This guideline on long term treatment of self harm goes into great detail about the history and risk assessment of patients with deliberate self-harm (DSH), including young people.
Elements of the history that I wouldn’t normally have thought of covering include asking about vulnerability (both socially and occupationally), asking about past suicidal intent (as well as attempts), asking about destructive relationships (as well as supportive ones) and asking about coping strategies. If you want a resource to revise the things you should be asking – this is a good place to start.
The main guidance advises GPs to ‘consider’ referral under certain listed circumstances (which are probably what most GPs are already doing). The patient leaflet says that if you have a history of self-harm “…if you have asked to see a specialist, you should be offered an appointment with community mental health services as soon as possible”. After assessment by the community mental health team, patients should be given a Care Plan. The guideline contains detailed lists of what this Care Plan should involve. GPs should be sent a copy. This will be a useful resource in managing these patients when they come back to us, especially as it should list what to do in a ‘crisis’.
In summary, for us, take a good history and do a risk assessment of further self-harm and the likelihood of escalation of self-harm. Refer if appropriate, or if the patient requests it. Refer to the patients Care Plan, if they have one.