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Self-Harm in Adolescents — MRCPsych Paper B MCQ

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ModerateChild & Adolescent PsychiatrySelf-Harm in AdolescentsMRCPsych Paper B

A 14-year-old girl attends the emergency department after taking an overdose of her mother's antidepressants. She is alert and able to engage, although physical monitoring is continuing. She describes the overdose as impulsive and asks to go home. Which approach to her mental health assessment is recommended by NICE NG225?

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Correct answer: C — Avoid predictive scales and use psychosocial assessment with risk formulation

The correct answer is C. NICE NG225 advises against using risk assessment tools, scales or global low–medium–high categories to predict suicide or repetition of self-harm, or to determine treatment or discharge. Instead, an experienced mental health professional should undertake an age-appropriate psychosocial assessment, incorporating a collaborative risk formulation focused on the young person's needs, vulnerabilities, strengths and immediate and longer-term safety. Her description of the overdose as impulsive does not justify discharge without assessment. Psychosocial assessment should not be delayed until physical treatment is complete when she can participate, and it does not require a formal psychiatric diagnosis first. Predictive scales may create false reassurance or inappropriate restriction and cannot replace individual formulation.

Reference: National Institute for Health and Care Excellence. Self-harm: assessment, management and preventing recurrence (NG225), sections 1.5 and 1.6, 2022. https://www.nice.org.uk/guidance/ng225/chapter/recommendations