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]

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.

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.

• 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

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 .