Lightning Learning: Self-Harming Patients

Lightning Learning: Self-Harming Patients

When risk assessing mental health patients, don’t just think ABCDE... think PEPI and SLIPA!
— advice is based on local guidelines & procedures


When risk assessing mental health patients who have self-harmed, don’t just think ABCDE… think ‘PEPI’ and ‘SLIPA’.

Primary Assessment (PEPI)

The primary assessment should focus on 4 key areas:

Physical: health needs and degree of arousal/agitation

Environment: in which the patient is being cared for – is this safe for you and or them?

Personal: items which the patient has in their possession (which may be used for self-harm or harm to others)

Intent: of the individual


Does the patient need immediate treatment? If YES put the patient in a safe environment (or ER) if needing rapid tranquilisation.

Secondary Assessment (SLIPA)

Now, go on to assess the following 5 key areas:

Suicidal: thoughts at the time of self-harm

Lethality: likelihood that the episode of self-harm would have resulted in death

Intent (now): whether the patient has any current thoughts of self-harm or suicide

Protective factors: e.g. personal relationships, family & friends, job, housing, finances and criminal charges

Adverse factors: same as Protective factors


Protective and Adverse factors: consider these both together as they often refer to the aspects of patient’s life which can be either protective or stressful (e.g. a job stressful of protective or both).

Assessment of these five SLIPA areas provides the basis for assessment of risk to which other relevant factors can be added – and produce an overall risk profile.

Demographic or Historical factors: these should be used in conjunction with the information obtained from SLIPA to enhance accuracy of the risk assessment.

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