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In Fact, The Likely Distress Associated With Self-harm May Necessitate ...

In fact, the likely distress associated with self-harm may necessitate additional care and tact when dealing with these patients.
Also, health services are urged to provide appropriate training to all staff (clinical and non-clinical) that has any form of contact with the patients to fully equip them with the necessary skills and knowledge to effectively understand and care for people who have self-harmed. Ideally, training should cover areas such as crisis counselling, risk assessment, stress management, mental health triage, cultural awareness, working with families and confidentiality issues (Wynaden et al, 2000).
Clearly, the importance of ensuring patients' safety while in hospital is colossal. These patients should be offered an environment that is safe, supportive and minimises any distress. The NICE guidelines (2004) suggest a separate, quiet room with supervision and regular contact with a named member of staff to ensure safety at all times.
2.1.1 Assessment
The high rate of self-harm patients who repeatedly self-harm or go ahead to commit suicide in the future makes it imperative to conduct an extensive and detailed assessment of young people who self-harm. Young people who have self-harmed in a potentially serious or violent way should be assessed either by a child and adolescent psychiatrist, a specialist mental worker, a psychologist, a psychotherapist or a psychiatric nurse (Hawton and James, 2005). The NICE guidelines propose that all people who have self-harmed should be offered this preliminary assessment at triage, regardless of the severity of the attack. Apart from the obligatory emergency physical assessment, this will give an insight into the patient's mental health, the level of distress and their willingness to co-operate with the medical team. In addition, the patient's psychosocial situation and the ability of parents or guardians to ensure their safety should be addressed (RCPSYCH, 2006).
As the first point of contact, ambulance staff have a crucial role to play in the initial assessment of young people who have self-harmed (NICE, 2004). The Australian Mental Health Triage Scale is a validated comprehensive assessment scale that provides a means of efficiently rating clinical urgency so that patients can be seen in a timely manner. This scale has been shown to improve staff confidence and attitudes in dealing with clients with mental health problems, thus improving patients' outcomes in the long-run (Broadbent et al, 2004).
Research has shown the importance of cultural, ethnic and racial awareness and sensitivity in the assessment process. Some cultures regard suicide attempts as taboo, and it is always good practice to take such factors into consideration. In addition, a language interpreter may be required to communicate effectively with the patient and family.
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