Management of Self-Harm in Adolescent Inpatient Settings Without Physical Restraint: A Service Evaluation of Physical Health Outcomes from a Least Restrictive Practice Unit

Purpose: To assess physical health outcomes for young people who self-harmed during admission to a general adolescent unit where physical restraint (PR) is proactively avoided in response to self-harm unless it is immediately life-threatening. Method: From the incident reporting system, we extracted data related to self-harm and PR, and calculated the proportion of incidents of self-harm that were managed with PR. We identified what proportion of incidents of self-harm resulted in physical health consequences that required transfer to the emergency department. Results: There were 1,638 incidents of self-harm. PR was used in 20 (1.2%) cases. There were 35 transfers to the emergency department, 15 of which required treatment (0.9% of all self-harm incidents). Conclusion: These data can inform thresholds for intervention in response to self-harm. There were a large number of self-harm incidents, PR was used in few cases, and the rate of clinically significant acute physical health consequences that required medical treatment was low. These findings support the view that PR in response to self-harm is not necessary in the majority of cases and should be avoided.