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Friday, 03 July 2015

PHA publish report on self-harm aftercare in Northern Ireland

Written by The Editorial Team

The Public Health Agency (PHA) in Northern Ireland has today published the findings of a study into the aftercare received by those who attended hospital after self-harming.

The report, ‘Recommended Next Care Following Hospital Treated Self-Harm in the Western Area of Northern Ireland, 2007-2012’, which concentrates on the Western Health and Social Care Trust (WHSCT) area, has been compiled by the National Suicide Research Foundation (NSRF) in collaboration with the PHA.

Earlier this year, the PHA launched a six-year review on the incidence of self-harm in the WHSCT area and today's report is the second of four supplements planned to accompany the six-year review.

Key findings include:

  • Between 2007 and 2012, 4,733 individuals were treated for 8,175 self-harm episodes. The number of self-harm presentations was highest on Sunday and Monday, accounting for 34% of all presentations. There were on average 282 additional self-harm presentations on both Sundays and Mondays, when compared with the remaining weekdays.

  • Attendance at the Emergency Department (ED) varied throughout the day, with the majority of presentations occurring at night time. Over a third of all presentations occurred between 11pm and 3am (34%).

  • Admission to either a general or psychiatric ward occurred in 61% of presentations. Over half of self-harm presentations resulted in admission to a general ward (54%) with a further 7% resulting in psychiatric admission. Just under one-third (29%) of cases of self-harm were not admitted. In 7% of self-harm presentations, the patient left the ED before a next care. recommendation could be made and just 3% of presentations resulted in a patient refusing to be admitted.

  • A mental health assessment was recorded as having been carried out for 15% of self-harm patients in the ED. An assessment can occur at different stages of a patient’s journey depending on the nature of their presentation and also their willingness to stay for an assessment. These assessments vary in nature across each hospital. Data collected in this report includes mental health assessments conducted for those patients in the ED at the time of presentation.

  • Alcohol was involved in 60% of self-harm presentations, and was highest among those refusing admission and those leaving the ED without being seen. In addition, the involvement of alcohol at the time of the self-harm presentation meant that a patient was less likely to receive a mental health assessment in the ED.

Brendan Bonner, who oversees the Self-Harm Registry for the PHA, said: “The majority of self-harm presentations to hospital Emergency Departments occurred out of normal working hours, and at the weekends, similar to findings in the Republic of Ireland and England. Self-harm patients were more likely to leave the ED without being seen when the presentation occurred outside of normal working hours. This underlines the need to continue the work to ensure that psychiatric services are available 24 hours a day, seven days a week, in line with international guidelines.”

The NICE guidelines state that all individuals presenting with self-harm should be offered a preliminary psychosocial assessment at triage, and there is evidence that having such an assessment is associated with lower rates of non-fatal repetition.

“The Northern Ireland Suicide Prevention Strategy, Protect Life, recommends that the link between the ED and mental health services should be enhanced. Future work should monitor the provision of assessments in the ED.

“The findings also show the importance of implementing and evaluating self-harm awareness training for all emergency department staff.

“Raising awareness of the unique needs of self-harm patients should ultimately improve patient experience in the ED setting and also the follow-up care offered to this patient group,” he added.

Based on the findings coming from the Self-Harm Registry, the PHA has commissioned training for front line staff in EDs to help them understand the issues around self-harm and the impact on family and carers. A range of information leaflets has also been produced for people who self-harm and their carers. A new regional Self-Harm Intervention Project has just been commissioned and will be implemented in the early autumn in all five trust areas.