What are the key components of a comprehensive assessment for a patient who has self-harmed?

Key components of a comprehensive assessment for a patient who has engaged in self-harm include:

• Establish the means of self-harm and, if accessible, discuss removing these means collaboratively to keep the person safe.
• Assess the severity of injury and determine the urgency of any required medical treatment.
• Evaluate the person's emotional and mental state, including level of distress, presence of depression, feelings of hopelessness, and suicidal ideation or intent by asking directly.
• Identify psychosocial needs such as social environment, family and support networks, recent life events, occupational and financial functioning, and any need for social care or support.
• Assess psychological and physical health needs, including mental health disorders, substance misuse, physical health problems, personal strengths, coping strategies, and need for psychological interventions.
• Explore the functions and motivations for self-harm to understand individual reasons and tailor interventions accordingly.
• Identify risk factors associated with increased risk of repetition or suicide, including history and frequency of self-harm, use of violent methods, evidence of planning, demographic factors (e.g., male sex, unemployment), and access to means.
• Identify protective factors such as coping strategies, supportive relationships, dependent children, and religious beliefs.
• Assess for safeguarding concerns especially in children, young people, and vulnerable adults, including risks related to abuse, neglect, or exploitation.
• Check for capacity, competence, and consent issues and seek advice if necessary.
• Seek consent to liaise with family members, carers, and other involved professionals to gather contextual information and support planning.
• Carry out concurrent physical healthcare and psychosocial assessment as soon as possible after the self-harm episode in a private setting.
• Develop or review a care plan collaboratively with the person and, where appropriate, their family or carers, including safety planning and crisis management strategies.
• Ensure assessments are adapted to the needs of specific groups such as children, young people, older adults, and people with learning disabilities, with involvement of appropriately experienced mental health professionals.

These components ensure a holistic understanding of the individual's needs, risks, and protective factors to guide appropriate care and referral decisions.

References: ¹,²