Self-harm and crisis intervention — structured clinical viva

This is an adolescent first hospital-treated self-harm case with chronic NSSI features plus impulsive overdose. Denial of current intent does not equal zero risk: youth self-harm associates with later mortality risk in multicentre data, and means remain accessible.^[2]

Assessment framework. Medical clearance done — proceed to psychosocial assessment: intent continuum at time of acts and now; functions of cutting (likely affect regulation); alcohol/substances; mood/anxiety/trauma/psychosis screen; bullying/online harms; family conflict; safeguarding; capacity and Gillick/developmental competence concepts as jurisdictionally framed; collateral from parents and ideally school with consent/safety framing.^[1][6]

Language with family. Validate parental fear without endorsing "attention-seeking". Reframe self-harm as a distress signal and maladaptive coping strategy that requires skills and support, not punishment. Set boundaries on pejorative labels in front of the young person.^[1]

Safety plan. Age-adapted SPI: warning signs, coping, people (including parents if alliance allows), professionals (CAMHS crisis numbers), means restriction for household medications, reasons for living. Negotiate school involvement carefully — partial information-sharing may be required for safety.^[5]

Disposition. Low threshold for CAMHS crisis/intensive community support; admission if residual intent high, means cannot be secured, or home unsafe. Booked urgent follow-up mandatory if discharged. Structured therapies have meta-analytic support in adolescents (Ougrin; Cochrane Witt).^[3][4]

Vs suicide-risk-assessment topic. Here emphasise NSSI functions, hospital self-harm pathway, family/school, and aftercare interventions; still screen suicide risk fully, but the examiner is testing self-harm care competence, not only ideation models or lithium/clozapine minutiae.^[1][5]