Children and young people: deliberate self-harm with suicidal intent (Paediatric Guidelines)

Self-harm presentation in locality areas (Skye, Lochaber and Caithness):

• Discuss with CAMHS unscheduled care team for advice prior to transfer or discharge.
• Out of Hours presentations must be discussed the following working day. CAMHS do not offer weekend cover.

Deliberate self-harm presentation to A&E:

• Provide medical assessment and treatment as required.

• The admitting ward should make contact with the Phoenix Centre reception as soon as possible to alert the CAMHS team to the admission.
• Representatives from Highland Children’s Unit also attend the CAMHS daily huddle for joint co-ordination of daily clinical activities.
• Mental Health Assessment will then be carried out by a nurse from the CAMHS unscheduled care team at the soonest opportunity following self-harm, depending on young person/family engagement and CAMHS clinician availability.

Contact Details:

• Phoenix Centre: 01463 705 597
  nhshighland.phoenixcentre@nhs.scot

Working Hours:

• Duty Clinician available for advice: Monday to Friday: 9am to 5pm

• Complete Child Concern Form (CCF) 
• Parent / Carer to be informed of CCF completion.
• Child protection guidelines to be followed and form copied to Social work, Child Protection Advisor and Ward.
• Admission to Children's Ward advised. 

Admitting to Children’s ward.

• Ward staff to contact CAMHS Admin with details. If admitted after 5pm, call before 9am next working day.
• CAMHS Admin to liaise with Duty Clinician to arrange assessment.
• Mental Health Assessment will be carried out at the soonest opportunity following self-harm and depending on young person/family engagement and CAMHS clinician availability.
• Parents/carers to be present at CAMHS assessment.

Admission refused

• If patient / family refuse admission, this is to be documented in the CCF.
• If emergency detention criteria ARE NOT met: Discharge from A&E.
• If emergency detention criteria ARE met: follow information in that section. 

If emergency detention criteria ARE met: follow information in that section.

If emergency detention criteria ARE NOT met:

• If admission is required: Admit to Adult Medical Unit
• If admission is not required OR refused: Discharge from A&E

Admission

• Due to nature of admission and associated risk, it is advised that the patient remains on 1:1 observations until CAMHS assessment is undertaken and recommendations made.
• Should a patient wish to leave the ward against medical advice, the police should be contacted in line with usual safeguarding policies. This would typically apply to both, patients detained under the mental health act - where there is a statutory obligation of care in place, as well as patients admitted on a voluntary basis, as both instances may give rise to risk and child protection concerns.
• Ward staff to contact CAMHS Admin with details. If admitted after 5pm, call before 9am next working day.
• CAMHS Admin to liaise with CAMHS unscheduled care team to arrange assessment (assessment arrangements for children’s unit usually agreed at CAMHS daily huddle).
• Mental Health Assessment will be carried out at the soonest opportunity following self-harm and depending on young person/family engagement and CAMHS clinician availability.
• Parents/carers to be present at CAMHS assessment.

• Follow Adult Mental Health Protocol

• Contact CAMHS unscheduled care Team via CAMHS Admin: 01463 705597 Monday to Friday 9 to 5pm.
• An appropriate response will be agreed in line with young person’s clinical need. Ie an assessment at A&E or allocation to urgent assessment (within 7 days).
• Details required:
  • Patient details (Name, CHI Number, Address)
  • Contact telephone number
  • Clinical details
  • Updated medical status, where relevant.

If detention is being considered, it is best practice to make contact with:

• CAMHS duty Psychiatrist on 0146 705597 IF patient open to CAMHS (available Mon-Fri 9-5pm)
• or duty Mental Health Officer on 01463 702 156 who can offer appropriate guidance on correct application of the powers.
• For detailed information on application of detention powers and the law, see: Emergency detention certificate - emergency and short-term powers: (www.gov.scot)
• For mental health detention paperwork, please see: Emergency detention certificate 2017.pdf (www.gov.scot)