Salford Children's Services Procedures Manual Salford City Council website
Greater Manchester SCB Procedures
Greater Manchester SCB Procedures Greater Manchester SCB Procedures

3.8.7 Self Harming

SCOPE OF THIS CHAPTER

This procedure applies to children placed in children's homes and foster homes managed by the authority, but the principles apply to the placement of all looked after children. Therefore, where children are placed with parents, relatives or friends or in placements not managed by the authority, the social worker must ensure these or other adequate procedures are applied.


Contents

  1. Definition
  2. Facts Around Self Harming
  3. Meanings of Self Harm
  4. Planning
  5. Notifications
  6. Recording

    Appendix: Self-harming Guidelines for Looked after Children/Young People their Carers and Professionals


1. Definition

  • Intentional injury to self.
  • Includes “overdosing”, hitting, cutting or burning oneself, pulling hair, pricking skin, self strangulation, biting.
  • Most who self harm do not report the desire to die although their self harming may result in accidental death.
  • Extreme risk taking behaviour which is detrimental to the health and well-being of the individual should always be considered as possible self-harm behaviour.


2. Facts Around Self Harming

  • Self-harming is an indicator that something is wrong (distressing) and should always be taken seriously.
  • The severity of the injury does not necessarily reflect the level of concern that should be attached.
  • It is important to consider the young person in a holistic way. Self harm is merely one feature of her/his presentation.
  • A comprehensive assessment of the young person should be carried out to address the issues underlying the self-harming.
  • Do not concentrate on the injury, but the causes
  • Overdose always needs emergency treatment and assessments.


3. Meanings of Self Harming

  • There are many meanings behind self-harming and we should be cautious of generalisations.
  • Self-harming should not be dismissed as attention seeking behaviour although it could be attention seeking. The question is why are they seeking this attention?
  • Self-harm must always be taken seriously.
  • Self-harming is a way of coping with difficult feelings such as desperation, hopelessness, feeling trapped and helpless. Self-harm may help the young person to feel more in control of these feelings.
  • There may be an expression of anger or tension with self-harming providing relief.
  • There may be an expression of guilt or shame as a response to abuse or trauma, with self-harming being the punishment or as a means of feeling more connected/alive.
  • Self-harming could be a response to isolation having no one to talk to or to listen to them.
  • Self harm can help distract from negative thoughts.
  • Self harm can be mood changes, giving someone a buzz- adrenalin rush when cutting.


4. Planning

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 Information Record and the Child’s Risk Assessment. RA8.

If no plan or strategy exists, all reasonable measures should be taken to reduce or prevent continuation of the behaviour. The Risk Assessment and Management Plan should then be immediately completed and shared will all professionals caring for and working with the child.

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.

A Risk Assessment should always consider whether the child may be involved in self-harming, the social worker must be informed if there is a risk. The risk assessment undertaken should detail a Risk Management plan with clearly agreed strategies being adopted to reduce or prevent the behaviour.

That strategy should then be included in the child's Placement Information Record and shared with all professionals involved. Consideration should be taken to inform school of Self-harming behaviour.

Specialist advice or support should be sought from STARLAC (Salford CAMHS for Looked After Children based at Turnpike House. Tel: 0161 779 7832


5. Notifications

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

5.1 Notifications of Minor or Non Persistent Self-Harming

Minor or non persistent self-harming should be notified to the Child’s Social Worker and residential manager/foster carers' family placement social worker. At the first opportunity; the manager/family placement social worker should ensure the relevant social worker has been informed and a serious incident report submitted. A decision about whether to notify the parents will be taken by the social worker.

5.2 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/ family placement social worker/Manager 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.

Following a serious incident of the self-harming, other people/agencies should be notified.

If the child needs immediate medical attention, he or she should be taken directly to A&E; they then should be seen by the Duty Psychiatrist for a mental health state assessment. If appropriate STARLAC/Salford CAMHS will offer a follow up to the child on discharge.

If the child does not need immediate medical attention but the incident is assessed as serious, the Social Worker must follow up by referring to Starlac for advice.


6. Recording

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

6.1 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. The updated Risk Assessment should be clearly visible in the child’s file.

6.2 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.


Appendix: Self-harming Guidelines for Looked after Children/Young People their Carers and Professionals

Click here to view guidelines

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