scholarly journals Self-harm during the early period of the COVID-19 Pandemic in England: comparative trend analysis of hospital presentations

2020 ◽  
Author(s):  
Keith Hawton ◽  
Deborah Casey ◽  
Elizabeth Bale ◽  
Fiona Brand ◽  
Jennifer Ness ◽  
...  
Keyword(s):  
Help Seeking ◽  
Age Groups ◽  
Early Period ◽  
Psychosocial Assessment ◽  
Health Measures ◽  
Self Injury ◽  
Self Harm ◽  
Substantial Decline ◽  
The Uk ◽  
Term Monitoring

ABSTRACTBackgroundThe COVID-19 pandemic and public health measures necessary to address it may have major effects on mental health, including on self-harm. We have used well-established monitoring systems in two hospitals in England to investigate trends in self-harm presentations to hospitals during the early period of the pandemic.MethodData collected in Oxford and Derby on patients aged 18 years and over who received a psychosocial assessment after presenting to the emergency departments following self-harm were used to compare trends during the three-month period following lockdown in the UK (23rd March 2020) to the period preceding lockdown and the equivalent period in 2019.ResultsDuring the 12 weeks following introduction of lockdown restrictions there was a large reduction in the number of self-harm presentations to hospitals by individuals aged 18 years and over compared to the pre-lockdown weeks in 2020 (mean weekly reduction of 13.5 (95% CI 5.6 - 21.4) and the equivalent period in 2019 (mean weekly reduction of 18.0 (95% CI 13.9 - 22.1). The reduction was greater in females than males, occurred in all age groups, with a larger reduction in presentations following self-poisoning than self-injury.ConclusionsA substantial decline in hospital presentations for self-harm occurred during the three months following the introduction of lockdown restrictions. Reasons could include a reduction in self-harm at the community level and individuals avoiding presenting to hospital following self-harm. Longer-term monitoring of self-harm behaviour during the pandemic is essential, together with efforts to encourage help-seeking and the modification of care provision.

scholarly journals Care-pathways for patients presenting to emergency ambulance services with self-harm: national survey

2020 ◽  
pp. emermed-2019-208967
Author(s):  
Mohammed Gaber Zayed ◽  
Victoria Williams ◽  
Alexander Charles Glendenning ◽  
Jenna Katherine Bulger ◽  
Tom Hewes ◽  
...  
Keyword(s):  
Mental Health ◽  
Hospital Admissions ◽  
Psychosocial Assessment ◽  
Mental Health Crisis ◽  
Health Crisis ◽  
Alternative Pathways ◽  
Mental Health Patients ◽  
Emergency Ambulance ◽  
Self Harm ◽  
The Uk

BackgroundSelf-harm is among the top five causes of acute hospital admissions and ambulance clinicians are often the first point of contact. However, the Emergency Department (ED) may not be the most appropriate place of care and little is known about the existence or nature of alternative pathways available to UK ambulance services. This survey describes the current management pathways used by ambulance services for patients who have self-harmed.MethodsA structured questionnaire was sent to all UK ambulance services by email and followed up by telephone in 2018. Three independent researchers (two clinical) coded responses which were analysed thematically.ResultsAll 13 UK ambulance services responded to the survey: nine by email and four by telephone interview. Two services reported a service-wide protocol for managing people presenting with self-harm, with referral to mental health crisis team available as an alternative to conveyance to ED, following on-scene psychosocial assessment. Four services reported local pathways for managing mental health patients which included care of patients who had self-harmed. Four services reported being in the process of developing pathways for managing mental health patients. Six services reported no service-wide nor local pathways for managing self-harm patients. No robust evaluation of new care models was reported.ConclusionPractice in ambulance services in the UK is variable, with a minority having a specific clinical pathway for managing self-harm, with an option to avoid ED. New pathways for patients who have self-harmed must be evaluated in terms of safety, clinical and cost-effectiveness.

scholarly journals ‘Wasn’t offered one, too poorly to ask for one’ – Reasons why some patients do not receive a psychosocial assessment following self-harm: Qualitative patient and carer survey

2021 ◽  
pp. 000486742110112
Author(s):  
Leah Quinlivan ◽  
Louise Gorman ◽  
Donna L Littlewood ◽  
Elizabeth Monaghan ◽  
Stephen J Barlow ◽  
...  
Keyword(s):  
Suicide Risk ◽  
Alcohol Intoxication ◽  
Waiting Times ◽  
Psychosocial Assessment ◽  
Compassionate Care ◽  
The United Kingdom ◽  
Qualitative Survey ◽  
Self Injury ◽  
Acute Hospitals ◽  
Self Harm

Objective: Psychosocial assessment following self-harm presentations to hospital is an important aspect of care. However, many people attending hospital following self-harm do not receive an assessment. We sought to explore reasons why some patients do not receive a psychosocial assessment following self-harm from the perspective of patients and carers. Methods: Between March and November 2019, we recruited 88 patients and 14 carers aged ⩾18 years from 16 mental health trusts and community organisations in the United Kingdom, via social media, to a co-designed qualitative survey. Thematic analyses were used to interpret the data. Results: Patients’ reasons for refusing an assessment included long waiting times, previous problematic interactions with staff and feeling unsafe when in the emergency department. Two people refused an assessment because they wanted to harm themselves again. Participants reported organisational reasons for non-assessment, including clinicians not offering assessments and exclusion due to alcohol intoxication. Other patients felt they did not reach clinically determined thresholds because of misconceptions over perceived heightened fatality risk with certain self-harm methods (e.g. self-poisoning vs self-cutting). Conclusion: Our results provide important insights into some of the reasons why some people may not receive a psychosocial assessment following self-harm. Parallel assessments, compassionate care and specialist alcohol services in acute hospitals may help reduce the number of people who leave before an assessment. Education may help address erroneous beliefs that self-injury and self-harm repetition are not associated with greatly raised suicide risk.

Police Referrals to a Psychiatric Hospital: Indicators for Referral and Psychiatric Outcome

1994 ◽  
Vol 28 (2) ◽  
pp. 259-268 ◽  
Author(s):  
Graham Meadows ◽  
Greg Calder ◽  
Hans van Den Bos
Keyword(s):  
Mental Illness ◽  
Psychotic Symptoms ◽  
Relative Odds ◽  
Self Injury ◽  
Language Difficulties ◽  
The Usa ◽  
Self Harm ◽  
Clinical Description ◽  
The Uk ◽  
Psychiatric Outcome

Studies of police psychiatric referrals in the USA and the UK generally show these patients to be ill and in need of care. There are, however, no published Australian studies and such findings may not be validly generalised. This prospective study of consecutive police psychiatric referrals in Adelaide reports psychiatric assessment in 92 cases and observations by police in 69 of these, with no evidence of selection bias. The most common reason for referral was threat of self harm (28%). Mental illness was deemed to be present in 49% and the most common clinical description was “situational crisis” (29%). Schizophrenia was diagnosed in 18%. Clinicians viewed 19% of referrals as inappropriate. Increased relative odds for mental illness were associated with police accounts of psychotic symptoms, and decreased odds with threat of self harm and violence. Increased odds for admission were associated with language difficulties and damage to own property, decreased odds with threat to others, threat of suicide, and threat to self injury. There were 14 cases where possible charges were not being pursued: of these 7 were regarded as ill and 4 were regarded as inappropriate referrals. The rates of major disorders are lower than in other published work. It is proposed that this can be explained by relative ease of referral by police to psychiatry and flexible acceptance criteria.

scholarly journals Hospital care and repetition following self-harm: Multicentre comparison of self-poisoning and self-injury

2008 ◽  
Vol 192 (6) ◽  
pp. 440-445 ◽  
Author(s):  
Rachael Lilley ◽  
David Owens ◽  
Judith Horrocks ◽  
Allan House ◽  
Rachael Noble ◽  
...  
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Hospital Care ◽  
Quantitative Research ◽  
Psychosocial Assessment ◽  
Teaching Hospitals ◽  
Hospital Services ◽  
Self Injury ◽  
High Incidence ◽  
Self Harm

BackgroundQuantitative research about self-harm largely deals with self-poisoning, despite the high incidence of self-injury.AimsWe compared patterns of hospital care and repetition associated with self-poisoning and self-injury.MethodDemographic and clinical data were collected in a multicentre, prospective cohort study, involving 10 498 consecutive episodes of self-harm at six English teaching hospitals.ResultsCompared with those who self-poisoned, people who cut themselves were more likely to have self-harmed previously and to have received support from mental health services, but they were far less likely to be admitted to the general hospital or receive a psychosocial assessment. Although only 17% of people repeated self-harm during the 18 months of study, survival analysis that takes account of all episodes revealed a repetition rate of 33% in the year following an episode: 47% after episodes of self-cutting and 31% after self-poisoning (P<0.001). Of those who repeated, a third switched method of self-harm.ConclusionsHospital services offer less to people who have cut themselves, although they are far more likely to repeat, than to those who have self-poisoned. Attendance at hospital should result in psychosocial assessment of needs regardless of method of self-harm.

scholarly journals Self-injury attendances in the accident and emergency department

2003 ◽  
Vol 183 (1) ◽  
pp. 34-39 ◽  
Author(s):  
Judith Horrocks ◽  
Sally Price ◽  
Allan House ◽  
David Owens
Keyword(s):  
Clinical Importance ◽  
Epidemiological Data ◽  
Psychosocial Assessment ◽  
Self Injury ◽  
After Care ◽  
Accident And Emergency ◽  
History Of ◽  
Self Harm ◽  
Accident And Emergency Department

BackgroundSelf-injury is a neglected area of self-harm research and we know little about its epidemiology, hospital care and outcome.AimsTo provide epidemiological data on self-injury and compare hospital management of self-injury with that for self-poisoning.MethodData were collected on all self-harm attendances to the general hospitals in Leeds over an 18-month period.ResultsPeople attending hospital for self-injury or self-poisoning do not form mutually exclusive groups. There were higher proportions of self-injury episodes compared with self-poisoning, where a history of self-harm or contact with mental health services had been recorded. Fewer psychosocial assessments were carried out after episodes of self-injury compared with self-poisoning but, when they were, follow-up was recommended more often.ConclusionsThe clinical importance of self-injury is not mirrored by the level of psychosocial assessment and after-care provided.

scholarly journals A Qualitative Study of Understanding Reasons for Self-Harm in Adolescent Girls

2021 ◽  
Vol 18 (7) ◽  
pp. 3361
Author(s):  
Michelle Miller ◽  
Marcus Redley ◽  
Paul O. Wilkinson
Keyword(s):  
Qualitative Study ◽  
Interpersonal Relationships ◽  
Adolescent Girls ◽  
Interpretative Phenomenological Analysis ◽  
Public Health Issue ◽  
Self Injury ◽  
Compulsive Behaviour ◽  
Self Harm ◽  
New Perspective ◽  
The Uk

Objective: Self-harm is an important public health issue in the UK. Young people who frequently self-harm feel misunderstood, and unable to access help. Improving understanding is key to informing the development and delivery of effective treatments and services. Methods: In this qualitative study, we interviewed nine adolescent girls (13–17 years old) with recurrent self-harm, recruited from NHS specialist child and adolescent mental health services. Data were analysed using Interpretative Phenomenological Analysis (IPA). Results: Findings revealed that self-harm is experienced as powerful mental and physical urges, sated only by self-harming, suggesting that self-harm could be considered a compulsive rather than impulsive disorder, representing a new perspective on the behaviour. Five themes emerged: emotion regulation; an addictive urge; self-harm to survive; interpersonal triggers; interpersonal relationships, not mechanical distractors, reduce self-harm. Conclusions: This study provides further evidence that non-suicidal self-injury may be engaged in to reduce suicidal risk. Seeking the company of helpful friends or family members may reduce the urge to self-harm. Repetitive self-harm may be a compulsive behaviour.

scholarly journals Parents’ Experience and Psychoeducation Needs When Supporting a Young Person Who Self-Harms

2020 ◽  
Vol 17 (10) ◽  
pp. 3662 ◽  
Author(s):  
Karolina Krysinska ◽  
Sophie Curtis ◽  
Michelle Lamblin ◽  
Nina Stefanac ◽  
Kerry Gibson ◽  
...  
Keyword(s):  
Young People ◽  
Help Seeking ◽  
Negative Impact ◽  
Well Being ◽  
Young Person ◽  
Emotional Reactions ◽  
Need For Support ◽  
Self Harm ◽  
Group Interviews ◽  
The Uk

Background: Self-harm in young people can have a substantial negative impact on the well-being and functioning of parents and other carers. The “Coping with Self-Harm” booklet was originally developed in the UK as a resource for parents and carers of young people who self-harm, and an adaptation study of this resource was conducted in Australia. This paper presents qualitative analysis of interviews with parents about their experiences and psychoeducational needs when supporting a young person who engages in self harm. Methods: The qualitative study drew on semi-structured individual and group interviews with parents (n = 19 participants) of young people who self-harm. Data were analysed using Thematic Analysis. Results: The analysis identified six themes: (1) the discovery of self-harm, (2) challenges in the parent-young person relationship, (3) parents’ need to understand self-harm, (4) parents’ emotional reactions to self-harm, (5) the importance of self-care and help-seeking among parents, and (6) the need for psychoeducational resources. Conclusion: The study highlights the need for support for parents and carers of young people who engage in self-harm, including development and adaptation of resources, such as the “Coping with Self-Harm” booklet, of which an Australian version has now been developed.

scholarly journals Factors influencing self-harm thoughts and behaviours over the first year of the COVID-19 pandemic in the UK: longitudinal analysis of 49 324 adults

2021 ◽  
pp. 1-7
Author(s):  
Elise Paul ◽  
Daisy Fancourt
Keyword(s):  
Risk Factors ◽  
Fixed Effects ◽  
Age Groups ◽  
Social Study ◽  
Social Consequences ◽  
Adverse Experiences ◽  
Related Risk ◽  
Increased Risk ◽  
Self Harm ◽  
The Uk

Background There is concern that the COVID-19 pandemic and its aftermath will result in excess suicides by increasing known risk factors such as self-harm, but evidence on how pandemic-related risk factors contribute to changes in these outcomes is lacking. Aims To examine how different COVID-19-related experiences of and worries about adversity contribute to changes in self-harm thoughts and behaviours. Method Data from 49 324 UK adults in the University College London COVID-19 Social Study were analysed (1 April 2020 to 17 May 2021). Fixed-effects regressions explored associations between weekly within-person variation in five categories of adversity experience and adversity worries with changes in self-harm thoughts and behaviours across age groups (18–29, 30–44, 45–59 and 60+ years). Results In total, 26.1% and 7.9% of respondents reported self-harm thoughts and behaviours respectively at least once over the study period. The number of adverse experiences was more strongly related to outcomes than the number of worries. The largest specific adversity contributing to increases in both outcomes was having experienced physical or psychological abuse. Financial worries increased the likelihood of both outcomes in most age groups, and having had COVID-19 increased the likelihood of both outcomes in young (18–29 years) and middle-aged (45–59 years) adults. Conclusions Findings suggest that a significant portion of UK adults may be at increased risk for self-harm thoughts and behaviours during the pandemic. Given the likelihood that the economic and social consequences of the pandemic will accumulate, policy makers can begin adapting evidence-based suicide prevention strategies and other social policies to help mitigate its consequences.

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