Self-Harm and Violence: Towards Best Practice in Managing Risk in Mental Health Services

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Assessment services help older people and their carers to identify care that best meets their needs and access Commonwealth Government services for older people. The Home and Community Care Program for Younger People provides funding for services which support frail older people, younger people with disabilities and their carers.


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A Victorian government resource providing information and advice on designing and caring for people with dementia in residential aged care settings. While there is no single prescribed standard of care or clinical approach for situations involving suicide and self-harm, Working with the suicidal person recommends a series of general practices and principles to guide the assessment and management of people at risk.

The ultimate judgement must be made by the attending clinician, based on their experience, the clinical presentation and the assessment and management options available at their health service.

Although risk factors cannot identify suicidal individuals with any certainty, they can alert a clinician to take particular care in assessing an individual. There is a wide range of factors that can influence suicide risk, from mental illness or physical ill-health to abusive relationships, stressful life events such as unemployment or bereavement, or a history of suicidal thoughts. There are several general principles for mental health staff to consider in the assessment and management of people at risk of suicide.

Good communication and listening are vital to establish rapport with a person, to validate their feelings and to discuss difficult issues with them in an empathetic way. Clinicians are encouraged to ask a person directly: Are you thinking about suicide? Talking about suicide will not encourage a person to take action — it will actually decrease their risk because it lets them know they are able to talk about it with you. Clinicians should find out if they have made any preparations for death, such as giving possessions away or saying goodbye to loved ones.

If a suicide attempt has been made, ask about any precipitating events, whether it was impulsive or premeditated, and whether they sought help beforehand. It is very important to gain information, not only from presenting individuals but from their friends, family, caregivers or medical records, which can help gauge their level of risk and determine appropriate clinical options. Clinicians should take particular care to ensure that pertinent information is accurately documented and passed on to other staff to ensure a consistent approach and prevent adverse outcomes.

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Keeping a person safe and comfortable while they are waiting for an assessment is paramount, and any restrictions of their liberty must be kept to an absolute minimum. For acutely suicidal people, assessment should be made immediately. Intoxication should not delay an assessment, as it can increase impulsiveness and the risk of self-injury in the short term. The practical quick guide, Working with the suicidal person, Rapid suicide-risk assessment at emergency department triage , provides a useful list of pointers and questions to assist clinicians during the key stages of a risk assessment.

An initial suicide risk assessment should always be followed up with a comprehensive mental health status examination and psychiatric assessment. This applies in particular to people who present after a suicide attempt or an episode of self-harm, with probable mental illness or dual diagnosis, or after a recent discharge from a psychiatric inpatient unit,. Please enable JavaScript in order to get the best experience when using this site. Our websites Better Health Channel Health and medical information for consumers, quality assured by the Victorian government.

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Funding, performance and accountability Funding, performance and accountability. Statement of Priorities Strategic planning Activity Based Funding Performance monitoring Annual reporting guidelines Integrity governance framework and assessment-tool Pricing and funding framework. Patient fees and charges Patient fees and charges.

Patient fees and charges Admitted patients Other compensable: Non-admitted patients Other services. Financial accounting and policy Financial accounting and policy. Portfolio entity financial reporting Accounting policy Common chart of accounts. Planning and infrastructure Planning and infrastructure. Primary care Primary care. Integrated care Integrated care. Community health Community health. Dental health Dental health. Access to public dental care Public dental fees Dental waiting list Dental reporting.

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Self-Harm & Suicide Issue - Foreword from the Editor - ACAMH

Mental health Mental health. Mental health services Mental health services.

Psychiatric Interviews for Teaching: Self-Harm

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