people considered to be mentally ill to be detained in hospital and given treatment against their will. They do not have to commit a crime or have harmed anyone. They are usually detained because it is considered in their interests and for their own safety, but they may be held because they are deemed a risk to others.

Mental Capacity Act 2005

The Mental Capacity Act 2005 for England and Wales come into force in 2007. The Act will generally only affect people aged 16 or over and provides a statutory framework to empower and protect people who may lack capacity to make some decisions for themselves, for example, people with dementia, learning disabilities, mental health problems, stroke or head injuries who may lack capacity to make certain decisions. It makes it clear who can take decisions in which situations and how they should go about this. It enables people to plan ahead for a time when they may lack capacity. The Act covers major decisions about someone's property and affairs, healthcare treatment and where the person lives, as well as everyday decisions about personal care (such as what someone eats), where the person lacks capacity to make the decisions themselves.

Guidance and Further Reading

Mental Health Foundation (2006). Truth Hurts: Report of the National Enquiry into Self- harm among Young People. Fact or Fiction?

Northumberland Families and Children's Trust. Deliberate Self Harm and Suicide: Care Pathway for Children and Young People in Northumberland (2008)

MIND. 'Understanding Self-Harm'.

Department of Health 2004. Case Study: Integrated Pathway for Children and Young People who Self harm

North East Regional Interagency Procedures Project 2005. Deliberate Self-harm and Suicide: Safeguarding Children and Young People

Cambridgeshire and Peterborough NHS Foundation Trust: Understanding and responding to children and young people who self-harm: a guide for practitioners (2009)

NSPCC Inform. Dealing with Self Harm. Services for Children and Young People (2008)

Hawton, K, Rodham, K and Evans, E (2006), By Their Own Hand: Deliberate Self-harm and Suicidal Ideas in Adolescents. London: Jessica Kingsley

Hawton, K, Rodham, K, Evans, E and Weatherall, R (2002), 'Deliberate self-harm in adolescents: self report survey in schools in England'. BMJ. 325, 1207-1211

Social Care Institute of Excellence (2005) 'Deliberate self-harm (DSH) among children and adolescents: who is at risk and how is it recognised?' Research Briefing 16.

Royal College of Psychiatrists: Managing Self Harm in Young People

Guidance for Developing a Local Suicide Prevention Action Plan: Information for Public Health Staff in Local Authorities


Appendix 4: Useful Organisations/Contacts

Childline

Tel: 0800 1111
Website: Childline

British Association for Counselling and Psychotherapy (BACP)

email: bacp@bacp.co.uk
Website: bacp

Mindinfoline

Tel: 0845 766 0163
Mind is the leading mental health organisation in England and Wales, providing a unique range of services. Mindinfoline is Mind's helpline and information service.

Samaritans

Tel: 08457 909090
Website: Samaritans
Befriending service for anyone going through a personal crisis who is at risk of suicide.

Self-harm Alliance

PO Box 61, Cheltenham, Gloucestershire GL51 8YB
Helpline: 01242 578 820
Website: Self harm resources and publications, self-harm links and websites
A national survivor-led voluntary group

Mental heath and counselling organisations

NHS Choices, A guide to mental health services in England

YoungMinds

parents information service: 0800 018 2138
Website: YoungMinds
For anyone concerned about a child's mental health

Websites

www.selfharm.co.uk

www.firstsigns.org

www.thebasementproject.co.uk/

www.nshn.co.uk

www.papyrus-uk.org

www.getconnected.org.uk

www.nationalworkinggroup.org/

Other websites for staff, parents, children and young people about health, wellbeing and selfharm:

Advice and guidance for professionals and parents/carers is also available from Hertfordshire Partnership NHS Foundation Trust (HPFT) via their Single Point of Access on 0300 777 0707 between 0800 and 1900 hours or 01438 843322 between 1700 and 0800 hours.

Hertfordshire Partnership (NHS) - Get help.


Appendix 5: Key Contacts in Hertfordshire

If an urgent referral is required then this should be direct to the child's GP, Children's Services or local CAMHS Service. In the case of self inflicted injuries needing treatment or when substances or tablets have been ingested then an emergency referral to A&E would be required, usually via a 999 call for an ambulance.

  Telephone Number
CAMHS Clinics
Borehamwood and Potters Bar
Hemel Hempstead
Hoddesdon
Bishop's Stortford
St. Albans (Kingsley Green)
Stevenage
Watford
Welwyn and Hatfield

0208 3598540
01442 259132
01992 465042
01279 827399
01923 289050
01438 781406
01923 470610
01707 351800
Customer Service Centre 0300 123 4043
Customer Service Centre Out of Hours (After 8 pm) 0300 123 4043
Counselling in Schools Service 01992 588796
Family Lives (previously Parentline Plus) 0808 800 2222
Parental Drug Awareness Service (PDAS) 01707 393934
School Nurses Contact your school nurse direct or via
01462 427113
Youth Connexions 0800 389 3258
Target Advice Service – Practitioner Consultations 01438 737511
Police Operation Halo Team 01707 355383

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