General hospital services for deliberate self-poisoning: an expensive road to nowhere?

Abstract

SummaryThis study was designed to investigate the clinical and economic aspects of deliberate self-poisoning services in four teaching hospitals in Leeds, Leicester, Manchester and Nottingham. We investigated the management of the current selfharm episode, including direct in-hospital costs, in 456 individuals who presented to hospital on a total of 477 occasions with deliberate self-poisoning during a 4-week period in 1996. Fewer than half of the patients received specialist psychosocial assessment or follow-up. Patients were more likely to receive an assessment if they were already in contact with psychiatric services, had a history of previous overdoses, if they presented during working hours, or if they lived near the hospital. Patients who were admitted were nearly twice as likely to receive specialist assessment, and those who received a specialist assessment were nearly three times as likely to be oVered follow-up. In-patient days and days on the intensive care unit accounted for 47% and 8% of the total costs, respectively. This study suggests that general hospital services are disorganised, with evidence of inequitable access to specialist assessment and aftercare. This state of aVairs cannot be justified on financial or clinical grounds.

Assessment Rates and Compliance With Assertive Follow-up After Self-Harm: Cohort Study

“…This is defined as an integrated assessment of needs and risk (National Collaborating Centre for Mental Health, 2004). It may improve access to aftercare (Barr, Leitner, & Thomas, 2005;Kapur, House, Creed et al, 1999) and protect against self-harm repetition (Kapur, House, May et al, 2003;Kapur, Murphy, Cooper et al, 2008).…”

“…Although several researchers have examined the factors associated with nonassessment, which include attendance outside working hours; discharge by hospital staff; younger age; cutting as a method of harm; and not being in contact with psychiatric services (Barr, Leitner, & Thomas, 2005;Bennewith, Peters, Hawton et al, 2005;Hickey, Hawton, Fagg et al, 2001;Kapur, House, Creed et al, 1999;Kapur, Murphy, Cooper et al, 2008); less is known about subsequent compliance with aftercare.…”

Direct and indirect cost of attempted suicide in a general hospital: cost-of-illness study

“…A study that compared the hospital costs relating to cases of intentional self-injury in different British hospitals showed that the costs were 33% higher when care was provided at university hospitals. 32 The length of follow-up was also a limiting factor for the present study. The three-month period characterizes the acute phase for both of these pathological conditions.…”

“…Some studies have included different age ranges in the same sample. 26,27,32,36 For example, it is known that studies that analyzed the cost of suicidal behavior during adolescence have found relatively low costs. 37,39 The majority of such studies only included a description of the hospital cost, and the elements considered in such evaluations were not homogenous among studies.…”

“…Estimates of the indirect costs are rarely available. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Few of these studies include the costs of care outside hospitals or any information that allows characterization of the suicide attempt. 28,[33][34][35]38 The meager clinical descriptions and heterogeneity of the samples in these studies make comparisons of the findings difficult.…”