Planning for safety

Risk of self-harm 

Adverse outcomes relating to patients who are distressed or have thoughts of self-harm or suicide or who have self-harmed are prevented through early recognition and effective response. Always consider self-harm seriously. 

Healthcare services should consider whether a patient may be at risk of experiencing harm from others. The level of risk may be increased by factors such as alcohol or drug use, disinhibition and other risk-taking behaviours, domestic and family violence, intimate partner violence, child abuse, discrimination and neglect.[i]

Risk of harm to others

Healthcare services should consider how to respond appropriately to a patient who discloses thoughts of harm to others or if they are assessed as representing a risk to others. Situations where there is a higher risk of harm to others include where:

• Patients are experiencing mental health issues 
• History of violence is evident or known 
• Abuse of alcohol and/or other drugs is present or known 
• Neglect to children is evident or known. 

Responding to patients who present a risk of harm to others may include referring to a specialist mental health service for assessment or to an emergency service if a crisis response is needed, and notification to child welfare services. Information about when legislation requires crisis intervention should be made available to the workforce, patients, families and carers.

Links to Actions 1.04 Risk management and 1.23 Safe environment

How does the workforce respond to patients who are distressed, have expressed thoughts of self-harm or suicide, or have self-harmed?

What information on other services can the healthcare provider give to patients when their healthcare needs are beyond the scope of the healthcare service?

• Develop and implement a process to:
  • respond to patients who are distressed, have expressed thoughts of self-harm or suicide, or have self-harmed 
  • respond to patients who present a risk of harm to others. 
• Facilitate training for the workforce to effectively recognise and respond to patients who are distressed or exhibit aggression, have expressed thoughts of self-harm or suicide, or have self-harmed. 
• Source and make information available on accessing other mental health services beyond the scope of the service. In most instances this will involve referring a patient to a general practitioner or rural generalist, community mental health service or hospital emergency department.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Processes that outline collaborative processes for identifying and treating patients at risk of self-harm or suicide, or who have self-harmed 
• Crisis intervention support processes aligned to relevant legislation
• Training documents about identifying and responding to patients at risk of self-harm or suicide, or who have self-harmed
• Patient resources about strategies for accessing health services beyond the scope of the service.

Commission resource

• NSQHS Standards User Guide for health services providing care for people with mental health issues – provides practical support for healthcare services where specific efforts or additional attention is required to meet the health needs of this patient population, based on the NSQHS Standards. The principles and strategies outlined in this resource are broadly applicable.

Other resources

• Australian Government Department of Health: Mental health and suicide prevention resources – a list of resources about mental health and suicide prevention in Australia. 
• Life in Mind: Suicide Prevention – a knowledge exchange portal providing translated evidence, policy, data and resources in suicide prevention. 
• Mental Health First Aid – offers skills based, early-intervention training programs to mobilise and empower communities by equipping people with the knowledge and confidence to recognise, connect and respond to someone experiencing a mental health problem or mental health crisis. 
• National Institute for Health and Care Excellence: Violence and aggression: short-term management in mental health, health and community settings – aims to safeguard both staff and people who use services by helping to prevent violent situations and providing guidance to manage them safely when they occur.
• The Multi-Agency Risk Assessment and Management Framework (MARAM) – provides guidance for services that come into contact with individuals and families experiencing family violence.