Standards and Regulations
The Fostering Services (England) Regulations 2011
Fostering Services: National Minimum Standards:
Training, Support and Development Standards for Foster Care
Related Chapter
First Aid and Medication Procedure
Scope of this Chapter
Any child or young person, who self-harms or expresses thoughts about this or about suicide, must be taken seriously and appropriate help and intervention should be offered at the earliest point.
This chapter was added in August 2023.
Self harm is:
In the vast majority of cases self-harm remains a secretive behaviour that can go on for a long time without being discovered. Many children and young people may struggle to express their feelings in another way and will need a supportive response to assist them to explore their feelings and behaviour and the possible outcomes for them.
The indicators that a child or young person may be at risk of taking actions to harm themselves or attempt suicide can cover a wide range of life events such as bereavement, bullying at school or a variety of forms of cyber bullying, often via mobile phones, homophobic bullying, mental health problems including eating disorders, family problems or any previous child abuse.
The signs of the distress the child may be under can take many forms and can include:
An assessment of risk should be undertaken at the earliest stage and should enquire about and consider the child or young person's:
Any assessment of risks should be talked through with the child or young person by the most appropriate person such as the foster carer and/or social worker and regularly updated as some risks may remain static whilst others may be more dynamic such as sudden changes in circumstances within the family or school setting. The focus of the assessment should be on the child or young person’s needs, and how to support their immediate and long term psychological and physical safety.
The level of risk may fluctuate and a point of contact with a backup should be agreed to allow the child or young person to make contact if they need to.
The research indicates that many children and young people have expressed their thoughts prior to taking action but the signs have not been recognised by those around them or have not been taken seriously.
In many cases the means to self-harm may be easily accessible such as medication or drugs in the immediate environment and this may increase the risk for impulsive actions. A plan for safe storage of medication in the household and other potential items which may be used by young people to self-harm should be made with the Fostering Service and you as the foster carer.
Good multi-disciplinary working is important and all health professionals including the GP should be aware of the child or young person's risk of self-harm to avoid prescribing medication without the foster carers knowledge or support.
If the young person is caring for a child or pregnant the welfare of the child or unborn baby should also be considered in the care plan.
A supportive response demonstrating respect and understanding of the child or young person, along with a non-judgmental stance, are of prime importance. Note also that a child or young person who has a learning disability may find it more difficult to express their thoughts.
You should talk to the child or young person and establish:
Do not:
Where hospital care is needed:
Where a child or young person requires hospital treatment in relation to physical self-harm, practice should be as follows (see NICE website):
You should support the child and young person at this time. If an alternative placement is needed to support the child or young person's mental health, the Fostering Service and the foster carer will help move the child or young person and support the multi-disciplinary team in any way they can.
The multi-disciplinary team around the child or young person will make decisions around consent issues and whether the young person needs to be detained to safeguard the child or young person from harm.
The best assessment of the child or young person's needs and the risks they may be exposed to, requires useful information to be gathered in order to analyse and plan the support services. In order to share and access information from the relevant professionals the child or young person's consent will be needed.
Professional judgement must be exercised to determine whether a child or young person in a particular situation is competent to consent or to refuse consent to sharing information. Consideration should include the child's chronological age, mental and emotional maturity, intelligence, vulnerability and comprehension of the issues. A child at serious risk of self-harm may lack emotional understanding and comprehension and the Gillick guidelines should be used. Advice should be sought from a Child and Adolescent Psychiatrist if use of the Mental Health Act may be necessary to keep the young person safe.
Informed consent to share information should be sought if the child or young person is competent unless:
If consent to information sharing is refused, or can/should not be sought, information should still be shared in the following circumstances:
If necessary, specialist advice or support should be sought such as from Children and Young People’s Mental Health Services (CYPMHS). The Children and Young People’s Mental Health Services (CYPMHS) workers and consultant psychiatrist will help formulate a protection plan around keeping the child or young person safe and advice on safety issues, medication use and how to respond and support the child and young person. They should also help support the Fostering Service and foster carer to support the young person.
If there is any suspicion that the child may be involved in self harming or any attempts of suicide, the foster carer must notify the Fostering Service and the social worker must be informed as soon as practicable.
All self-harming must be recorded by the foster carer.
An Incident Report must also be completed.
If First Aid is administered, details must be recorded.
A risk assessment undertaken (if it does not already exist with a view to deciding whether a strategy should be adopted to reduce or prevent the behaviour) and that strategy should be included in the child's Placement Plan.
Consideration should be given by the Fostering Service to whether the incident is a Notifiable incident to Ofsted. See Significant Events and Notifications – When I need to tell other people about things Procedure.
The links relate to publications about self-harm and suicide with sections about children and young people as in the latest national strategy:
The Truth About Self-harm, The Mental Health Foundation
Suicide Prevention: Resources and Guidance, GOV.UK
Suicide by Children and Young People 2017, (HQIP)
Self-harm: Assessment, Management and Preventing Recurrence NICE Guidance
Websites: