Varying degree of care shown across UK hospitals for cases of self harm

The way hospitals care for patients who have deliberately harmed themselves varies widely across England, according to new research from the University of Bristol published in the BMJ today.

Each year in England and Wales, hospitals treat more than 140,000 people after an episode of self harm.  Improving the general hospital management of these people is a key area in preventing suicide.

The study by David Gunnell, Professor of Epidemiology at Bristol University and colleagues at the universities of Oxford and Leeds involved a random sample of 32 hospitals.  Each hospital was assessed on 21 recommended self harm service standards and each hospital did an eight-week audit of their management of self harm.

The study found that:

• 23 of the 32 hospitals had a designated self harm liaison service
• 11 hospitals had less than half of the 21 recommended service structures in place
• 17 hospitals had guidelines available for assessing the risk of suicide.
• Only 14 hospitals had self harm service planning meetings
• Routine contact with patients' general practitioners within 24 hours of discharge from emergency departments happened at only 16 hospitals.

During the audit, there was no significant difference in the proportion of assessments, admissions, or monitoring arrangements between hospitals with and without a designated service.  However, at hospitals with a designated service, assessments were less likely to be undertaken by a junior (training grade) psychiatrist alone (17% compared to 75% in those without such a service).

Professor Gunnell said: “This is the first national study of variation in the general hospital management of adult self-harm patients.  Variability in organisation and provision of services for patients with self harm was striking. 

“There was a two-fold difference across hospitals in levels of psychosocial assessment, four-fold variation in the proportion of attendances leading to admission to a hospital bed, and 10-fold variation in the proportion admitted to a psychiatric bed.  There were also wide variations in the implementation of the recommended service structures.

“Future research should examine the relationships between the patient management/service structures described here and indicators such as repetition and suicide.”

Paper:

Olive Bennewith, David Gunnell, Tim J Peters, Keith Hawton, Allan House: Variations in the hospital management of self harm in adults in England: observational study BMJ Volume 328, pp 1108-9