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Nonsuicidal Self-Harm Clinical Case

Nonsuicidal self-harm clinical case presentation, free google slides theme and powerpoint template.

All clinical cases are of equal importance: "very important". There are cases of self-harm, without suicidal intentions, that are caused by some mental disorders, or even as an after effect of bullying. Time to contribute to the medical community: customize this template and share a clinical case on self-harm by explaining information on these slides. There's a simple approach when it comes to the design of these slides: this way, the focus will be on your data, not on decorations.

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CUTTING AND SELF HARM

By Clint Newman

This will answer some questions for people who want to help someone they know, or themselves. This will show why kids cut and what could happen if they don’t get help sooner rather than later.

One question people want to ask is, “why do they cut themselves?”

People cut themselves when they feel sad or upset with someone or them self.

They do this to try and cope with problems t hat they are having at home, school, or where ever.

Most people who cut themselves are feeling a lot of emotions like being sad, mad, or feeling pressure to do something they don’t feel like doing.

The people who do this try to get away from what they are feeling at the time or to get away from life/reality so they can feel better.

People hide cutting because they feel it is of no ones concern on what they do to their body. Or they hide it to not get made fun of by others because they think it is weird or gross.

According to ABC News the most likely age group to cut themselves are teenagers age 11- 19 and one out of twelve teens cut.

If help is not gotten when it is discovered or started this could lead to addiction to cutting and or death from infection or major blood loss.

Survey question results: out of 50 students surveyed of team F of N.F.H.S.

18% of people say they don’t know anyone who cuts, the other 82% say they do know someone who cuts.

It is said by many that listening to music and drawing can keep them/yourself occupied so they don’t feel the need to cut themselves and make sure that the music is happy and up beat and the drawings are nicer more challenging than then a simple 5 second drawing unless they don’t want to do the harder drawing.( this is recommended by doctors for people with depression also!)

PICTURES: all pictures were gotten from Google images from the following searches; *people cutting, *kids sad/mad/being pressured, *people hiding, *people trying to get away, *life, *one out of twelve people, *blood, *tombstone, *people cutting, *happy faces, *pie charts, *kids listening to music, * kids drawing

PICTUES CITED PAGE

INFO : all info was gotten from the following: ABC News . ABC News Network, n.d. Web. 17 Nov. 2016. ABC News . ABC News Network, n.d. Web. 17 Nov. 2016. , "Cutting and Self-Harm."  Cutting and Self-Harm: How to Feel Better without Hurting Yourself . N.p., n.d. Web. 17 Nov. 2016. "KidsHealth - the Web's Most Visited Site about Children's Health."  KidsHealth - the Web's Most Visited Site about Children's Health . The Nemours Foundation, n.d. Web. 17 Nov. 2016.

HAVE A GOOD DAY!!!

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Everyone can play a role in preventing suicide. Use these resources to raise awareness about suicide prevention.

Suicide is a major public health concern. More than 48,100 people die by suicide each year in the United States ; it is the 11th leading cause of death overall . Suicide is complicated and tragic, but it is often preventable.  For more information on suicide prevention, visit our health topic page or download our brochures .

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If You’re in Crisis, Help is Available

If you’re in crisis, there are options available to help you cope. You can call or text the 988 Suicide & Crisis Lifeline at any time to connect with a trained crisis counselor. For confidential support available 24/7 for everyone in the U.S., call or text 988 or chat at 988lifeline.org, or visit https://go.usa.gov/xyxGa  . #shareNIMH

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Suicide is complicated and tragic, but it is often preventable. Knowing the warning signs for suicide and how to get help can help save lives. Learn about behaviors that may be a sign that someone is thinking about suicide. For more information, visit https://go.usa.gov/xVCyZ  #shareNIMH

5 Action Steps for Helping Someone in Emotional Pain

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NIMH Experts Discuss Youth Suicide Prevention: Learn how to talk to youth about suicide risk, how to identify the warning signs of suicide, risk factors for suicide, and about NIMH-supported research on interventions for youth suicide prevention.

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Hope Through Early Prevention and Intervention: Share information on NIMH research efforts to identify at-risk individuals, help them improve quality of life, and prevent suicide attempts.

NIH Experts Discuss the Intersection of Suicide and Substance Use : Learn about common risk factors, populations at elevated risk, suicides by drug overdose, treatments, prevention, and resources for finding help.

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IACP Suicide Prevention Sample Presentations

This section includes numerous PowerPoint presentations on a wide range of suicide-related topics. These presentations are provided for educational purposes and as a resource for agencies looking to create their own similar presentations. Advance through the slides to view all information.

General Suicide Presentations National Strategy for Suicide Prevention: Goals and Objectives for Action Retooling the Village [FRCPI] Suicide Epidemiology in the United States, (2004) NCSPT Suicide Preventability Workshop Trends in Rates and Methods of Suicide, Harvard Injury Control Research Center and SPRC Florida’s Commitment to Suicide Prevention [FRCPI]

Law Enforcement Suicide Overview Police Suicide: In Harm’s Way II [FRPCI] Stress Behind the Badge: Understanding The Law Enforcement Culture and How It Affects The Officer and Family…Plus Tools and Skills To Overcome The Challenges [FRPCI] Death by Their Own Hand: Have We Failed to Protect Our Protectors? [LASD] Code of Silence/Culture of Suicide: Why Law Enforcement Officers Keep Killing Themselves Despite Our Prevention Efforts [LAPD]

Law Enforcement Suicide Prevention and Intervention Dealing with Depression & Suicide Situations: Tactics for Prevention and Intervention [SBSD] Law Enforcement Suicide: Tactics for Prevention and Intervention [FRCPI] Law Enforcement Suicide: Prevention, Intervention and Postvention [LASD]  

More Sample Suicide Prevention Program Materials

• Initial Program Development Guidance
• Sample Suicide Prevention Materials
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• Sample Funeral Protocols

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People often keep it a secret, but the urge to self-harm isn’t uncommon, especially in adolescents and young adults. Many overcome it with treatment.

Whether a person has recently started hurting themself or has been doing it for a while, there is an opportunity to improve health and reduce behaviors. Talking to a doctor or a trusted friend or family member is the first step towards understanding your behavior and finding relief.

What Is Self-Harm?

Self-harm or self-injury means hurting yourself on purpose. One common method is cutting with a sharp object. But any time someone deliberately hurts themself is classified as self-harm. Some people feel an impulse to cause burns, pull out hair or pick at wounds to prevent healing. Extreme injuries can result in broken bones.

Hurting yourself—or thinking about hurting yourself—is a sign of emotional distress. These uncomfortable emotions may grow more intense if a person continues to use self-harm as a coping mechanism. Learning other ways to tolerate the mental pain will make you stronger in the long term.

Self-harm also causes feelings of shame. The scars caused by frequent cutting or burning can be permanent. Drinking alcohol or doing drugs while hurting yourself increases the risk of a more severe injury than intended. And it takes time and energy away from other things you value. Skipping classes to change bandages or avoiding social occasions to prevent people from seeing your scars is a sign that your habit is negatively affecting work and relationships.

Why People Self-Harm

Self-harm is not a mental illness, but a behavior that indicates a need for better coping skills. Several illnesses are associated with it, including borderline personality disorder, depression, eating disorders, anxiety or posttraumatic distress disorder.

Self-harm occurs most often during the teenage and young adult years, though it can also happen later in life. Those at the most risk are people who have experienced trauma, neglect or abuse. For instance, if a person grew up in an unstable family, it might have become a coping mechanism. If a person binge drinks or uses illicit drugs, they are at greater risk of self-injury, because alcohol and drugs lower self-control.

The urge to hurt yourself may start with overwhelming anger, frustration or pain. When a person is not sure how to deal with emotions, or learned as a child to hide emotions, self-harm may feel like a release. Sometimes, injuring yourself stimulates the body’s endorphins or pain-killing hormones, thus raising their mood. Or if a person doesn’t feel many emotions, they might cause themself pain in order to feel something “real” to replace emotional numbness.

Once a person injures themself, they may experience shame and guilt. If the shame leads to intense negative feelings, that person may hurt themself again. The behavior can thus become a dangerous cycle and a long-time habit. Some people even create rituals around it.

Self-harm isn’t the same as attempting suicide. However, it is a symptom of emotional pain that should be taken seriously. If someone is hurting themself, they may be at an increased risk of feeling suicidal. It’s important to find treatment for the underlying emotions.

Treatment And Coping

There are effective treatments for self-harm that can allow a person to feel in control again. Psychotherapy is important to any treatment plan. Self-harm may feel necessary to manage emotions, so a person will need to learn new coping mechanisms.

The first step in getting help is talking to a trusted adult, friend or medical professional who is familiar with the subject, ideally a psychiatrist. A psychiatrist will ask that person questions about their health, life history and any injurious behaviors in the past and present. This conversation, called a diagnostic interview, may last an hour or more. Doctors can’t use blood tests or physical exams to diagnose mental illness, so they rely on detailed information from the individual. The more information that person can give, the better the treatment plan will be.

Depending on any underlying illness, a doctor may prescribe medication to help with difficult emotions. For someone with depression, for instance, an antidepressant may lessen harmful urges.

A doctor will also recommend therapy to help a person learn new behaviors, if self-injury has become a habit. Several different kinds of therapy can help, depending on the diagnosis.

• Psychodynamic therapy  focuses on exploring past experiences and emotions
• Cognitive behavioral therapy  focuses on recognizing negative thought patterns and increasing coping skills
• Dialectical behavioral therapy  can help a person learn positive coping methods

If your symptoms are overwhelming or severe, your doctor may recommend a short stay in a psychiatric hospital. A hospital offers a safe environment where you can focus your energy on treatment.

What To Do When Someone Self-Harms

Perhaps you have noticed a friend or family member with frequent bruises or bandages. If someone is wearing long sleeves and pants even in hot weather, they may be trying to hide injuries or scarring.

Keep in mind that this is a behavior that might be part of a larger condition and there may be additional signs of emotional distress. They might make statements that sound hopeless or worthless, have poor impulse control, or have difficulty getting along with others.

If you’re worried a family member or friend might be hurting themself, ask them how they’re doing and be prepared to listen to the answer, even if it makes you uncomfortable. This may be a hard subject to understand. One of the best things is to tell them that while you may not fully understand, you’ll be there to help. Don’t dismiss emotions or try to turn it into a joke.

Gently encourage someone to get treatment by stating that self-harm isn’t uncommon and doctors and therapists can help. If possible, offer to help find treatment. But don’t go on the offensive and don’t try to make the person promise to stop, as it takes more than willpower to quit.

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NAMI HelpLine is available M-F, 10 a.m. – 10 p.m. ET. Call 800-950-6264 , text “helpline” to 62640 , or chat online. In a crisis, call or text 988 (24/7).

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• Volume 19, Issue 3
• Interventions to prevent self-harm: what does the evidence say?
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• Kate E Saunders 1 , 2 ,
• Katharine A Smith 1 , 2 , 3
• 1 Department of Psychiatry , University of Oxford, Warneford Hospital , Oxford , UK;
• 2 Oxford Health NHS Foundation Trust, Warneford Hospital , Oxford , UK;
• 3 NIHR Oxford Cognitive Health Clinical Research Facility, Warneford Hospital , Oxford , UK
• Correspondence to Dr Kate E Saunders, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK; kate.saunders{at}psych.ox.ac.uk

Self-harm is a major public health concern and a risk factor for future suicide. It predominantly occurs in young people with around 65% of self-harm occurring before the age of 35. Self-harm causes distress to families and is associated with poorer educational outcomes as well as increased health and social care costs. Repetition is common with a quarter of individuals presenting to hospital with a further episode of self-harm within a year. We review the evidence from randomised controlled trials of treatments for self-harm, focusing on pharmacological and psychological approaches. We then contrast this with the current observational evidence and reflect on the challenges and limitations of randomised controlled trials for the treatment of self-harm.

https://doi.org/10.1136/eb-2016-102420

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Introduction

Self-harm (SH) refers to intentional self-poisoning or self-injury, irrespective of motive or the extent of suicidal intent. 1 Thus, it includes acts intended to result in suicide (sometimes referred to as ‘attempted suicide’), those without suicidal intent (eg, to communicate distress or reduce unpleasant feelings) and those with a mixed (or unclear) motivation. It is a major public health concern and a common cause of assessment, treatment and admission to general hospitals. 2 However, the majority of those who SH do not present to hospital, and community prevalence is estimated to be as high as 20% in those aged 15 years. 3 SH presentations increase significantly from the age of 12 years and decline from the mid-20s onwards. 4 Repetition of SH is common, with up to 25% of individuals who present to hospital following SH returning to the same hospital following further SH within a year. Repetition is also frequent (54.8%) in adolescents who do not present to clinical services. 5 At least 80% of individuals presenting to hospital following SH are suffering from at least one mental disorder 6 (including major depression, bipolar disorder, anxiety and substance misuse, often in combination with personality disorders). However, the aetiology is complex; SH is often associated with acute life events, often against a background of longer term social and personal difficulties (such as relationship problems, financial difficulties or social isolation). A history of SH is associated with a significantly increased risk of subsequent suicide. 7 One to three per cent of those who present to hospital after SH will die by suicide in the following year. 7 Of those who die by suicide, over 50% have a history of SH and 15% have presented to hospital with SH in the preceding year. 8 SH is not only a problem in terms of healthcare. It is also associated with poorer educational outcomes as well as significant health and social care costs. 9 , 10 Improving the treatment of SH has been a focus of a number of national and international guidelines, 1 , 11 although the paucity of evidence for effective treatments has been highlighted. 12 The aetiology of SH is complex, encompassing not only mental health problems, but also psychological and social influences. Treatment options to be appraised should include pharmacological and psychological treatments, and studies of the role of social and societal change. As SH is a problem that often emerges during the teenage years, it is important to encompass studies in children and adolescents as well as adults.

To identify relevant evidence for the treatment and clinical management (whether short or long term) of SH, we searched PubMed, PsycINFO, Google Scholar and the Cochrane Library for systematic reviews and meta-analyses of randomised controlled trials (RCTs) published between 1980 and May 2016. No language constraints were applied and the following key words were used: self-harm, suicide attempt, non-suicidal self-injury, treatment . In case of multiple publications on the same topic, only the most recent or most comprehensive article was considered. The reference lists of reports identified were used to find additional publications.

Three Cochrane reviews were identified 13–15 which focused on pharmacological treatments, psychological treatments and interventions for children and adolescents. These Cochrane reviews are related. They were completed by the same group of authors (encompassing experts in suicide research in the UK, Ireland, Australia and Belgium), and the three together update a single Cochrane review originally published in 1999. The update was divided into three reviews to allow space for the assessment of secondary outcomes where possible.

Pharmacological treatments for SH

Given the high prevalence of depressive illness and depressive symptoms in people who SH, 6 antidepressants would seem to be possible candidates for prevention of recurrence. Mood stabilisers may also be a possibility, as there is evidence of a specific antisuicidal effect of lithium when used to treat people with affective disorders. 16 Antipsychotic medication, particularly in low doses, might also be considered, especially in those who frequently repeat SH, and or those with a diagnosis of borderline personality disorder.

The Cochrane review included seven RCTs with a total of 546 patients. 14 Interestingly, the reviewers did not find any new trials when they searched for this update, compared with their original search for the 1999 Cochrane review. 12 It is not clear why this might be, but the difficulties in conducting RCTs of in this group in general are particularly pronounced when considering drug treatment. All studies were assessed using the risk of bias tool 17 and were reported as being of low or very low quality, and no data on adverse events were reported. Information on psychiatric diagnosis was reported only in some trials and additional comorbidity in only one trial. Thus, it was not possible to make any association between the effects of different types of pharmacological treatment on repetition of SH according to diagnostic group.

Meta-analysis revealed no significant treatment effects on repetition of SH for antidepressants (OR 0.76, 95% CI 0.42 to 0.36), lithium (0.99, 0.33 to 2.95), low-dose fluphenazine (1.51, 0.50 to 4.58) or natural products (1.33, 0.38 to 4.62). The antipsychotic flupenthixol was found to significantly reduce SH in a single trial (0.09, 0.02 to 0.50) but numbers were small (n=30). These findings are in contrast to the observational data, particularly for lithium. The Cochrane review's analysis (of 167 participants) found no beneficial effect for lithium on repetition of SH, or on the secondary outcomes of depression score, hopelessness, suicidal ideation or suicide. Although with such a relatively small number of participants, it is very unlikely that there was sufficient power to show an effect on a relatively rare event such as suicide, the other data are somewhat surprising, given the evidence supporting the role of lithium in the reduction of suicidal behaviour. A systematic review and meta-analysis of 48 RCTs of lithium in 6674 patients with mood disorders found that lithium was more effective than placebo at reducing suicides but had little discernible effect on SH. 16 However, the results of a number of observational studies suggest that lithium may reduce SH 18 , 19 when compared with other anticonvulsants. In the specific population of patients with bipolar disorder, a recent large (n=14 396) population-based electronic health records study 20 showed that rates of SH and unintentional injury were lower in the group treated with lithium compared with other mood stabilisers (valproate, olanzapine, quetiapine). It has been argued that the findings may be confounded by the secondary benefits of being on lithium (such as repeated blood tests, more clinic attendances). However, in a large naturalistic longitudinal study of non-fatal SH in individuals with bipolar disorder which replicated the protective effects of lithium, no difference was observed in the number of physician contacts in patients on lithium compared with those on other medications.

Other potential treatments such as ketamine and buprenorphine were not included in the review. There is an emerging evidence to support a rapid antidepressant effect of ketamine, a glutamate N-methyl-d-aspartate receptor antagonist, in the treatment of unipolar and bipolar depression. 21 , 22 In depressed patients in the emergency department, a rapid reduction in suicidal ideation was observed following an intravenous infusion of ketamine with the reduction being maintained for up to 10 days. 23 Suicidal cognition was eradicated in patients with depression given three times weekly infusions. Recent evidence suggests that these effects are mediated by the reduction in non-suicide-related depressive symptoms. 24 Open-label studies investigating suicidal ideation and anhedonia suggest that both are reduced after acute intravenous ketamine. 25 Further studies are needed to assess whether this effect is related to the antidepressant effect or is independent of it. In a multisite randomised, double-blind, placebo-controlled trial, ultra low-dose sublingual buprenorphine was associated with a significant reduction in Beck Suicidal Ideation Scores at 2 and 4 weeks in severely suicidal patients without substance abuse. 26

Electroconvulsive therapy (ECT) is widely acknowledged as an effective treatment for severe depressive episodes and is cited as a treatment for suicidal behaviour by the American Psychiatric Association. 26 In some observational studies, ECT appears to significantly reduce the frequency of suicide attempts in depressed patients. 27 , 28 While none of these approaches are included in the Cochrane review as no RCTs are yet available, initial findings suggest that they may be a helpful approach in the treatment of SH.

Psychological treatments

This Cochrane review identified 55 RCTs for psychological interventions for SH. 13 The most common treatment modality was cognitive behavioural therapy (CBT)-based psychological therapy (18 trials). The majority of these trials explored the effects of a 1:1 intervention delivered in fewer than 10 sessions. The remaining 37 trials evaluated a range of other psychological interventions including dialectical behavioural therapy (DBT), mentalisation-based therapy (MBT), group-based psychotherapy and remote contact interventions (postcards, emergency cards, telephone contact). A significant treatment effect for CBT-based therapy compared with treatment as usual was observed with respect to repetition of SH (OR 0.70, 95% CI 0.55 to 0.88) although no reduction in the frequency of SH was found. While just 6% fewer people repeated SH following CBT, improvements in mood, hopelessness and suicidal thoughts were also observed. Most studies were small in nature and there was considerable variability between trial outcomes. The effects of the other therapeutic approaches remain unclear as they were mostly evaluated in small single studies. The evaluation of psychological treatments within an RCT is more challenging than that of pharmacological treatments as patients and therapists are aware of the treatment modality that they are receiving such that true blinding cannot be achieved. There is also the issue of the comparison arm of the trial. In the review, all ‘active’ treatments were compared with ‘treatment as usual’. While this addresses to some extent the non-specific effects of any type of psychological treatment (face-to-face contact, feeling that another individual is listening, etc), treatment as usual varies between centres in each country and between countries. This means that combining the studies together in a meta-analysis, while increasing the power, is not strictly comparing like with like.

In addition, the studies of psychological treatments did not routinely document the ‘fidelity’ to the treatments. In other words, we do not know for certain how many of the offered sessions (either active treatment or treatment as usual) the participant actually attended. In addition, we cannot be certain how closely therapists adhered to the manualised therapy. So, by drawing a parallel with pharmacological studies, we do not know the ‘dose’ of active or placebo treatment that the participants received. While the findings for brief CBT-like therapy are encouraging, the trials did not identify for whom this intervention would be most effective. This is important—while the data suggest the best evidence that we have is that CBT should be offered to those who SH, we do not know whether it should be offered to all or a subgroup. Given the finite resources in psychological services, identifying the ‘active’ elements of the CBT intervention is a key question. Only studies comparing the full CBT intervention with the same intervention but missing a defined key element could answer this question.

Implementing this strategy into clinical care also presents other problems. Only a small percentage present to services following SH, 29 so hospital-based interventions will inevitably miss a significant number of the target population. In addition, psychiatric services are focused on providing treatment resources to those with a diagnosed mental illness, and many patients with SH will not meet standardised criteria. The most persuasive argument for implementing such a service would be an economic one. SH carries a significant direct and indirect cost in healthcare (in addition to the costs to the individual and their family). 10 Future studies of CBT would be enhanced by including assessments of healthcare costs as an integral part of the study. While CBT is the most widely available modality of psychological treatment in the UK following the launch of the IAPT (Improving Access to Psychological Therapies) scheme, 30 those who SH or are expressing suicidal ideation are often deemed too high risk to be eligible and are referred to specialist services where waiting times are often much longer. The single trials of other psychotherapies that were associated with favourable outcomes, for example, DBT and MBT, were all conducted in patients diagnosed with borderline personality disorder. The use of a specified diagnostic group means that there is clearer and more consistent framework for psychological intervention and understanding of SH as well as a more homogeneous patient group.

Treatments for children and young people

In their third Cochrane review Hawton et al 15 identified only 11 trials of interventions for SH in children and adolescents. This was a surprisingly low number of trials, given that under 18s are a key target age group for SH interventions and suicidality is a relevant clinical issue in child and adolescent psychiatry. 31 , 32 Most interventions were limited to single trials and the quality of the evidence was mostly graded as low. No trials of pharmacological interventions were identified. Neither group-based therapy nor DBT (adapted for use in adolescents) was found to be associated with a reduction in the proportion of participants engaging in SH compared with treatment as usual (OR 0.72, 0.12 to 4.40 and 1.72, 0.56 to 5.24 for DBT and group therapy, respectively), although a reduction in the frequency of SH over time was observed following DBT. There were also significantly greater reductions in depression, hopelessness and suicidal ideation in this group. MBT was associated with fewer adolescents scoring above the cut-off for repetition of SH based on the Risk-Taking and Self-Harm Inventory 12 months postintervention, although this study was limited to individuals who had multiple episodes of SH or emerging personality problem.

School-based interventions were not included in the review as they generally target individuals irrespective of whether they have self-harmed or not. In a recent multicentre cluster RCT, a Youth Aware of Mental Health Programme intervention significantly reduced the incidence of suicide attempts (OR 0.45, 0.24 to 0.85) and suicidal ideation at 12-month follow-up (0.50, 0.27 to 0.92) compared with the control group. The reported reduction was more than 50% compared with the control group. Similar reductions were not associated with a manualised gatekeeper programme or screening for high-risk individuals by professionals. 33 However, there are concerns about large-scale implementation of interventions in schools. While it is logical to focus on schoolchildren at an early age before SH is likely to start, careful assessment of risk needs to be undertaken. It is possible that interventions may harm as well as benefit. For the child and adolescent population, the issue of ‘contagion’ is particularly important (Hawton 2012). 34

Methodological challenges in designing studies to assess the efficacy of interventions for self-harm

Methodological challenges in assessing the efficacy of interventions for self-harm:

Heterogeneity of a study population recruited on the basis of a behaviour;

Which population to study;

Definitions of self-harm;

Study context;

Timing of intervention;

Time to follow-up;

Ethics of randomising suicidal patients;

Finding an appropriate control intervention (particularly in psychological treatment trials).

SH describes a range of different behaviours and is associated with nearly all mental disorders. 6 The reasons for SH vary widely as to the methods and lethality. While a number of models for the emergence of SH and suicidality have been proposed, all highlight the complex nature of the behaviour and none provide a clear single focus for intervention. In view of the heterogeneous nature of the SH as well as the absence of a mechanistically valid treatment target, it is not surprising that treatment effects are small at best. Data from the treatment of specific disorders, for example, mood disorders indicate that significant reductions in SH can be achieved by targeting the disorder rather than the SH per se. 16 The settings in which individuals who SH are most commonly encountered are the emergency department, general practice or in education. All of the treatment trials included in the three Cochrane reviews were limited to trials conducted in inpatient or outpatient settings which further limits the generalisability of the findings.

The three Cochrane reviews identified highlight the challenges of testing interventions for a SH that are generalisable to routine clinical practice. They summarise the available randomised controlled evidence available, and therefore provide useful suggestions for effective therapies and inform areas for further research. However, the reliance on RCT data, while methodologically robust, leads to a limited summary of the available evidence and overlooks a number of important interventions for the reduction of SH. Given the many ethical and methodological challenges inherent in RCTs for SH, observational data are an important complementary source of evidence which is generalisable to clinical and non-clinical settings. In conclusion, there is limited RCT evidence for interventions for SH, whereas observational studies in specific diagnostic group highlight a number of effective treatments, in particular lithium.

Acknowledgments

The authors acknowledge support from the NIHR Oxford Cognitive Health Clinical Research Facility.

• ↵ National Institute for Health and Clinical Excellence . Self-harm: longer term management 2011. NICE guideline (CG133) .
• Bennewith OM ,
• Gunnell D , et al
• ↵ http://www.hbsc.org/ (accessed 25 Jun 2016 ).
• Geulayov G ,
• Turnbull P , et al
• Evans E , et al
• Saunders KEA ,
• Topiwala A , et al
• Carroll R ,
• Metcalfe C ,
• Crane C , et al
• Sinclair JM ,
• Rivero-Arias O , et al
• ↵ World Health Organization . Preventing suicide: a global imperative . 2014 . http://www.who.int/mental_health/suicideprevention/world_report_2014/en/ (accessed 15 Jun 2016 ).
• Townsend E ,
• Arensman E , et al
• Taylor Salibury TL , et al
• Taylor Salisbury TL , et al
• Cipriani A ,
• Stockton S , et al
• Higgins JPT ,
• Baldessarini RJ ,
• Davis P , et al
• Goodwin FK ,
• Fireman B ,
• Simon GE , et al
• Marston L , et al
• McCloud TL , et al
• McCloud TL ,
• Jochim J , et al
• Kashani P ,
• Yousefian S ,
• Amini A , et al
• Iosifescu DV ,
• Murrough JW , et al
• Schwartz J ,
• MUrrough JW ,
• Iosifescu DV
• Mashiah M , et al
• ↵ American Psychiatric Association . Practice guideline for the assessment and treatment of patients with suicidal behaviours. http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/suicide.pdf (accessed 24 Jun 2016 ).
• Brådvik L ,
• Mcmahon EM ,
• Cannon M , et al
• ↵ http://cep.lse.ac.uk/textonly/research/mentalhealth/DEPRESSION_REPORT_LAYARD2.pdf (accessed 22 Jun 2016 ).
• Giovane CD , et al
• Mavridis D ,
• Giannatsi M ,
• Cipriani A , et al
• Wasserman D ,
• Wasserman C , et al
• O'Connor RC

Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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Self Harm Awareness: CPD for Staff

Subject: Whole school

Age range: Age not applicable

Resource type: Other

Last updated

13 February 2022

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An easy to follow, informative PowerPoint addressing four focal questions:

• What is self-harm?
• Why might young people self-harm?
• What signs should I look out for?
• How can I respond helpfully?

This can be used as a 30 minute staff information session or a 90 minute interactive seminar with optional discussion points included. This resource is suitable for all student supporting staff including general teaching staff, support staff and safeguarding team.

School specific safeguarding policy can be added into the powerpoint.

This resource has been created by a Dr. in clinical psychology and an experienced Physical Education teacher to combine mental health and teaching expertise.

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Emergency department presentations with suicide and self-harm ideation: a missed opportunity for intervention?

Affiliations.

• 1 Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
• 2 Service Development, Screening and Health Improvement, Public Health Agency, Ballymena, Northern Ireland.
• PMID: 37069827
• PMCID: PMC10130835
• DOI: 10.1017/S2045796023000203

Aims: Suicidal ideation constitutes a central element of most theories of suicide and is the defining facet separating suicide from other causes of death such as accidents. However, despite a high worldwide prevalence, most research has focused on suicidal behaviours, such as completed suicide and suicide attempts, while the greater proportion who experienced ideation, which frequently precedes suicidal behaviour, have received much less attention. This study aims to examine the characteristics of those presenting to EDs with suicidal ideation and quantify the associated risk of suicide and other causes of death.

Methods: Retrospective cohort study was performed based on population-wide health administration data linked to data from the Northern Ireland Registry of Self-Harm and centrally held mortality records from April 2012 to December 2019. Mortality data, coded as suicide, all-external causes and all-cause mortality were analysed using Cox proportional hazards. Additional cause-specific analyses included accidental deaths, deaths from natural causes and drug and alcohol-related causes.

Results: There were 1,662,118 individuals aged over 10 years, of whom 15,267 presented to the ED with ideation during the study period. Individuals with ideation had a 10-fold increased risk of death from suicide (hazard ratio [HR adj ] = 10.84, 95% confidence interval [CI] 9.18, 12.80) and from all-external causes (HR adj = 10.65, 95% CI 9.66, 11.74) and a threefold risk of death from all-causes (HR adj = 3.01, 95% CI 2.84, 3.20). Further cause-specific analyses indicated that risk of accidental death (HR adj = 8.24, 95% CI 6.29, 10.81), drug-related (HR adj = 15.17, 95% CI 11.36, 20.26) and alcohol-related (HR adj = 10.57, 95% CI 9.07, 12.31) has also significantly increased. There were few socio-demographic and economic characteristics that would identify which of these patients are most at risk of suicide or other causes of death.

Conclusions: Identifying people with suicidal ideation is recognized to be both important but difficult in practice; this study shows that presentations to EDs with self-harm or suicide ideation represent an important potential intervention point for this hard-to-reach vulnerable population. However, and unlike individuals presenting with self-harm, clinical guidelines for the management and recommended best practice and care of these individuals are lacking. Whilst suicide prevention may be the primary focus of interventions aimed at those experiencing self-harm and suicide ideation, death from other preventable causes, especially substance misuse, should also be a cause of concern.

Keywords: alcohol abuse; epidemiology; mental health; suicide; suicide ideation.

• Emergency Service, Hospital
• Retrospective Studies
• Self-Injurious Behavior* / epidemiology
• Suicidal Ideation
• Suicide, Attempted