Intended for healthcare professionals


Variations in the hospital management of self harm in adults in England: observational study

BMJ 2004; 328 doi: (Published 06 May 2004) Cite this as: BMJ 2004;328:1108
  1. Olive Bennewith, research associate1,
  2. David Gunnell, professor of epidemiology (,
  3. Tim Peters, professor of primary care health services research2,
  4. Keith Hawton, professor of psychiatry3,
  5. Allan House, professor of liaison psychiatry4
  1. 1Department of Social Medicine, University of Bristol, Bristol BS8 2PR
  2. 2Division of Primary Health Care, University of Bristol, Bristol BS6 6JL
  3. 3Centre for Suicide Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX
  4. 4Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, Leeds LS2 9LT
  1. Correspondence to: D Gunnell
  • Accepted 18 November 2003


More than 140 000 people present to hospital after an episode of self harm each year in England and Wales.1Improving the general hospital management of these people is a key area in preventing suicide.2Although professional consensus has been reached on how self harm services should be organised and delivered,3wide variations in care delivery have been reported in two regions in England.45Using a nationally representative sample, we investigated the variation in services and delivery of care for self harm patients in hospitals in England.

Participants, methods, and results

We selected a stratified random sample of 32 hospitals, four from each former health region (see At each hospital we interviewed two to five key emergency and psychiatric staff about hospital service structures and made arrangements with them to start audits of the processes of care. We assessed each hospital on 21 recommended self harm service standards (see table A on …

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