This audit is of particular relevance to those services providing assessments to children who self-harm. The original audit was conducted in a child and family psychiatry service covering children up to the age of 13.
The National Institute for Health and Clinical Excellence (NICE) produced a guideline on the topic of self-harm in 2004, with a section relating to the special provision for children and young people. It recommends that all those involved in triage, assessment and treatment should be ‘trained to work with children and young people who self-harm’ and should be ‘adequately trained to assess mental capacity in children of different ages and must understand how issues of capacity and consent apply to this group and have access at all times to specialist advice about these issues’. NICE further recommends that ‘All children and young people should normally be admitted into a paediatric ward under the overall care of a paediatrician and assessed fully the following day’ and the responsible paediatric team should ‘obtain consent for mental health assessment’.
ᐅ All patients should have a psychosocial assessment.
ᐅ Consent for a mental health assessment should be recorded in the case notes.
ᐅ The assessment should be performed by a clinician trained to work with children and young people.
ᐅ The parents or other responsible adult should be consulted in the process of the assessment.
ᐅ An assessment of risk should be recorded.
All patients presenting to accident and emergency (A&E) with self-harm were identified using the department's computer system. The search terms ‘self-harm’ and ‘overdose’ were used. The psychiatric case file was then accessed. Where there were no child or adult psychiatry notes, the A&E cards were examined. If they were also unavailable, the children's hospital medical notes were examined. The notes were inspected to determine the following:
ᐅ the nature of the self-harm and age of the patient
ᐅ whether a mental health assessment was requested
ᐅ whether consent for a mental health assessment was recorded by the requesting clinician
ᐅ whether the assessment was conducted by a clinician trained to work with children and young people
ᐅ whether a risk assessment was recorded
ᐅ whether the parents or other responsible adults were consulted.