Assessing Clients For Self Harm Tendencies

[emmalou*]

Hi all

I'm an occupational health nurse working in a large public hospital in Australia.

A large part of my role is case managing injured workers for workplace rehabilitation, I.e. to return to their usual role and ensure their safety and wellbeing.

In the past year I've been in this field of nursing (my history is acute med/surg nursing and I'm now acting in a higher level role), I've attended to 3 clients who've applied for stress claims, who've expressed self harm tendencies while in a one on one interview situation, in my own office. Basically they say, I've thought about killing myself, or I don't have anything to live for, but I'm OK NOW and I then have to listen, ensure their safety, sit with them for as long as it takes and make sure they're OK to go home. We can take them up to the ER or request a psychiatric liason officer to assess them if they're acutely ill but I've not done this as the client seems OK, stating they're fine, have a calm affect etc, and I send them on their way. I've looked after patients in a ward situation who've attempted suicide but a ward environment is far more controlled and there is a specific protocol so I find this much more difficult.

I personally don't think this is appropriate practice - there isn't a protocol in my work unit for assessment of clients who've expressed self harm, its kind of like we're flying by the seat of our pants in a way or working from our own professional or personal experience.

This post is a vent, as this happened today and was quite upsetting as I have no qualifications to do this and to top it all off, my colleagues who are in a similar role to me, are administrative officers, so they don't even have a health background (in saying that, they are excellent at their jobs).

I'd love some advice from people who've had similar experiences or even some good common sense advice on how to assess clients with self harm tendencies or severe depression.

[Thunderwolf, MSN, RN]

Due to the topic, this post was moved here from another forum for better visibility.....as you can see, no one has answered yet due to its getting buried in the other forum.

Who would like to start off some feedback for this member?

[dan_aus]

hi there,

wow sounds stressful!!! i'm an aussie nurse and i have worked in an acute ward and community environment. self harm and suicidal ideation is always a tough one. there are objective measures you can use when assessing someone, you should look up some triage kind of information. I would reccommend getting in touch with Natisha Sands at University of Melbourne, she is fantastic!

you are doing the right thing though by offering an environment for the client to vent and to feel supported. unfortunately in a community environment when you make an assessment that the situation is not critical and does not warrant an admission all you can do is orificere that they have a safe environment to go home to (not easy sometimes!). you could always ask the client to give you a buzz when you get home, ask them if they are going to be home alone- or if someone can be home with them for the night, give the number for the local triage team (thats what they are for!!!) and offer reassurance. assessing the intensity of the thoughts, the way in which they want to self harm or suicide will also arm you in assessing the urgency of the situation. and make sure you document as best as you can! we cannot control everything but my advice would be to be as cautious and as safe as you can.

i hope this helps... this is a great topic and hopefully more people contribute. i dont have that much experience so i would also love to hear what people have to say.

hope you are doing ok!!!

dan

[karynfrances]

Surely if you are in a large public hospital you would have access to a mobile psych team that could follow up these people through a phone call etc. I think you need to refer these people on to psych for the patients sake and to keep you safe in your job knowing you had done all you could for your clients.

[scstuartKiwi]

Hi,

Whilst assessing suicidal risk is difficult, it focuses on the key areas, of thoughts, plans, means and intent. I would suggest that if you are concerned about someone or someone wants help and there is no immediate risk, they should in the first instance be referred back to their G.P. If they do not have a G.P, give them the details for the local mental health service, both the 24hr crisis service and the community day service.

If you are concerned about the immediate safety of someone, if they are cooperative, send them to the nearest crisis service, if they do not want help but you believe they are at serious risk, phone the police or ambulance, they have the power to detain someone under the mental health act, Emergency Examination Order and will arrange for them to be seen.

Your job will be to identify persons with potention mental health problems and refer them on, it shouldnt be your job to preform long mental state examinations, treat, give therapy or counselling as that is a very time consuming process.

Bottom line, anyone your concerned about, get them seen by someone from that department ASAP

Good Luck!