Attitudes towards clinical services among people who self-harm: systematic review

Abstract

The prevalence of self-harm, defined as any intentional selfpoisoning or self-injury regardless of the degree of suicidal intent, 1 and the high rate of repetition and eventual suicide 2,3 make selfharm a major healthcare problem in many parts of the world. [4][5][6] Despite widespread variation in services and the general trend towards greater inclusion of consumer views in the evaluation of health service outcomes, 7-9 there appears to have been little attempt to draw together the available evidence on people's perceptions of self-harm services. Assembling such information is important in the design and successful implementation of better quality care. 10 We have conducted a systematic review of the international literature on people's attitudes to and satisfaction with health services (specifically medical management, in-hospital psychiatric management and post-discharge management) following selfharm in order to inform the development of improved services. MethodWe sought to identify all relevant qualitative and quantitative studies of participants of either gender or any age who had engaged in self-poisoning or self-injury and had contact with hospital services. We also included studies of patients' friends or relatives. Electronic databases (EMBASE, MEDLINE, PsycINFO, AMED, British Nursing Index, CINAHL, Global Health, HMIC, International Bibliography of the Social Sciences, Sociofile and SIGLE) were searched for any relevant international literature published until June 2006. Search terms relevant to the experiences of care of individuals who self-harm were those used in the National Collaborating Centre for Mental Health 10 report on self-harm (see online supplement). Reference lists of relevant studies were also searched. There were no language restrictions. Experts in the field working in non-English speaking countries were consulted in order to determine whether they knew of any published or unpublished literature concerning attitudes to services among those who self-harm.Research based on quantitative methods was used to provide evidence about the general experiences of a larger population of people who self-harm, with findings from qualitative studies used to extend understanding through the recounting of specific examples and incidents. Data were extracted independently by two reviewers. For studies using qualitative methodology, quotations and themes regarding attitudes and experiences of services were coded using a pen and paper method by a single reviewer (T.T.). The second reviewer (S.F.) extracted data to ensure all relevant quotations and topics were recorded and to reduce possible bias in reporting findings. Similarities and differences between participants' accounts were noted.The quality of all included studies was assessed independently by at least two reviewers using a combination of the Social Care Institute for Excellence's quality assessment tool 11 and the Critical Appraisal Skills Programme's '10 Questions to Help you Make Sense of Qualitative Research'.12 Relevance was assessed usi...

Trust is the Basis for Effective Suicide Risk Screening and Assessment in Veterans

“…11 In a study examining psychosocial assessment processes among individuals who had self-harmed, Taylor and coauthors found three factors contributed to a positive experience during the mental health assessment: 1) having ample time to respond; 2) perceived genuineness of the clinician conducting the assessment; and 3) receiving an explanation of the rationale and goals of the assessment. 12 Otherwise, little is known regarding the barriers to and facilitators of suicidal ideation disclosure among Veterans in the context of routine screening. In this study, we sought to understand, using qualitative methods, Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veteran perceptions of suicide screening and risk assessment process, the barriers and facilitators to disclosing suicidal ideation, and Veteran reactions and perceptions of possible consequences to endorsing suicidal ideation.…”

Oppfølging og behandling etter selvpåført forgiftning

“…For å kunne tilby dette er blant annet helsepersonells kompetanse og engasjement avgjørende. En sammenstilling av flere internasjonale studier har vist at helsepersonells holdninger i stor grad varierer når det gjelder grad av interesse og forståelse for selvmordstruede pasienter og dette vil også i noe grad gjenspeiles i pasientenes tilfredshet med den behandlingen de har mottatt i helsevesenet (Taylor, Hawton, Fortune, & Kapur, 2009). I denne artikkelen belyses faktorer omkring behandlingstilbudet til selvmordstruede pasienter ved å oppsummere resultater fra to tidligere publiserte norske studier (Grimholt, Bjornaas, Jacobsen, Dieserud, & Ekeberg, 2012;Grimholt, Haavet, Jacobsen, Sandvik, & Ekeberg, 2014).…”

“…Minst tilfredse var pasientene med planer for oppfølging og ventetiden til første behandlingsavtale. En systematisk litteraturgjennomgang av Taylor og medarbeidere viste også et tydelig behov for bedre tilgjengelighet til oppfølging i denne pasientgruppen (Taylor et al, 2009). Det er per i dag begrenset evidensbasert kunnskap om effektive intervensjoner som reduserer ytterligere selvmordsatferd blant pasienter som innlegges i sykehus med selvpåførte forgiftninger (Mehlum et.al., 2008).…”

Suicide prevention: are we doing enough?

“…It has been documented that 55% of emergency staff dislike working with patients who attend following self harm; as many as 69% of people who presented with selfharm were dissatisfied with the emergency care they received (Friedman 2006). In a review exploring attitudes towards clinical services among people who selfharm, one of the observations was that patients felt healthcare workers were concerned only with their physical health and not their mental state (Taylor 2009). …”