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Deliberate self-harm: how feasible are the current guidelines?

Published online by Cambridge University Press:  13 June 2014

Alan Currie  and
Richard Blennerhassett
Alan Currie
Affiliation:
Hadrian Clinic, Newcastle General Hospital, Westgate Road, Newcastle-upon-Tyne, NE4 6BE, England
Richard Blennerhassett
Affiliation:
St. Ita's Hospital, Portrane, Donabate, Co Dublin, Ireland
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Abstract

Objectives: To examine the operation of a deliberate self-harm service at a large general hospital with reference to standards outlined by the Royal College of Psychiatrists. To examine the characteristics of referrals and to make recommendations for improvements to the service.

Method: Data on referral and assessment characteristics were collected for 96 consecutive referrals over a three month period.

Results: The services achieved the college standards in relation to the time period for assessments. Most referrals were made routinely at a predictable time but assessments were conducted on an ad hoc basis. Only a minority of those referred had a mental illness or complex problems. A significant number of patients were discharged from the A&E department without a psychiatric assessment. Assessors underemphasised the role of previous deliberate self-harm and/or the presence of mental illness in forming a judgment on the risk of suicide. After-care arrangements were predominantly medical (general practitioners or psychiatrists) with little multidisciplinary input.

Conclusions: The deliberate self-harm service at the hospital could be improved by the establishment of a self-harm services planning group to oversee the delivery of the service throughout the hospital and address the deficits identified. Given the number of referrals seen within the service and the fact that deliberate self-harm is only one element of a comprehensive liaison service, consideration should be given to the establishment of a separate multi-disciplinary liaison team. Once again importance is drawn to the need for all assessors to be aware of the risk factors in relation to the future risk of suicide rather than placing undue emphasis on whether the most recent attempt was planned or impulsive in nature.

Keywords

Deliberate self-harmGuidelinesMulti-disciplinary liaison team
Type
Brief Reports
Information
Irish Journal of Psychological Medicine , Volume 16 , Issue 2 , June 1999 , pp. 61 - 63
Copyright
Copyright © Cambridge University Press 1999

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References

1.Hawton, K, Fagg, J. Trends in deliberate self-poisoning in Oxford 1976-1990. BMJ 1992; 304: 1409–11.CrossRefGoogle Scholar
2.Hawton, K, Fagg, J. Suicide and other causes of death following attempted suicide. Br J Psychiat 1988; 152: 359–66.CrossRefGoogle ScholarPubMed
3.Nordentoft, M, Breum, L, Munck, LK, Nordestgaard, AG, Hunding, A, Bjaeldager, PAL. High morality by natural and unnatural causes: A 10 year follow up study of patients admitted to a poisoning treatment centre after suicide attempts. BMJ 1993; 306: 1637–41.CrossRefGoogle Scholar
4.Hawton, K, Catalan, J. Attempted suicide: A practical guide to its nature and management. Oxford: Oxford University Press, 1987.Google Scholar
5.Butterworth, E, O'Grady, TJ. Trends in the assessment of cases of deliberate self-harm. Health Trends 1989; 21: 61.Google Scholar
6.Hamer, D, Sanjeev, D, Butterworth, , Barczak, P. Using the Hospital Anxiety and Depression Scale to screen for psychiatric disorders in people presenting with deliberate self-harm. Br J Psychiat 1991; 158: 782–4.CrossRefGoogle ScholarPubMed
7.Department of Health and Social Security. The management of deliberate self-harm. Heywood, Lancashire: Department of Health and Social Security, 1984. (Health Notice: HN(84)25).Google Scholar
8.Royal College of Psychiatrists. The general hospital management of adult self-harm. A consensus statement on standards for service provision. London: Royal College of Psychiatrists 1994. (Council Report Number 32).Google Scholar
9.Newson-Smith, JGB, Hirsch, SR. A comparison of social workers and psychiatrists in evaluating parasuicide. Br J Psychiat 1979; 134: 335–42.CrossRefGoogle ScholarPubMed
10.Catalan, J, Marsack, P, Hawton, K, Whitwell, D, Fagg, J, Bancroft, J. Comparison of doctors and nurses in assessment of deliberate self-poisoning patients. Psychol Med 1980; 10: 483–91.CrossRefGoogle ScholarPubMed
11.Gardner, R, Hanka, R, O'Brien, VC, Page, AIF, Rees, R. Psychological and social evaluation in cases of deliberate self-poisoning admitted to a general hospital. BMJ 1977; ii: 1567–70.CrossRefGoogle Scholar
12.Gardner, R, Hanka, R, Roberts, SJ, Allon-Smith, JM, Kings, AA, Nicholson, R. Psychological and social evaluation in cases of deliberate self-poisoning seen in an accident department. BMJ 1982; 284: 491–3.CrossRefGoogle Scholar
13.Waterhouse, J, Piatt, S. General hospital admission in the management of parasuicide. A randomised controlled trial. Br J Psychiat 1990; 156: 236–42.CrossRefGoogle ScholarPubMed
14.Owens, D, Dennis, M, Jones, S, Dove, A, Shivraj, D. Self-poisoning patients discharged from accident and emergency: Risk factors and outcome. J R Coll Physicians of Lond 1991; 25: 218–22.Google ScholarPubMed
15.Owens, D, Dennis, M, Read, S, Davis, N. Outcome of deliberate self-poisoning. An examination of risk factors for repetition. Br J Psychiat 1994; 165: 797–801.CrossRefGoogle ScholarPubMed
16.Owens, D. Self-harm patients not admitted to hospital. J R Coll Physicians of Lond 1990; 24:281–3.Google Scholar
17.House, A, Owens, D, Storer, D. Psychosocial intervention following attempted suicide: is there a case for better services? Int Review of Psychiat 1992; 4: 15–22.CrossRefGoogle Scholar