Setting

This audit is relevant to all mental health professionals who assess patients who present with self-harm to accident and emergency (A&E) departments (e.g. liaison workers, home treatment teams and on-call psychiatrists).

Background

Self-harm is a common presentation to A&E departments. All patients presenting thus should receive a comprehensive assessment. This audit was part of a regional audit comparing self-harm assessments in different A&E departments.

Standards

The standards were obtained from a 2004 guideline on self-harm produced by the National Institute for Health and Clinical Excellence (NICE). It states that every person who self-harms and presents to the health service should receive a comprehensive assessment of psychosocial needs and risk by a healthcare professional. As defined in standards 8 and 9 from the guideline, this assessment should include all the following information:

ᐅ social situation (living arrangements, work, debt)

ᐅ personal relationships

ᐅ recent life events and current difficulties

ᐅ psychiatric history (previous self-harm, drug and alcohol use)

ᐅ mental state examination

ᐅ enduring psychological characteristics associated with self-harm

ᐅ motivation for the act

ᐅ characteristics of the act (intent, planning, violent methods)

ᐅ characteristics of the person (hopelessness, forensic history, future suicidal intent)

ᐅ circumstances of the person (social class, physical illness, social isolation, bereavement).

Any decision to refer for further management must be based upon the combined needs and risk assessment.

Method

Data collection

ᐅ All self-harm assessments completed by mental health professionals were identified for a certain time period. The records were retrieved from different locations (e.g. liaison notes, A&E notes, home treatment notes).

ᐅ The hospital used a specific self-harm assessment tool, which made data collection easier.

ᐅ A data-collection tool was used to determine whether all the relevant information required by NICE had been recorded at each assessment.

Data analysis

The percentage of assessments that had recorded each part of the needs and risk assessment was calculated.

Resources required

People

As this was part of a regional audit, several people were involved at different locations. Approximately two people per hospital are required.

Time

It is estimated that data collection for 50 cases will take 6 hours.