Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-10T00:40:38.618Z Has data issue: false hasContentIssue false

Assessment following deliberate self-harm: who are we seeing and are we following the guidelines?

Published online by Cambridge University Press:  13 June 2014

MacDara McCauley
Affiliation:
St. Davnet's Hospital, Monaghan, Ireland
Vincent Russell
Affiliation:
Cavan General Hospital, Cavan, Ireland
Declan Bedford
Affiliation:
Department of Public Health, North Eastern Health Board, Navan, Co. Meath, Ireland
Ashar Khan
Affiliation:
Mental Health Service, Wellington Hospital, Private Bag 7902, Wellington South, New Zealand
Roisin Kelly
Affiliation:
St Davnet's Hospital, Monaghan, Ireland

Abstract

Objectives: To determine whether assessments of patients admitted to a general hospital following deliberate self-harm (DSH) were in line with the Royal College of Psychiatrists guidelines. To examine the profile of cases and presentations and to make recommendations for improvements to the service.

Method: Clinical and demographic data recorded on 70 admissions after DSH during 1997-98 were analysed retrospectively. A checklist was also developed, using factors shown by previous research to be associated with future risk of suicide, to determine the quality of assessments.

Results: The majority (70%) of assessments took place within 24 hours of admission thereby meeting College recommendations. Medical personnel performed all adult assessments. Circumstances of the overdose, recent stresses, psychiatric diagnosis, immediate risk and follow-up arrangements were documented in the majority of cases. Family psychiatric history, past suicidal behaviour, alcohol and drug abuse history, and previous violence, were frequently not documented. A copy of a discharge summary to the GP was found in 41% of charts. Overdoses accounted for 93% of cases of DSH. The most frequently recorded problem (37.5%) was adjustment disorder.

Conclusions: Despite evidence showing that non-psychiatric medical staff are competent in assessing DSH and guidelines encouraging multidisciplinary involvement, DSH assessments remain the preserve of the medical psychiatric team. Closer attention should be paid to all the risk factors associated with suicide by assessors; a checklist could prove helpful. There is room for improved communication between psychiatric services and GPs following DSH. The setting up of a self-harm service planning group could improve the co-ordination and efficiency of delivery of general hospital services to this patient group.

Type
Original Papers
Copyright
Copyright © Cambridge University Press 2001

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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.Barraclough, B, Bunch, J, Nelson, B, Sainsbury, P. A hundred cases of suicide: clinical aspects. Br J Psychiat 1974; 125: 355–73.CrossRefGoogle ScholarPubMed
4.Hawton, K, McKeown, S, Day, A, Martin, P, O'Connor, M, Yule, J. Evaluation of outpatient counselling compared with general practitioner care following overdoses. Psychol Med 1987; 17: 751–61.CrossRefGoogle ScholarPubMed
5.Mortensen, PB. Can suicide research lead to suicide prevention? Acta Psychiat Scand 1999; 99: 397–8.Google ScholarPubMed
6.Jackson, R, Feder, G. Guidelines for clinical guidelines. BMJ 1998; 317: 427–8.CrossRefGoogle ScholarPubMed
7.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
8.Department of Health and Children. Report of the National Task Force on Suicide. Department of Health and Children 1998.Google Scholar
9.Kelleher, MJ. Youth suicide trends in the Republic of Ireland. Br J Psychiat 1998; 173: 196–7.CrossRefGoogle ScholarPubMed
10.Newson-Smith, JGB, Hirsch, SR. A comparison of social workers and psychiatrists in evaluating parasuicide. Br J Psychiat 1979; 134: 335–42.CrossRefGoogle ScholarPubMed
11.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
12.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
13.Currie, A, Blennerhasset, R. Deliberate self-harm: how feasible are the current guidelines? Ir J Psych Med 1999; 16(2): 6163.CrossRefGoogle Scholar
14.Malone, K, McCormack, G, Malone, JP. Non-fatal deliberate self-poisoning in Dublin's north inner city – an overview. IMJ 1992; 85(4): 132–5.Google ScholarPubMed
15.Hawton, K, Harris, L, Simkin, S, Fagg, J, Bale, E, Bond, A. (unpublished). Deliberate self-harm in Oxford 1997.CrossRefGoogle Scholar
16.Krietman, N, Casey, P. Repetition of parasuicide: an epidemiological and clinical study. Br J Psychiat 1988; 153: 792800.CrossRefGoogle Scholar
17.De Moore, GM, Robertson, AR. Suicide in the 18 years after deliberate self-harm. A prospective study. Br J Psychiat 1996; 169: 489–94.CrossRefGoogle ScholarPubMed
18.Appelby, L, Cooper, J, Amos, T, Faragher, B. Psychological autopsy of suicides by people aged under 35. Br J Psychiat 1999; 175: 168–74CrossRefGoogle Scholar
19.Goldstien, RB, Black, DW, Nasrallah, A, Winokur, G. The prediction of suicide. Arch Gen Psychiat 1991; 418–22.CrossRefGoogle Scholar
20.Pokorny, AD. Prediction of suicide in psychiatric patients. Arch Gen Psychiat 1983; 40: 249–57.CrossRefGoogle ScholarPubMed
21.Newson-Smith, JG, Hirsh, SR. Psychiatric in self-poisoning patients. Psych Med 1979; 9: 501–7.CrossRefGoogle ScholarPubMed
22.Welch, SS. A review of the literature on the epidemiology of parasuicide in the general population. Psych Services 2001; 52 (3) 368–75.CrossRefGoogle ScholarPubMed
23.House, A, Owens, D, Storer, D. Psycho-social intervention following attempted suicide: Is there a case for better services? Int Rev Psych 1992; 2: 1522.CrossRefGoogle Scholar
24.Lockhart, E, Audit cycle on young people presenting with self-harm. Psych Bull 1998; 22: 100–01.CrossRefGoogle Scholar
25.Head, L, Campbell-Hewson, GL, O'Keane, V. No harm done? Psychological assessment in the A&E department of patients who deliberately harm themselves. J R Coll Phys Lond 1999 Jan-Feb; 33(1): 51–5.Google ScholarPubMed
26.Malone, K, Szanto, K, Corbitt, E, Mann, JJ. Clinical assessment versus research methods in the assessment of suicidal behaviour. Am J Psychiat 1995; 152: 1601–7.Google Scholar