Working with children and adults who may be at risk of self harm: practice guidance

4. PROTECTION AND SUPPORT FOR THOSE WHO SELF-HARM

Children and Young People

When children need extra help, they should have a Child’s Plan that is coordinated by the Named Person if it is a single agency plan or Lead Professional if two or more agencies need to work together to help the child. The Getting it right for every child approach means that the National Practice Model will inform assessment, planning and the action that is to be taken by the partners to the plan. It also supports those involved to monitor the effectiveness of any help given. This can be used in a single- or multi-agency context. It promotes the participation of children and their families in gathering information and making decisions. It combines knowledge, theory and good practice and focuses on improved outcomes for the child in question.

As with any child who requires extra help, those who may be at risk of harm should have a Child’s Plan to address their needs and improve their wellbeing. It is likely for this group of children that other agencies will need to become involved, either to contribute to the assessment or to offer services as part of the Child’s Plan. The Named Person or Lead Professional, in consultation with the child, the parent or carer and others involved with the child, will arrange for such help. Further information can be found at http://www.scotland.gov.uk/Publications/2010/07/19145422/0.

There may be concerns about the well-being of a young person who self-harms because of the nature of the social circumstances in which they live. For example, (1) a young person - say, caring for a parent with a chronic illness - who self-harms daily by cutting to manage difficult emotions about their circumstances; or (2) because of the frequent and potential lethality of their behaviour, a young person who frequently ties ligatures around their neck and often contemplates taking their own life; or (3) because they live in a household where a parent or guardian is self-harming for whatever reason.

Practitioners who are concerned will need to take all possible circumstances into account during any initial assessment and treatment and decide whether the concerns about the child or young person’s well-being warrant involvement of other agencies. In instances where social circumstances are relevant to the self-harming behaviour, or where repeated self-harm is potentially dangerous, or where a parent or guardian is self-harming, a multi-agency action plan will need to be developed. Such plans need to be based on a comprehensive assessment of the young person’s health, educational and social needs using the GIRFEC National Practice Model, supplemented by any specialist assessment as appropriate.

In endeavouring to serve the needs of young people with complex needs, care should be taken to ensure that the involvement of one agency does not result in the decrease or even removal of another agency from involvement in any agreed care plan. This is never helpful nor is it consistent with prioritising the needs of the young person. It is important that the Lead Professional addresses this in their role of co-ordinating multi-agency planning and making sure that the different services provide a network of support around the child in a seamless, timely and proportionate way. Staff, child and family need to ensure that they understand each other’s roles and responsibilities in supporting a child who self-harms.

Support, treatment and protection can be particularly challenging in the context where a child is at high risk due to the seriousness of their self-harming behaviour and where there is a need to balance their immediate safety with improving longer term outcomes. In such situations a multi-agency approach is best to agree the balance of risks and benefits of different treatment options, thus ensuring the development of a clear and manageable Child’s Plan. In some circumstances self-harm may be symptomatic of other concerns experienced by a child, for example, child abuse. In such instances child protection measures - as outlined in the National Guidance for Child Protection in Scotland 2010 www.scotland.gov.uk/publications/2010/12/09134441/0 may need to be considered, but any interventions to protect the child should also include supporting a child who self harms.

Adults

In the case of adults, a key worker or care coordinator may need to ensure that other relevant services are alerted to the possible need for assessment, with any necessary protection procedures initiated. The Adult Support and Protection (Scotland) Act 2007 (the ASP Act) places a duty on local authorities and a range of public bodies, including health boards, to make inquiries when they know or suspect that an individual is or may be an adult at risk of harm. The ASP Act defines ‘harm’ to include self-harm.

The police have a key role in identification and referral of concerns about adults who are at risk from harm. Mechanisms should be in place to provide good multi-agency responses. A range of public bodies have duties of co-operation under the ASP Act, and a multi-agency approach is built into adult protection.

Beyond the initial duty to make inquiries, the ASP Act allows a range of actions to be taken to support and protect an adult. These include formal interventions under the ASP Act, such as removing the adult from a place where harm is occurring or is likely to occur. However, other actions can be taken under other statutes, particularly where the adult does not meet the conditions of the 3-point test, or through more informal methods, to ensure that an adult receives appropriate support and protection. This may include, for example, a care plan.

Practitioners should always be aware of the possible impact of an adult’s situation (such as that of an adult who self-harms) on the well-being of any children in that adult’s care and should be prepared to raise a concern if necessary, in line with the Getting it right for every child approach.