1. Gloucestershire’s Deliberate Self Harm Framework

2. DSH: Whose Responsibility? Gloucestershire’s response has been to bring all partners together to look at the whole pathway from education and prevention to early help, treatment and recovery. We recognise the respective roles that local authority, health, education, and other providers play in the wider system. We now collectively have a much better understanding of deliberate self-harm and an agreement where to invest in improvements to services and pathways.

3. DSH Programme Data, Information & Analysis Outcome: Data collated across services; needs analysis underpins service developments. Education & Prevention: Schools & Colleges Outcomes: Improved mental health & DSH awareness in schools, quality of support commissioned by schools, CYP access to support and EHWB capacity within schools. Prevention via Trading Standards: Paracetamol Outcome: Reduced danger to children & young people from bulk Paracetamol; wider awareness across stakeholders.

4. DSH Programme NHS Pathways & Services (including A&E streamlining) Outcomes: Improved access to assessment and support within NHS system (including extra capacity within CYPS); improved environment in A&E; reduced unnecessary admissions to hospital. Residential Options for DSH Outcome: Alternative overnight or shared care options for DSH explored and appraised; new provision will offer a safe alternative for CYP post DSH. Prevention of repeat DSH presentation at A&E Outcome: Improved resilience and reduced risk of repetition amongst individual CYP following incident of DSH, specifically aimed at those not requiring MH services.

5. Building Emotional Resilience The gap in the pathway When young people who self-harm and attend hospital are assessed as having a specific mental health component to their needs this is followed up by the mental health services. But for those assessed as having no specific mental health need, there is currently no specific follow-up. This runs the risk of the young person returning home without the resilience to cope differently in future. Gloucestershire’s response We have co-developed and commissioned a building emotional resilience service led by the Youth Support Team. This will link with hospital services and the 2gft CYPS at one end and the young person’s family and school at the other, and: support young people who are not in need of mental health services per se back into their school/home environment support young people after an episode of self-harm, help them tackle the reasons for it, and reduce the risks of them repeating it liaise with others in the workforce, such as school nurses and pastoral support workers in schools, social workers, foster carers and parents.

6. Aims To foster understanding that Deliberate Self Harm is not a psychiatric disorder. We all need to talk about, and work together, to address this behaviour and the many varied reasons behind it. Bringing together health and social support towards improved inter-agency communications, decision-making and support. Rebuilding the resilience of those that who have self- harmed in the context of their families, communities and schools is better than removing them from these contexts.

7. DSH Targeted and Specialist Pathway YPHospital CYPS BERs Context -Home -School -Community -Services

8. What Happens Now? >16 assessed in Emergency Department by Adult Mental Health Liaison Team <16 admitted to Paediatric Ward and assessed by CYPS Most discharged home, occasionally MH inpatient admission is indicated All offered follow-up appointment within 2 weeks

9. What Happens Now? Around half are discharged without further specialist follow up Half will begin specialist MH interventions such as – Cognitive Behavioural Therapy – Pharmacological Therapy – Dialectical Behaviour Therapy – Engagement and Case Management

10. Building Emotional Resilience Background to the Liaison and Diversion model in Youth Offending Evidence-based Early identification of holistic needs Keeping young people out of the Youth Justice system and the negative effects associated with this. Accelerating relevant young into the Youth Justice system where necessary. Liaison: right information, to the right people, at the right time. Family-based, programmatic interventions.

11. Building Emotional Resilience The Building Emotional Resilience team Small team Hospital notification via CYPS to BER team. Information-gathering and liaison towards improved decision-making Engagement of those falling beneath the CYPS threshold, and those disengaging Step-down from CYPS

12. Building Emotional Resilience The Building Emotional Resilience team (cont.) Triage Brokering cases into community assets and local services as needed Programmatic interventions 1:1 and/or with the family Tracking and reporting