Self-harm, self-mutilation, eating disorders, suicide threats and gestures by a child must always be taken seriously and may be indicative of a serious mental or emotional disturbance.
In most cases of deliberate self harm the child should be seen as a Child in Need and offered help via the school counselling service, the GP, Child and Adolescent Mental Health Service (CAMHS) or other therapeutic services e.g. paediatric or psychiatric services.
The possibility that self-harm, including a serious eating disorder, has been caused or triggered by any form of abuse or chronic neglect should not be overlooked.
The above possibility may justify a referral to Children’s Social Care for an assessment as a Child in Need and/or a child in need of protection.
Consideration must also be given to protect children who engage in high risk behaviour which may cause serious self injury such as drug or substance misuse, running away, partaking in daring behaviour e.g. running in front of cars etc (all of which may indicate underlying behavioural or emotional difficulties or abuse).
3. Responding to Incidents of Self-harm
It is good practice, whenever a child is known to have either made a suicide attempt or been involved in self-harming behaviour, to undertake a multi-disciplinary risk assessment, along with an assessment of need.
Any child under 12 reported to be self-harming must be the subject of a comprehensive paediatric assessment leading to a possible referral to CAMHS.
This must be undertaken as a matter of urgency for any child aged under 5.
In addition to the normal child protection procedures the following procedures may apply.
Child presented at school
All school personnel who come into contact with a child who is self harming should inform the school’s named designated teacher.
Information should also be passed to the school nurse who can liaise with the child’s GP where necessary.
The school should make arrangements to interview the child and ascertain whether the difficulties presented can be resolved with her/him and their parents within the school environment or whether outside help from other professionals is required.
Child referred to a social work team
In all cases where self harm or attempted suicide is suspected or known, the child should be seen by a doctor at the A&E department.
For cases where self harm has been reported but the child is not in immediate danger, an Initial Assessment should be undertaken to determine what course of action should follow. This will include consideration as to whether a referral to CAMHS is necessary and if a Section 47 Enquiry should be initiated.
In all cases an assessment should consider whether:
- There is evidence the parents / carers are failing to protect the child from harm or are failing to diminish the risks of further attempts at harm
- The child is exhibiting behaviour beyond the control of their parent / carer and they continue to self harm or attempt suicide
- The child is too young or has learning difficulties and is unable or does not give an explanation that is consistent with self harming
- The child is being harmed or suspected of being harmed by another adult or child – this may include injury from a sibling or severe bullying by other children or situations where the child is a witness to or the subject of domestic violence
- Following an assessment there is significant concern that the child’s family circumstances would continue to place them at risk of Significant Harm.
Child referred to CAMHS
In all cases where self harm or attempted suicide is suspected or known, the child should be seen by a doctor at the A&E department. For cases where self harm has been reported but the child is not in immediate danger, consideration must be given to the need for a multi-agency assessment and specifically for a:
- Paediatric assessment
- Referral to Children’s Social Care
Child presented at hospital
Where the child has presented at hospital, the doctor should undertake a preliminary examination and decide what further assessment is required. For a younger child, a referral to CAMHS should be considered.
In cases of attempted suicide a hospital admission will usually be arranged to enable a psycho-social assessment, which should consider whether or not the child is at risk of Significant Harm and the need to refer to Children’s Social Care for assessment.
All overdose presentations at A & E of children aged 15 and under, should be admitted to the paediatric ward for further assessment and CAMHS review.
Where a child has been hospitalised as a result of self-harm, any discharge should involve co-ordinated planning with community services, including Children’s Social Care and CAMHS.
4. Further Information
Please see the following documents:
- Understanding and responding to children and young people at risk of self-harm and suicide (Cambridgeshire and Peterborough NHS Foundation Trust).
- Suicide and deliberate self-harm in young people (BMJ Article April 2005).
Additional useful information may also be found on the following websites: