Lepping et al (Psychiatric Bulletin, May 2006, 30, 169–172) report an increase in the number of psychosocial assessments following the introduction of a self-harm pathway. Questions remain about patients who abscond from the accident and emergency department (A&E). Factors that may lead to qualitative improvement in assessments should be given further consideration.

An integrated care pathway between the local university hospital and the mental health trust was set up in Middlesbrough in February 2004. Doctors in A&E use a modified SAD PERSONS scale for triage (Hockberger & Rothstein, 1998). Patients scoring <5 are offered home visits by the self-harm team and those scoring ≥5 are admitted to the medical assessment unit for daytime assessments the following day. Six-month data for comparable months in 2003 and 2004 have shown a 24% increase in referrals, a 17.8% (P<0.0001) increase in assessments and a reduction in the number of absconsions/self-discharges by 81.5% (P<0.0001). Admissions to the medical assessment unit have increased by 33%; 42% of planned home visits were cancelled by patients. These were from a group who had a low-risk score in triage.

The modified SAD PERSONS scale is easy to use by non-psychiatrists and allows reliable risk assessment of self-harm to be carried out at an early stage, which guides professionals if patients refuse treatment or abscond. We consider that daytime assessments after patients have had time to recover from the effects of drugs, alcohol or overdose, which allow access to collateral information, are of further benefit.