FMH4 Support an individual to reduce the risk and impact of self-harming behaviour

Overview

This standard covers the assessment of the risk of individuals harming themselves, and, where a risk is identified, finding the means to reduce that risk in the immediate circumstances and longer term through the individuals’ care plans. This includes reducing the level of injury, both emotional and physical, caused by self-harming behaviours. Gender issues may need consideration too, for instance with women who have experienced past physical or sexual abuse. All members of the multidisciplinary team need to know and support the care plan through the Care Programme Approach in order to achieve clarity and consistency of management. Users of this standard will need to ensure that practice reflects up to date information and policies. Version No 1

Knowledge and Understanding

You will need to know and understand:

1. clinical assessment
2. risk assessment
3. mental health disorders
4. drug, alcohol or substance misuse
5. the psychology of self harm, para suicide and suicide
6. the principles and practice of harm reduction programmes in self-harming behaviours
7. national standards and guidelines
8. the range of treatments available at your own and other establishments
9. enquiry reports on forensic mental health settings, including recommendations and analysis of practice in the treatment of individuals
10. protocols for avoiding individuals’ self harm
11. negotiation, conflict resolution, empathy and reassurance in working with self-harming behaviour
12. techniques of questioning, discussion and conversation
13. unconditional positive regard and supportive counselling techniques
14. the religious beliefs of different cultures
15. the effects of culture and religious beliefs on individual communication styles
16. the different features services must have to meet people’s gender, culture, language or other needs
17. the effects of different cultures and religions on care management
18. the principle of confidentiality and what information may be given to whom
19. how information obtained from individuals should be recorded and stored (eg for audit)
20. local policy and governance arrangements

Performance Criteria

You must be able to do the following:

1. assess the lethality of the individual’s previous self-harming behaviour
2. identify the triggers and the function of the self-harming behaviour
3. identify changes in mood and behaviour that indicate an increase in the risk of self harm
4. identify the individual’s perception of self harm, the triggers and the reasons for its use as a coping strategy (including gender specific issues)
5. develop a formulation of the self-harming behaviour
6. identify the therapeutic needs of the individual (e.g. to develop coping skills to replace the self-harming behaviour)
7. maintain opportunities for engagement with the individual to collaborate on addressing the problems that are most important to them (e.g. recreational activities, conversation)
8. share the formulation with the team
9. update the individual’s care plan to help them deal with the problems that create the risk of self harm (e.g. introduce new psychosocial therapeutic measures)
10. implement agreed procedures to engage with and monitor the individual proportionate to the risk of self harm, and consistent with the individual’s clinical needs and, where possible, Advance Statement
11. make environmental changes to reduce access to the means of self harm without excessively restricting the individual’s activities (e.g. calmness and space)
12. review relational, procedural and environmental measures frequently.

Additional Information

This National Occupational Standard was developed by Skills for Health. This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004): Dimension: HWB3 Protection of health and wellbeing