Patients at risk of self-harm after discharge from psychiatric care

Non-fatal self-harm may occur in over ten per cent of adults discharged from psychiatric inpatient care in England and Wales, according to new research from the University of Bristol published in the BMJ. The risk was found to be greatest in the first month, Professor David Gunnell and colleagues found.

Patients who had previous self-harming behaviour were at the greatest risk. Others at increased risk included women, the young, and those with depression, personality disorders and substance misuse.

Although the high risk of suicide shortly after discharge from psychiatric inpatient care is well documented, less is known about the rates of non-fatal self harm. Professor Gunnell's study used routine hospital data on all patients aged 16-64 years who had been discharged from hospitals in England after general adult psychiatric care on at least one occasion between 1 April 2004 and 31 March 2005.

75,401 patients were discharged from psychiatric inpatient care in England during that period of whom 11.7 per cent (8,837) had been admitted to hospital for self harm in the year before their index psychiatric admission. Overall, 18,650 (24.7 per cent) of those discharged were readmitted to a psychiatric bed within a year and 4,935 (6.5 per cent) were readmitted to a general hospital or psychiatric bed for self harm.

The risk of readmission for self harm was higher in females than in males (8.0 per cent v 5.3 per cent). About one third of those who self harmed (38.5 per cent) after discharge had been admitted to hospital for self harm in the year before their index admission.

Risk of self harm diminished rapidly in the weeks following discharge. One third of admissions for self harm occurred in the month after discharge, with 11.9 per cent occurring within a week of discharge; 57.3 per cent occurred within 12 weeks.

Professor Gunnell said: "These findings suggest the need to develop interventions to reduce the risk of fatal and non-fatal self-harm in the weeks immediately after hospital discharge. Such interventions might include improved discharge arrangements, and clear crisis plans and lines of communication with specialist staff."

Hospital admissions for self harm after discharge from psychiatric inpatient care: cohort study by David Gunnell, Keith Hawton, Davidson Ho, Jonathan Evans, Susan O'Connor, John Potokar, Jenny Donovan and Nav Kapur. BMJ 2008;337:a2278, doi: 10.1136/bmj.a2278