Youth self-harm — assessment, safety planning, family/school, and disposition (MEQ)

(i) Continuum. NSSI: self-injury without intent to die, often affect regulation. Suicide attempt: self-injury with at least some intent to die. Mixed/unclear: ambivalence. This presentation is predominantly NSSI/mixed: chronic cutting for feelings plus impulsive low-count overdose after bullying and family conflict; deny clear intent now but document intent at the time of each act and expectation of death. Method superficiality does not equal zero risk.^[1][2]

(ii) Assessment structure. Medical clearance done. Explain confidentiality-with-safety limits. Private youth interview: precipitants (bullying, argument), functions of cutting, intent continuum, substances, mood/anxiety/trauma/psychosis screen, reasons for living, means at home, school experience, online harms, safeguarding. Family session: validate parental fear; reframe away from "attention-seeking"; assess supervision capacity. Collateral from school with consent/safety framing; prior CAMHS/GP notes. Psychosocial assessment is standard after hospital-treated self-harm.^[1][8]

(iii) Safety plan and means. Youth-adapted Stanley-Brown written plan: warning signs; internal coping/distress tolerance; social distraction; trusted adults; CAMHS crisis/ED numbers; means restriction for household medications (secure storage/disposal with parents); school-day coping plan; reasons for living. Young person keeps a copy. No no-suicide contract.^[7]

(iv) Therapy evidence. DBT-A (Mehlum RCT) reduced self-harm vs enhanced usual care in repeated suicidal/self-harming adolescents.^[3] Ougrin meta-analysis supports therapeutic interventions overall vs control on average.^[4] Cochrane Witt children/adolescents: structured psychosocial interventions best evidence base among psychological options, heterogeneous effects.^[5] SHIFT family therapy pragmatic RCT: major trial; interpret primary outcomes carefully (mixed/null at main endpoint) while still valuing family engagement work.^[6]

(v) Disposition and prognosis. If residual intent low, means securable, carers engaged → urgent booked CAMHS follow-up (hours–few days) with safety plan, not weeks-only routine. Escalate to crisis intensive or inpatient if intent high, means unsecured, home unsafe, or non-engagement. Hospital-treated self-harm in children/adolescents carries elevated later mortality risk (Hawton 2020) — not trivial "attention-seeking". Empty discharge plans are indefensible.^[2][7][8]