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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 ,
Vincent Russell ,
Declan Bedford ,
Ashar Khan  and
Roisin Kelly
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
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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.

Keywords

Deliberate self-harmGuidelinesSelf-harm services planning group
Type
Original Papers
Information
Irish Journal of Psychological Medicine , Volume 18 , Issue 4 , December 2001 , pp. 116 - 119
Copyright
Copyright © Cambridge University Press 2001

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