Youth self-harm and suicide — structured clinical viva

This is a first hospital-treated youth self-harm case with chronic NSSI plus impulsive overdose. Denial of current intent is not zero risk: multicentre data show elevated later mortality after child/adolescent hospital-treated self-harm, and means remain accessible.[2]

Assessment framework. Private youth interview after explaining confidentiality-with-safety limits; intent continuum and NSSI functions; bullying/school; substances; mood/trauma/psychosis screen; safeguarding; family collateral; developmental competence principles (jurisdiction-specific — do not invent section numbers). Structured tools (e.g. C-SSRS concepts) adjunct only; formulation drives care (Large critique of crude stratification).[1][8]

Language with family. Validate fear; reframe self-harm as distress signal and maladaptive coping; stop pejorative labels in front of the young person.[1]

Safety plan. Youth-adapted SPI with carer means restriction, trusted adults, CAMHS crisis numbers; negotiate school involvement for safety rather than absolute secrecy.[6][7]

Evidence. Name Mehlum DBT-A, Ougrin meta-analysis, Witt Cochrane children/adolescents; family engagement and SHIFT as examinable family-therapy trial with careful interpretation of primary outcomes.[3][4][5]

Disposition. Low threshold for urgent CAMHS/crisis intensity; admit if residual high intent, means unsecured, or home unsafe. Booked rapid follow-up mandatory if discharged.[2][6]

Vs adult topics. Emphasise private interview + family + school triad, Gillick/confidentiality, safeguarding, CAMHS ladder, DBT-A/family evidence, non-stigmatising language with parents — not adult lithium/clozapine minutiae or adult-only pathway detail.[2][3]