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Compliance with NICE guidelines in the management of self-harm

  • Diane Mullins (a1), Siobhan MacHale (a2) and David Cotter (a2)

Abstract

Aims and method

To identify the provision of psychosocial assessments for all people attending an accident and emergency department in Ireland with a presentation indicative of self-harm over 12 months and to investigate whether the National Institute for Health and Clinical Excellence (NICE) guidelines for self-harm were met.

Results

A total of 834 attendances for self-harm were recorded. A psychosocial assessment was undertaken by a member of the liaison psychiatry team in 59% of attendances. Single male patients under 45 years of age represented 39% of those who did not receive a psychosocial assessment.

Clinical implications

Single men under the age of 45 years represent a vulnerable group in which levels of psychosocial assessment need to be optimised in order to meet the NICE guidelines for standards of care.

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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.

Corresponding author

Diane Mullins (dianetmullins@rcsi.ie.)

Footnotes

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Declaration of interest

None.

Footnotes

References

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1 Ramirez, A, House, A. ABC of mental health: common mental health problems in the general hospital. BMJ 1997; 314: 1679–81.
2 Bolton, J. Accident and emergency psychiatry. Psychiatry 2006; 5: 73–6.
3 National Registry of Deliberate Self Harm Ireland. Annual Report 2005. National Suicide Research Foundation, 2005.
4 Gunnell, D, Bennewith, O, Peters, T, House, A, Hawton, K. The epidemiology and management of self-harm amongst adults in England. J Public Health (Oxf) 2004; 27: 6773.
5 Kapur, N, House, A, Dodgson, K, May, C, Creed, F. Effect of general hospital management on repeat episodes of deliberate self poisoning: cohort study. BMJ 2002; 325: 866–7.
6 Kapur, N, House, A, Creed, F, Feldman, E, Friedman, T, Guthrie, E. Management of deliberate self poisoning in adults in four teaching hospitals: descriptive study. BMJ 1998; 316: 831–2.
7 National Institute for Health and Clinical Excellence. Self-Harm: The Short Term Physical and Psychological Management and Secondary Prevention of Self Harm in Primary and Secondary Care. Clinical Guidelines 16. NICE, 2004.
8 Mackway-Jones, K. Emergency Department: Manchester Triage Group. BMJ Publishing, 1997.
9 Horrocks, J, Price, S, House, A, Owens, D. Self-injury attendances in the accident and emergency department. Clinical database study. Br J Psychiatry 2003; 183: 34–9.
10 Australasian College for Emergency Medicine. The Australasian Triage Scale. ACEM, 2000.
11 Broadbent, M, Jarman, H, Berk, M. Improving competence in emergency mental health triage. Accid Emerg Nurs 2003; 10: 155–62.
12 Sidley, G. General nurses' attitudes to patients who self-harm. Nursing Standard 1996; 10: 32–6.
13 Hemmings, A. Attitudes to deliberate self harm among staff in an accident and emergency team. Ment Health Care 1999; 21: 300–2.
14 McAllister, M, Creedy, D, Moyle, W, Farrugia, C. Nurses' attitudes towards clients who self-harm. J Adv Nurs 2002; 40: 678–86.

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Compliance with NICE guidelines in the management of self-harm

  • Diane Mullins (a1), Siobhan MacHale (a2) and David Cotter (a2)
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eLetters

A need for predictors of non-completion of psychosocial assessment following self-harm presentation

Alexandra L Pitman, MRC Research Fellow
09 October 2010

Mullins et al’s study of A&E presentations following self-harm added to the evidence for poor uptake of psychosocial assessments in the initialmanagement of self harm (1). Of particular concern was the finding that single males under 45 represented 39% of those not assessed. Although suicide rates amongst men in the UK fell from 1992-2007, the 2008 figures show a rise to 17.7 per 100,000, with highest rates seen in men aged 15-44(2). A young man’s presentation to A&E following self-harm represents a valuable opportunity to offer interventions which reduce his risk of repetition. The paradox is that with many of these opportunities being missed researchers cannot evaluate the effectiveness of interventions to reduce repetition in this group.

Those who discharge themselves from an emergency department before completed assessment are three times more likely to repeat self-harm in the subsequent year than those who are assessed (3). It is possible that impulsive personality traits are more heavily implicated than the lack of an assessment, but we need to know more about this group’s behavioural characteristics so that we can learn how to engage them as soon as they present. From the Mullins et al study it is not clear whether patient factors or staff factors were more influential in determining completion of a psychosocial assessment. NICE recommends that patients who self-harm are “treated with the same care, respect and dignity as other patients” (4), and reforms to medical and nursing training in some areas of the UK have managed to achieve cultural change (5). This is crucial because a humiliating or uncomfortable experience in A&E is likely to dissuade a patient from representing should they self-harm again, and in cases of overdose this may increase mortality risk.

It is striking that of the 341 patients in Mullins et al’s study who did not receive a psychosocial assessment, 141 (41%) subsequently represented within the year of data collection having self-harmed, of whom74 (52%) slipped through the net a second time. We are unclear of the demographic characteristics of this sub-group, or whether there was a tendency for these individuals to leave the department at the same stage in the referral process. However if a study of this kind was repeated across a larger geographical area it could be sufficiently powered to reveal valuable predictors which would help A&E staff decide which patients to fast-track.

Finally NICE’s recommendations on the communication of findings afterself-harm assessments require auditing in future similar studies. A patient’s GP or CMHT may remain completely unaware of their presentation to A&E following self harm unless a copy of the assessment is communicatedto the relevant professionals. Even if the full psychosocial assessment was not performed an outline of the presenting complaint would be of value. Armed with this information a GP or key worker would be able to discern any patterns emerging in self-harm presentations, sometimes to many different hospitals, and would be in a unique position to manage apparent escalations in risk.

Declaration of interest: none

References:

1) Mullins D, MacHale S, & Cotter D. (2010) Compliance with NICE guidelines in the management of self-harm The Psychiatrist 2010 v. 34, p. 385-389 http://pb.rcpsych.org/cgi/content/full/34/9/385

2) Office of National Statistics. Suicides: UK suicides increase in 2008. Office of National Statistics 2010. Available from: URL: http://www.statistics.gov.uk/cci/nugget.asp?id=1092

3) Crawford MJ, Wessely S (1998) Does initial management affect the rate of repetition of deliberate self harm? Cohort study BMJ 1998;317:985 http://www.bmj.com/content/317/7164/985.1.full

4) National Institute for Health and Clinical Excellence. (2004) Self-Harm: The Short Term Physical and Psychological Management and Secondary Prevention of Self Harm in Primary and Secondary Care. Clinical Guidelines16. NICE, London. http://www.nice.org.uk/nicemedia/live/10946/29424/29424.pdf

5) Pitman A, Tyrer P. (2008) Implementing clinical guidelines for self harm – highlighting key issues arising from the NICE Guideline for Self-Harm. Psychology and Psychotherapy: Theory, Training and Practice (Special Issue: Implementing clinical guidelines in everyday practice) 8 (4): 377-397
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Conflict of interest: None Declared

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