Assessing Self-Harm Risk

9 September, 2011 by: colinparker

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Assessing the risk of self harm or suicide in adolescents is a daunting concept for the occassional player.  Many Emergency Departments have a qualified Mental Health professional embedded in their clinical workforce… which means that we can become de-skilled in the art of risk assessment.

Last time, we discussed the HEADSS assessment tool for communicating with adolescent patients, and this is a great place to start.  In this episode we explore some of the elements of a structured mental health assessment.

Outline:  Self-Harm Risk Assessment

Usual to have low mood at times (due to challenges, etc)
Assessment = History, Examination, “Special investigations”
ie History, Mental State Examination, +/- structured assessment tool, +/- referral to Mental Health professional

Why do people harm themselves?
The effect of cultural / social trends

Structured suicide risk-assessment scores eg Pierce, SADPERSONS, etc
-evidence of validity?
-widely used? or not?
-applicable to adolescents?

PATHOS assessment tool (chronicity, planning, hopelessness)

HEADSS assessment as a structured conversation

Management options:
Medical management in parallel with psychiatric and other issues (eg self-poisoning, self-harm injuries)
Reassurance alone may occassionally be sufficient
Referral to Mental Health professional – acutely or follow-up
Short-term agreement / contract to not self-harm
Social work – support services, organisations, financial, legal, etc
Drug & alcohol / addiction medicine service
Sexual health services
Medications ? (caution with benzos; SSRIs – may suggest to GP but dont start in ED)

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