Further memorandum from Professor Keith
Hawton
When I attended the meeting of the Defence Committee
Inquiry into Duty of Care in the Armed Forces some months ago,
together with Professor Wessley, I said I would send some further
information. I have already sent you the information about the
USAF suicide prevention programme. I also said I would make some
comments about the NICE Guideline on self-harm. The full report
from NICE has recently become available (see below). The Guideline
contains specific advice on the physical management of episodes
of deliberate self-harm. However, I think that the Committee wanted
me to comment more on the relevant psychosocial sections of the
Guideline. In summary, these indicate that:
1. All individuals who present to general
hospital with self-harm should be offered a psychosocial assessment
including an assessment of needs and risk.
2. The results of the assessment should
be clearly recorded, preferably with joint agreement between patient
and assessor.
3. Risk assessment should always be conducted,
including risk of further self-harm and/or suicide.
4. All staff conducting psychosocial assessments
of patients with self-harm should receive proper training and
should be supervised.
5. Decisions about further assessment and
treatment should be based upon combined assessment of needs a
risks.
6. Aftercare arrangements should not be
organised solely on presence or absence of mental illness or risk
of repetition of self-harm.
7. Temporary admission should be considered
following acts of self-harm, to help with distress and to allow
full assessment.
8. Following psychosocial assessment, decision
about referral for further treatment and help should be base upon
comprehensive psychiatric, psychological and social assessment,
including an assessment of risk.
9. There should be clear communication with
the patient's GP of the treatment plan and such information should
also be passed onto other mental health services if they are already
involved.
10. For people who are at high risk of repetition
intensive therapeutic intervention combined with outreach should
be considered.
This summarises the main points that may be
of relevance to the Armed Forces. I hope this will be of some
assistance to the Committee.
December 2004
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