# data[].attributes.body
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]

# data[].attributes.body
The Columbia-Suicide Severity Rating Scale (C-SSRS) is a unique suicide risk assessment tool that supports suicide risk assessment through a series of simple, plain-language questions that anyone can ask. The answers help users identify whether someone is at risk for suicide, assess the severity and immediacy of that risk, and gauge the level of support that the person needs. Users of the C-SSRS tool ask people:

Whether and when they have thought about suicide (ideation)

What actions they have taken—and when—to prepare for suicide

Whether and when they attempted suicide or began a suicide attempt that was either interrupted by another person or stopped of their own volition

# data[].attributes.body
1.7.1

When a person presents to a healthcare professional or social care practitioner following an episode of self-harm, the professional should:

establish the means of self-harm and, if accessible to the person, discuss removing this with therapeutic collaboration or negotiation, to keep the person safe

assess whether there are concerns about capacity, competence, consent or duty of care, and seek advice from a senior colleague or appropriate clinical support if necessary; be aware and accept that the person may have a different view and this needs to be taken into account

seek consent to liaise with those involved in the person's care (including family members and carers, as appropriate) to gather information to understand the context of and reasons for the self-harm

discuss with the person and their families or carers (as appropriate), their current support network, any safety plan or coping strategies.

When a person presents to a healthcare professional or social care practitioner following an episode of self-harm, the professional should establish the following as soon as possible:

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

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

# data[].attributes.attachment_link.readable_text
University can be a stressful experience, as well as being fun and exciting. You may feel stressed about starting university, exams, coursework deadlines, living with people you do not know, or thinking about the future.

Stress is a natural feeling, designed to help you cope in challenging situations. In small amounts it can be good, because it pushes you to work hard and do your best, such as during exams.

But if you're feeling very stressed or feel you cannot manage stress, it can lead to mental health problems such as depression and anxiety. It can also affect your academic performance.

Leaving home to start your studies can involve some stressful changes. These might include moving to a new area, meeting new people and managing on a tight budget.

Signs you might be stressed

There are lots of possible signs of stress.

Stress can make you feel:

irritable

anxious

like you cannot enjoy yourself

worried a lot of the time

You may start to:

have sleep problems (insomnia)

find it hard to concentrate

bite your nails, pick your skin or grind your teeth

snap at people

feel short of breath or breathe very fast

Things that can help with stress

Short periods of stress are normal and can often be resolved by something as simple as completing a task which cuts down your workload, or by talking to others and taking time to relax.

It might also help to:

Work out what it is that's making you feel stressed. For example, is it exams, money or relationship problems? See if you can change your circumstances to ease the pressure you're under.

Try to have a healthy lifestyle. Eat well, get enough sleep, be physically active, cut down on alcohol, and take time to relax as well as working and studying.

Read about the 5 steps to mental wellbeing.

Avoid drugs, including lots of caffeine - this can have a negative impact on your stress levels and wellbeing.

Try not to worry about the future or compare yourself with others.

Try relaxation and breathing exercises.

Try to plan your time to help you keep track of your work. Break it down into manageable chunks so you can keep up with deadlines.

Try talking to a friend, tutor or someone in your family about your stress.

Read about tips on preparing for exams

More information

When to get help for stress

You may want to consider getting help for stress if:

you're struggling to cope with stress

things you're trying yourself are not helping

stress is affecting your life or university work

You could try speaking to friends, family or your university tutor. A GP is also a good place to start and they can help you with advice or access to treatments if you need them.

Find out more about counselling for student mental health problems.

Video: stress

In this video, a GP describes what stress is, the physical and mental effects it can have and when to seek help.

# data[].attributes.attachment_link.description
How to cope with the pressures of student life, such as exams, money worries, and separation from friends and family.

# data[].attributes.body
At the earliest opportunity after an episode of self-harm, a mental health professional should carry out a psychosocial assessment to:

develop a collaborative therapeutic relationship with the person

begin to develop a shared understanding of why the person has self‑harmed

ensure that the person receives the care they need

give the person and their family members or carers (as appropriate) information about their condition and diagnosis.

However ,sometimes it is hard due to the environment, limited time ,and confidentiality in the school settings among the teenagers involving the patient. patient might appear withdrawn ,scared, and can refuse to collaborate. Involving family in the school settings can cause distress not only for the patient ,but also for other children.

# data[].attributes.body
While most exams naturally trigger stress in teenagers, certain factors and beliefs can dial up the pressure levels. These may include feeling unprepared through lack of revision or procrastination, coupled with fears of failure and/or catastrophic thoughts regarding poor results.  Stress levels typically peak during the exam period when there is intense preparation, revision, and grade-related worries, but they can still cause a significant impact on a students' mental and emotional well-being. As parents and carers, it’s not always easy to know how best to support young people through these times

# data[].attributes.attachment_link.title
Helping Teens Cope with Exam Stress & Pressure — Let’s all Talk Mental Health

# data[].attributes.attachment_link.description
While most exams naturally trigger stress in teenagers, certain factors and beliefs can dial up the pressure levels. Feeling unprepared through lack of revision or procrastination, coupled with fears of failure or poor results can lead to a peak in stress during preparation time, having a significan

# data[].attributes.attachment_link.readable_text
This section contains information for children and young people, and parents and carers, about mental health.

It is written by psychiatrists and children and young people working together. We hope you find it useful.

We believe everyone needs to make informed decisions about their health, and aim to produce information which is evidence-based, accessible and up to date.

# data[].attributes.attachment_link.title
Young people's mental health | Royal College of Psychiatrists

# data[].attributes.attachment_link.description
This page contains information for young people, parents and carers, about young people's mental health.

# data[].attributes.attachment_link.title
Useful mental health contacts - for 11-18 year olds | Mind - Mind

# data[].attributes.attachment_link.description
Get details of useful contacts and organisations for 11-18 year olds looking for information or support for mental health.

# data[].attributes.body
During the assessment it is important to maintain professionalism,however, it is important to build Therapitic relationships with the person, in this case 17 years old teenager is going to be scared due to the school settings. She will be worried and scared for other children finding out,and therefore, might be withdrawn and refusing to be involved in the care.

It is important to provide safe environment.

The assessment tools involve direct questions,however , the better way might be to ask the question in the simplest way that can directly help with building the understanding and trust.

Ask the patient what can we do to make the patient feel safer and try to adjust to the situation,although this is not the part of the assessment it is important to build therapeutic relationships.

We need to consider maintaining privacy, therefore , concerning and dressing the cuts might be a good idea, however, it might make the situation worse and make it more noticeable for other children and draw the attention.

Involving family and teaching staff is important and essential,however ,it is important to ensure the patient is aware of this and the importance of the involvement. Meanwhile ,is it important to discuss with the family the best way to approach the situation to prevent patients anxiety . It is important to make the environment as stressless as possible to prevent worsening symptoms and maintain wellbeing .