Striking differences found in self harm services

May 06, 2004

Striking differences exist in the care of self harm patients in hospitals in England, finds a study in this week's BMJ.

Each year in England and Wales, more than 140,000 people present to hospital after an episode of self harm. Improving the general hospital management of these people is a key area in preventing suicide.

The study, by researchers from the Universities of Bristol, Oxford and Leeds, involved a random sample of 32 hospitals. Each hospital was assessed on 21 recommended self harm service standards and each hospital did an eight-week audit of their management of self harm.

A designated self harm liaison service was available at 23 of the 32 hospitals. At 11 hospitals, more than half of the 21 recommended service structures were not in place.

Guidelines for assessing the risk of suicide were available at 17 hospitals. Only 14 hospitals had self harm service planning meetings. Routine contact with patients' general practitioners within 24 hours of discharge from emergency departments happened at only half of the hospitals.

During the audit, there was no significant difference in the proportion of assessments, admissions, or monitoring arrangements between hospitals with and without a designated service. However, at hospitals with a designated service, assessments were less likely to be undertaken by junior psychiatrists.

Variability in organisation and provision of services for patients with self harm was striking, say the authors. There was a two-fold difference across hospitals in levels of psychosocial assessment, four-fold variation in the proportion of attendances leading to admission to a hospital bed, and 10-fold variation in the proportion admitted to a psychiatric bed.

There were also wide variations in the implementation of the recommended service structures.

Future research should examine the relationships between the patient management and service structures described here and indicators such as repetition and suicide, they conclude.


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