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Management of self-harm in older people

  • Nikki D. Toms (a1) and Craig W. Ritchie (a2)
Abstract
Aims and Method

The epidemiology of self-harm in older people is poorly understood and a low incidence rate hampers research efforts. Regional surveillance for this may assist with research and improve clinical services accordingly. This study involved undertaking a scoping exercise to explore current management of self-harm in elderly people in selected North London hospitals, by interviewing healthcare professionals directly involved in their treatment.

Results

The study showed varied methods of coding clinical information across trusts, with no consistent method of surveillance.

Clinical Implications

Implications of this exercise involve generation of a summary document that will educate stage two of the project, which is the convention of a working party to implement a surveillance system across the region.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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1 Conwell, Y, Duberstein, PR, Caine, ED. Risk factors for suicide in later life. Biol Psychiatry 2002; 52: 193204.
2 National Institute for Health and Clinical Excellence. Clinical Guideline: CG16. the short term physical and psychological management and secondary prevention of self harm in primary and secondary care. National Institute for Health and Clinical Excellence 2004 (http://www.nice.org.uk/nicemedia/pdf/CG16FullGuideline.pdf).
3 Salib, E, Tadros, G, Cawley, S. Elderly suicide and attempted suicide: one syndrome. Med, Sci Law 2001; 41: 250–5.
4 Hawton, K, Harriss, L. Deliberate self harm in people aged 60 years and over: characteristics and outcome of a 20 year cohort. Int J Geriatr Psychiatry 2006; 21: 572–81
5 Centre for Suicide Research. The Oxford Monitoring System for Attempted Suicide. University of Oxford, 2007 (http://cebmh.warne.ox.ac.uk/csr/monitoring.html).
6 Semple, D, Smyth, R, Burns, J, Darjee, R, McIntosh, A. Liaison psychiatry. In Oxford Handbook of Psychiatry. 725–61. Oxford University Press, 2005.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Management of self-harm in older people

  • Nikki D. Toms (a1) and Craig W. Ritchie (a2)
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eLetters

Management of self-harm in older people

Vinay Sudhindra Rao, ST6 in Older People's Mental Health Services, Peterborough
09 December 2009

N Toms and C Ritchie, ¹ have highlighted the importance of a surveillance system for older people presenting with the self-harm. This is particularly relevant, given that, in the UK the suicide rate among older men is equivalent to that among young males and it is higher among older women as compared to younger women. Reassuringly, older people are more likely to receive psychosocial assessment from a mental health specialist and they are much more likely than younger patients to be offered after care.³ The national suicide prevention strategy in England was launched in 2002 with the aim of supporting the target to reduce the death rate from suicide and undetermined injury by at least 20% by the year 2010.²

Unarguably, it is a good practice to code every diagnosis made, including self-harm (for example ICD 10 code –X60 to X84 4) . Unfortunately, in our routine clinical experience we have observed that this is not always the case. Although the primary psychiatric diagnoses are listed with the codes, additional coding of episodes of self-harm are often omitted.

Further, most general hospital trusts in the UK maintains separate medical and psychiatric case notes and the documentation done in the Accident and Emergency departments constitute a third set of records. Thisdistinction remains even when the documentation is done or maintained electronically.

This lack of documentation would hinder attempts at conducting auditsor research aimed at improving awareness and understanding of this important presentation in the elderly. We therefore support the authors’ proposal of ‘establishing a computerized database that is standard across hospitals’. This could be like the Falls Register, which includes both primary and secondary care and aims to aid risk assessment and management.Probable implementation of NPfIT(National Programme for IT) in the near future will only serve to facilitate setting of electronic surveillance system.5

REFERENCES

1 Toms ND, Ritchie CW. Management of self-harm in older people. Psychiatr Bull 2009; 33:423-5.

2 Department of Health 2002. National Suicide prevention strategy forEngland (http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4019548.pdf)

3 Marriot R, Horrocks J, House A and Owens D. Assessment and management of self-harm in older adults attending accident and emergency: a comparative cross-sectional study. Intl J Geriatr Psychiatry 2003;18:645-652

4 The ICD-10 Classification of mental and Behavioural Disorders. World Health Organization Geneva 1992; 304-6

5 http://www.connectingforhealth.nhs.uk/about/benefits/statement0607.pdf
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