Deliberate self-harm patients who leave the accident and emergency department without a psychiatric assessment: A neglected population at risk of suicide

ArticleinJournal of Psychosomatic Research 50(2):87-93 · March 2001with16 Reads
DOI: 10.1016/S0022-3999(00)00225-7 · Source: PubMed
Deliberate self-harm (DSH) patients, despite their risk of suicide, are often discharged directly from accident and emergency (A&E) departments without undergoing a psychiatric assessment. The aims of this study were to determine the characteristics and outcome of these patients. The characteristics of DSH patients who were discharged directly from an A&E department over a 2-year period were investigated, comparing those who had a psychiatric assessment with those who did not. In a matched control design, the outcome of a group of patients who did not receive a psychiatric assessment was compared with that of a group of patients who were assessed. Of DSH patients who were discharged directly from the A&E department 58.9% (145/246) did not have a psychiatric assessment. Nonassessed patients were more likely to have a past history of DSH, to be in the 20-34 year age group, and to have exhibited difficult behaviour in the A&E department. Patients presenting between 5 p.m. and 9 a.m. were less likely to be assessed than those attending between 9 a.m. and 5 p.m. Further DSH during the subsequent year occurred in 37.5% of the nonassessed patients compared with 18.2% of matched assessed patients. They were also more likely to have psychiatric treatment. A substantial proportion of DSH patients discharged directly from A&E departments do not receive a psychiatric assessment. Nonassessed patients may be at greater risk of further DSH and completed suicide than those who are assessed. Hospital services need to be organised such that DSH patients managed in A&E departments can receive an assessment of psychosocial problems and risk.
    • "The Royal Australian and New Zealand College of Psychiatrists (RANZCP) states that patients presenting to the ED with evidence of self-harm should receive a comprehensive psychiatric assessment and that, where possible, this should take place in the ED (Boyce et al., 2003). The incidence of self-harm in the year following an initial ED presentation due to self-harm is significantly higher among those who do not receive such an assessment compared with those who do (Hickey et al., 2001; Shahid et al., 2009), further increasing both individual risk and health-care costs. Importantly, this suggests that it may already be 'too late' once an individual presents to the ED following self-harm, as these individuals should already have received mental Table 4. Secondary outcomes for 165 ED presentations resulting from self-harm following release from prison. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: Prisoners are at increased risk of both self-harm and suicide compared with the general population, and the risk of suicide after release from prison is three times greater than for those still incarcerated. However, surprisingly little is known about the incidence of self-harm following release from prison. We aimed to determine the incidence of, identify risk factors for and characterise emergency department presentations resulting from self-harm in adults after release from prison. Method: Cohort study of 1325 adults interviewed prior to release from prison, linked prospectively with State correctional and emergency department records. Data from all emergency department presentations resulting from self-harm were secondarily coded to characterise these presentations. We used negative binomial regression to identify independent predictors of such presentations. Results: During 3192 person-years of follow-up (median 2.6 years per participant), there were 3755 emergency department presentations. In all, 83 (6.4%) participants presented due to self-harm, accounting for 165 (4.4%) presentations. The crude incidence rates of self-harm for males and females were 49.2 (95% confidence interval: [41.2, 58.7]) and 60.5 (95% confidence interval: [44.9, 81.6]) per 1000 person-years, respectively. Presenting due to self-harm was associated with being Indigenous (incidence rate ratio: 2.01; 95% confidence interval: [1.11, 3.62]), having a lifetime history of a mental disorder (incidence rate ratio: 2.13; 95% confidence interval: [1.19, 3.82]), having previously been hospitalised for psychiatric treatment (incidence rate ratio: 2.68; 95% confidence interval: [1.40, 5.14]) and having previously presented due to self-harm (incidence rate ratio: 3.91; 95% confidence interval: [1.85, 8.30]). Conclusion: Following release from prison, one in 15 ex-prisoners presented to an emergency department due to self-harm, within an average of 2.6 years of release. Demographic and mental health variables help to identify at-risk groups, and such presentations could provide opportunities for suicide prevention in this population. Transition from prison to the community is challenging, particularly for those with a history of mental disorder; mental health support during and after release may reduce the risk of adverse outcomes, including self-harm.
    Article · Mar 2016
    • ", morbidity and mortality rates related to untreated self-harm are likely to increase. Incomplete assessment has three times the risk of repetition of self-harm (). Risk of repetition can also mean risk of suicide is increased. People who self-harm are 18 times more likely than the general population eventually to commit suicide (Ryan et al. 1997). Hickey et al. (2001) found that up to 58% of presenting clients are not assessed accurately and that nonassessed clients may be at greater risk of further selfharm and completed suicide than those who are assessed. Hospital services need to be organized such that self-harm clients managed in ED receive an assessment of psychosocial problems and risk. It is "
    Full-text · Dataset · Nov 2015 · Nordic Psychology
    • "Sanders (2000) found that negative attitudes may lead to a reduction in care from nurses. Indeed, negative attitudes are linked with decreased helping behavior (Mackay & Barrowclough, 2005), which is alarming considering that the risk of further SIB is particularly high for patients who leave hospital without adequate assessment (Hickey et al., 2001). This formed the basis of the final hypothesis regarding the consequences of self-injury, whereby it is stated that episodes of NSSI will be followed by lesser level of medical care than episodes of SSI. "
    [Show abstract] [Hide abstract] ABSTRACT: Nonsuicidal self-injury (NSSI) and suicidal self-injury (SSI) co-occur in adults. The purpose of the current study was to examine differences and similarities in NSSI and SSI in adult women with respect to (1) methods used and lethality of methods, (2) intent and impulsivity of act, (3) precipitating events, and (4) consequences. The data consist of variables pertaining to 46 self-injurious acts committed by 16 Finnish female participants and recorded using Suicide Attempt Self-Injury Interviews (SASII). The data were analyzed using variables weighted by the number of acts. This study found several differences as well as similarities between the acts of SSI and those of NSSI: (a) the respective acts differ in the methods used, in the lethality of the methods, and in the expectations of resulting lethality of the acts, (b) they further differ in the functions the respective acts serve and (c) in some of the precipitating events and consequences. The acts were similar in (d) impulsivity of act and (e) some of the precipitating events and consequences. Because both types of behavior can occur within the same individual, and due to the progressing evolution between them, a thorough assessment of both NSSI and SSI needs to be completed. More emphasis needs to be placed on both the assessment of social connections and interpersonal conflict as well as how it informs the treatment. Because the behavior studied is multifunctional and changing, its treatment too needs to be customized to the multiple and changing needs of the individual patients, as opposed to diagnostic tailored treatment.
    Full-text · Article · Feb 2015
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