Variations in the hospital management of self harm in adults in England: observational studyBMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7448.1108 (Published 06 May 2004) Cite this as: BMJ 2004;328:1108
Table A Hospital services scale with number of hospitals for each aspect of hospital service structure, delivery, or management: results derived from interviews with key emergency and mental health service staff at 32 hospitals
No of hospitals with service in place
Is there a protocol/guideline/aide memoire for staff in the emergency department for the immediate medical management of self harm patients?*
Is there a protocol/guideline/aide memoire for staff in the emergency department for the immediate assessment of risk and severe mental disorder for self harm patients?
Is there a designated self harm specialist clinical service?†
Is there a local specific planning/working group (of the team who undertake the psychosocial assessments) which meets at least once a year to plan/oversee the service for self-harm patients?
Are there psychosocial assessment training sessions for new staff who are involved in the psychosocial assessment of patients?‡
Are there supervision arrangements in place for staff members who undertake psychosocial assessments?§
Are there written guidelines/a checklist, to assist clinicians in the psychosocial assessment of self-harm patients?
Does the emergency department have 24 hour access to a psychiatrist, psychiatric nurse or social worker who is able to undertake psychosocial assessments?
If yes to 8, is immediate (within 15 minutes) advice available over the telephone?
If yes to 8, is emergency attendance, when requested, available within 1 hour?¶
Do regular (at least once a year) service planning/strategy meetings take place between the self-harm team/psychiatric service and the general medical service involved in the care of self harm patients?
Are rooms which allow for privacy and confidentiality available for conducting interviews with self-harm patients either in or close to the emergency department?
Are rooms which allow for privacy and confidentiality available for conducting interviews with self-harm patients either in or close to the inpatient unit where most of the patients are assessed?
Does a formal arrangement exist with Social Services to visit and offer advice to self-harm patients who have significant social difficulties?#
Can those admitted as inpatients remain in hospital until they have received a psychosocial assessment?
Is there a policy stating that a patient’s GP should be contacted within 24 hours of patient discharge from an emergency department?**
Is there a policy stating that a patient’s GP should be contacted within 24 hours of patient discharge from an inpatient unit?**
Are self harm patients routinely given printed material about local services, voluntary groups and how to obtain access to them?
Are there any formal links with non-statutory services (eg self help groups, the Samaritans)?††
Has a system been set up for the monitoring of hospital attendance/discharge and referral of self harm patients?
Has there been any audit of the service for self-harm patients in the last 2 years?
*routine use of the Manchester triage system or/and a toxicology database were considered equivalent to management guidelines.
†where at least one member of mental health staff was based at the general hospital and was responsible for carrying out psychosocial assessments.
‡training at induction (including experiential training) for at least one group of staff involved in the psychosocial assessment of patients at the general hospital.
§0=no supervision, 0.5=weekly or elective, 1=ongoing.
¶1=yes, 0.5=usually, 0=no.
#in A&E or within self-harm service based at the general hospital
**posted <24 hours except at weekends.
††involvement in the planning of self-harm services for the general hospital.
Self harm admissions data, derived from national Hospital Episodes Statistics (HES), were used to compute readmission rates for all Hospital Trusts in England. Readmission rates are only a proxy measure of repetition as the proportion of self harm admissions who are re-admitted is higher in hospitals that admit a larger proportion of cases from A&E.
To control for these effects when sampling, we conducted a linear regression analysis using as our outcome measure the proportion of self harm patients admitted to each hospital who were re-admitted in the subsequent 6 months. In the absence of data on the proportion of self harm patients admitted to a hospital bed, we controlled for its effect on self harm readmission rates by adding a term for the number of self harm admissions to a hospital as a proportion of all first attendances at each hospital’s A&E department. To control for the influence of socioeconomic deprivation on the incidence of self harm we further controlled for the Townsend score, a census derived aggregate measure of socioeconomic deprivation. The residuals from this regression analysis represent the difference between the predicted and the actual readmission rate for each hospital – positive residuals suggest the hospital’s repetition rate is higher than expected, negative residuals indicate it is lower than expected.
For each region we randomly sampled:
(a) one hospital with a higher than predicted readmission rate from hospitals with admission rates below the median for that region;
(b) one hospital with a higher than predicted readmission rate from hospitals with admission rates above the median for that region;
(c) one hospital with a lower than predicted readmission rate from hospitals with admission rates below the median for that region;
(d) one hospital with a lower than predicted readmission rate from hospitals with admission rates above the median for that region
Note that the one hospital that declined participation was replaced by a randomly selected hospital from within the appropriate stratum.
- This Week In The BMJ Published: 06 May 2004; BMJ 328 doi:10.1136/bmj.328.7448.0-c
- Letter Published: 10 June 2004; BMJ 328 doi:10.1136/bmj.328.7453.1440
- Maternal deaths from suicide must be tackled, say expertsBMJ December 07, 2016, 355 i6585; DOI: https://doi.org/10.1136/bmj.i6585
- Dyspnoea after home improvement workBMJ November 30, 2016, 355 i5957; DOI: https://doi.org/10.1136/bmj.i5957
- Risks of duloxetine for stress incontinence outweigh benefits, say researchersBMJ November 15, 2016, 355 i6103; DOI: https://doi.org/10.1136/bmj.i6103
- Health professionals’ stereotyping is impeding suicide prevention effortsBMJ November 11, 2016, 355 i6072; DOI: https://doi.org/10.1136/bmj.i6072
- Action is urged to improve physical health in severe mental illnessBMJ October 25, 2016, 355 i5729; DOI: https://doi.org/10.1136/bmj.i5729
- Extending the liaison psychiatry service in a large hospital in the UK: a before and after evaluation of the economic impact and patient care following ED attendances for self-harm
- Epidemiology and trends in non-fatal self-harm in three centres in England, 2000-2012: findings from the Multicentre Study of Self-harm in England
- Scales for predicting risk following self-harm: an observational study in 32 hospitals in England
- Non-fatal repetition of self-harm in Taipei City, Taiwan: cohort study
- Are hospital services for self-harm getting better? An observational study examining management, service provision and temporal trends in England
- Epidemiology and trends in non-fatal self-harm in three centres in England: 2000-2007
- Cyclic variations in demand for out-of-hours services in child and adolescent psychiatry: implications for service planning
- Attitudes towards clinical services among people who self-harm: systematic review
- Suicide risk after a suicide attempt
- Relationship between service ecology, special observation and self-harm during acute in-patient care: City-128 study
- Repeated self-injury from a liaison psychiatry perspective
- Increasing psychosocial assessment by introducing a self-harm pathway
- Self harm and attempted suicide in adults: 10 practical questions and answers for emergency department staff.
- Management of self-harm in adults: which way now?
- Hospital management of self harm in adults in England: Study contains important data not reported in the paper