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Hospital care and repetition following self-harm: Multicentre comparison of self-poisoning and self-injury

  • Rachael Lilley (a1), David Owens (a1), Judith Horrocks (a1), Allan House (a1), Rachael Noble (a1), Helen Bergen (a2), Keith Hawton (a2), Deborah Casey (a2), Sue Simkin (a2), Elizabeth Murphy (a3), Jayne Cooper (a3) and Navneet Kapur (a3)...

Abstract

Background

Quantitative research about self-harm largely deals with self-poisoning, despite the high incidence of self-injury.

Aims

We compared patterns of hospital care and repetition associated with self-poisoning and self-injury.

Method

Demographic and clinical data were collected in a multicentre, prospective cohort study, involving 10 498 consecutive episodes of self-harm at six English teaching hospitals.

Results

Compared with those who self-poisoned, people who cut themselves were more likely to have self-harmed previously and to have received support from mental health services, but they were far less likely to be admitted to the general hospital or receive a psychosocial assessment. Although only 17% of people repeated self-harm during the 18 months of study, survival analysis that takes account of all episodes revealed a repetition rate of 33% in the year following an episode: 47% after episodes of self-cutting and 31% after self-poisoning (P<0.001). Of those who repeated, a third switched method of self-harm.

Conclusions

Hospital services offer less to people who have cut themselves, although they are far more likely to repeat, than to those who have self-poisoned. Attendance at hospital should result in psychosocial assessment of needs regardless of method of self-harm.

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Copyright

Corresponding author

Dr David Owens, Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Woodhouse, Leeds LS2 9LJ. Email: d.w.owens@leeds.ac.uk

Footnotes

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Declaration of interest

None.

Funding detailed in Acknowledgements.

Footnotes

References

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Hospital care and repetition following self-harm: Multicentre comparison of self-poisoning and self-injury

  • Rachael Lilley (a1), David Owens (a1), Judith Horrocks (a1), Allan House (a1), Rachael Noble (a1), Helen Bergen (a2), Keith Hawton (a2), Deborah Casey (a2), Sue Simkin (a2), Elizabeth Murphy (a3), Jayne Cooper (a3) and Navneet Kapur (a3)...
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eLetters

We should assess all patients regardless of method

Danielle Kirwan, Formerly FY1 in Liaison Psychiatry
06 November 2008

A recent multicentre comparison by Lilley et al reported that hospital services offer less to people who have cut themselves than those who have self-poisoned, despite these patients being more likely to self-harm again. We agree with the recommendation that hospital attendance following a self-harm episode should result in psychosocial assessment of needs, regardless of the method used. We would like to describe how we achieve close to 100% contact with people who have self-harmed.

Psychological Medicine at South Kensington and Chelsea Mental Health Unit (CNWL Foundation Trust) offers a 24hr psychiatric liaison service to the Emergency Department and the wards of the Chelsea and Westminster Foundation Trust. All psychiatric referral including self-harm from the ED are offered psychosocial assessment by this liaison team, which comprises liaison psychiatry nurses and/or doctors. Care plans are developed following full psychosocial assessment. They may include referral to the GP, Crisis Resolution and Assessment Teams, or follow up by staff of the Psychological Medicine Unit.

Every week, Psychological medicine staff scrutinise all ED attendances for the previous week. This process takes relatively little time because it utilises computer systems to generate a list which gives the presenting complaint and discharge diagnoses. All patients who presented to ED with psychosocial difficulties including self harm are identified and those not referred Psychological Medicine Unit are contacted and offered an appointment, or their GP is alerted to their presentation.

A recent departmental audit revealed that between 20th November 2007 and 31st March 2008, 949 patients presented to the ED with psychiatric complaints, of which 146 (15%) presented with deliberate self-harm. Of them only 9 (6%) had not been assessed by the psychological medicine team and they were offered appointments.

Psychological medicine staff aim to offer psychosocial assessment to all patients presenting to ED or admitted to the Acute Trust with mental health issues, including self-harm. This is in keeping with the recommendations of the NICE guidelines on self-harm (July 2004). ReviewingED attendances and following up those who do not receive a psychosocial assessment is a simple mechanism for implementing the NICE guidelines and significantly adds to the quality of the service we provide to the ED.

Lilley R, Owens D, Horrocks J, House A, Noble R, Bergen H et al Hospital care and repetition following self-harm: multicentre comparison of self-poisoning and self-injury British Journal of Psychiatry 2008; 192:440-445.

National Institute for Health and Clinical Excellence. Self-harm: TheShort term Physical and Psychological Management and Secondary Prevention of Self- harm in Primary and Secondary care. NICE, 2004.
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Conflict of interest: None Declared

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