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System-wide approach needed to care for people who self-harm, NICE says


By Jess Hacker
18 January 2022

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Professionals across the health and care system have a role to play in supporting people who self-harm, NICE has said in new draft guidance.

In the draft for its first new guidance for delivering self-harm care in 11 years, the Institute’s independent committee called for greater and more regular primary care involvement.

This would mean if a person who has self-harmed was being supported and given care in primary care, their GP should ensure they arrange regular follow-up appointments, in addition to referring them to mental health service.

They must also make sure the patient receives care for any coexisting mental health problems, including a referral to mental health services where appropriate.

Ensuring continuity of care and regular reviews would help make the person who has self-harmed feel ‘supported and engaged with services’, the committee said.

Similarly, the draft guidelines advise ambulance staff and paramedics to suggest a person who has self-harmed but who does not need urgent physical care see their GP.

Dr Paul Chrisp, director of the centre for guidelines at NICE, said: ‘Self-harm is a growing problem and should be everyone’s business to tackle – not just those working in the mental health sector.’

Professor Nav Kapur, topic advisor for the self-harm guideline and professor of psychiatry and population health at the University of Manchester, added: ‘Historically, people who have harmed themselves have had a highly variable experience of services.

‘This new guideline is an opportunity to make things better, particularly from the point of view of assessment and aftercare.’

The draft will remain open for consultation until 1 March.

It comes one month after a Government inquiry into children’s mental health found that inadequate early intervention creates ‘unnecessary pressure’ across the NHS, including in GP practices.

And in November, a CQC review identified silo working limited GPs’ ability to work collaboratively with mental health services.

‘Specific’ training needed for all staff

Non-specialist staff who work with these patients should receive training ‘specific to their role’ so that they can provide care, the guidelines also said.

The recommendation came after the committee found a ‘significant overlap’ in the kind of training specialists and non-specialists want to receive.

However, it would be ‘unreasonable and impractical’ to expect both kinds of staff to receive the same level of training, they said.

The guidance recommended that all staff who work with patients who self-harm, regardless of specialty, should receive training covering:

  • Treating and managing episodes of self-harm
  • Discussing self-harm openly
  • Involving the patient in all discussions
  • Compassionate communication
  • Cultural competency
  • Underlying factors or triggers for self-harm
  • The need to avoid judgemental attitudes, stigma and discrimination
  • The impact of comorbidities
  • Balancing patient autonomies
  • Risk assessment
  • The full treatment process, including relevant pathways and procedures.

Specialist staff should also receive additional training about how to conduct a psychosocial assessment, the committee said.

It comes after a study published last month suggested health bodies should invest in more frequent training for GPs in the care of patients with mental health disorders.

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