Quality standard

Quality statement 2: Initial assessments

Quality statement 2: Initial assessments

Quality statement

People who have self‑harmed have an initial assessment of physical health, mental state, safeguarding concerns, social circumstances and immediate concerns about their safety.

Rationale

An initial assessment can identify ways to keep the person safe after an episode of self-harm and can be used to inform future safety plans and referral. People who have self-harmed value positive, compassionate support after an episode of self-harm.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that initial assessments of people who have self‑harmed include physical health, mental state, safeguarding concerns, social circumstances and immediate concerns about their safety.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Process

Proportion of people who have self‑harmed who have an initial assessment of physical health, mental state, safeguarding concerns, social circumstances and immediate concerns about their safety.

Numerator – the number of people in the denominator who have an initial assessment of physical health, mental state, safeguarding concerns, social circumstances and immediate concerns about their safety.

Denominator – the number of people with a new episode of self‑harm.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers ensure that people who have self‑harmed have an initial assessment after an episode of self‑harm that includes physical health, mental state, safeguarding concerns, social circumstances and immedicate concerns about their safety.

Healthcare professionals ensure that people who have self‑harmed have an initial assessment after an episode of self‑harm that includes physical health, mental state, safeguarding concerns, social circumstances and immediate concerns about their safety.

Commissioners ensure that they commission services that undertake an initial assessment of physical health, mental state, safeguarding concerns, social circumstances and immediate concerns about their safety for people after an episode of self‑harm.

People who have self‑harmed have their physical health, mental state, social circumstances and immediate concerns about their safety assessed after an episode of self‑harm.

Source guidance

Self-harm: assessment, management and preventing recurrence. NICE guideline NG225 (2022), recommendations 1.3.1, 1.7.1, 1.7.9 and 1.7.12

Definitions of terms used in this quality statement

People who have self‑harmed

People who have carried out intentional self‑poisoning or injury, irrespective of the apparent purpose of the act. [Adapted from NICE's guideline on self-harm, terms used in this guideline; self-harm]

Initial assessment

The first assessment by a healthcare professional after an episode of self‑harm. It applies to people first seen in primary care, ambulance services, emergency departments or minor injury units. It also applies to the first assessment of episodes of self‑harm in inpatient settings. An initial assessment should be undertaken each time a person presents with an episode of self‑harm. It should include, relevent to the setting:

  • information about the home environment

  • information about the social and family support network

  • the history leading to self-harm

  • any medicines found at their home

  • the severity of the injury and how urgently medical treatment is needed

  • the person's emotional and mental state, and level of distress

  • whether there is immediate concern about the person's safety

  • whether there are any safeguarding concerns

  • whether the person has a care plan

  • the person's willingness to accept medical treatment and mental healthcare

  • the appropriate nursing observation level

  • if there is a need to refer the person to a specialist mental health service for assessment.

[Adpated from NICE's guideline on self-harm, recommendations 1.7.2, 1.7.9, and 1.7.12, and expert opinion]