Psychosocial Assessment Following Self-Harm
Repetition of Nonfatal Self-Harm After Assessment by Psychiatrists or Mental Health Nurses
Abstract
Background: Patients admitted to hospital because of self-harm should receive psychosocial assessment before discharge. In practice many of these assessments in the United Kingdom and elsewhere are undertaken by trainee rather than specialist psychiatrists. Aims: To compare psychosocial assessments, aftercare, and the pattern of non-fatal repetition for patients admitted to general hospital after self-harm: comparing assessments carried out by trainee psychiatrists, allocated to the task alongside other duties on a roster, or by mental health nurses with a designated role in self-harm services. Methods: Arrangements for aftercare and rates of non-fatal repetition of self-harm in 787 consecutive psychosocial assessments in a large UK city were compared, according to whether the assessments were carried out by trainee psychiatrists or mental health nurses. Results: Compared with nurses, psychiatrists were much more likely to arrange psychiatric admission or outpatient follow-up. Nurses more often pointed people towards voluntary sector help – such as drug, alcohol or relationship counselling. Repetition of self-harm was equally common among those assessed by nurses or psychiatrists (33%; hazard ratio 0.93, 95% confidence interval 0.71 to 1.2). Conclusions: Despite making fewer aftercare arrangements that involved statutory mental health care services, psychosocial assessment by mental health nurses showed no sign of detrimental effects on repetition of self-harm.
References
2004). Variations in the hospital management of self-harm in adults in England: observational study. British Medical Journal, 328, 1108–1109.
(2007). Variations in time of hospital presentation for deliberate self-harm and their implications for clinical services. Journal of Affective Disorders, 98, 227–237.
(1989). Trends in the assessment of cases of deliberate self-harm. Health Trends, 21, 61.
(1980). Comparison of doctors and nurses in the assessment of deliberate self-poisoning patients. Psychological Medicine, 10, 483–491.
(2002). National suicide prevention strategy for England. London: Author.
. (1984). The management of deliberate self harm. Health Notice HN(84):25. London: Author.
. (1977). Psychological and social evaluation in cases of deliberate self-poisoning admitted to a general hospital. British Medical Journal, 2, 1567–1570.
(2001). Introducing a nurse-led deliberate self-harm assessment service. Psychiatric Bulletin, 25, 212–214.
(2007). Self-harm in England: A tale of three cities. Social Psychiatry and Psychiatric Epidemiology, 42, 513–521.
(2003). Deliberate self-harm in Oxford, 1990–2000: A time of change in patient characteristics. Psychological Medicine, 33, 987–996.
(2003). Suicide following deliberate self-harm: Long-term follow-up of patients who presented to a general hospital. British Journal of Psychiatry, 182, 537–542.
(1998). Management of deliberate self-poisoning in adults in four teaching hospitals: Descriptive study. British Medical Journal, 316, 831–832.
(1961). Attempted suicide. HM(61):94. London: Author.
. (2004). Self-harm. The short-term physical management and secondary prevention of self-harm in primary and secondary care. Clinical Guideline 16. London: Author.
. (1979). A comparison of social workers and psychiatrists in evaluating parasuicide. British Journal of Psychiatry, 134, 335–342.
(2005). Mortality and suicide after nonfatal self-poisoning: A 16-year outcome study of patients attending accident and emergency. British Journal of Psychiatry, 187, 470–475.
(1990). Self-harm patients not admitted to hospital. Journal of the Royal College of Physicians of London, 24, 281–283.
(1994). The general hospital management of adult deliberate self-harm: A consensus statement on standards for service provision. Council Report Number 32. London: Royal College of Psychiatrists.
. (2000). The assessment of a “nurse led” deliberate self-harm service. Health Bulletin, 58, 221–223.
(2003). SPSS for Windows Release 12. Chicago, IL: Author.
. (2003). Comparison of the assessment by doctors and nurses of deliberate self-harm. Psychiatric Bulletin, 27, 57–60.
(2001). Deliberate self-harm. The impact of a specialist DSH team on assessment quality. Psychiatric Bulletin, 25, 98–101.
(1998). Liaison psychiatric nurses can be used to increase psychosocial assessments. British Medical Journal, 317, 415.
(