The assessment and management of self‐harming patients in an Accident and Emergency department: an action research project

Abstract

The Government, in Health of the Nation (DoH, 1992), set targets for health authorities to introduce specific interventions intended to reduce the rates of suicide in the districts for which they are responsible. Those who deliberately harm themselves are an important group for interventions aimed at suicide prevention. Self-harming individuals are known to seek help from a range of care providers, not just those specifically intended to meet their needs. Individuals with problems of self-poisoning and self-injury have placed increasing pressure on general hospital staff involved in their care. There should therefore be adequate services for suicide attempters in every general hospital. Policies and protocols must be introduced and evaluated, to ensure that the self-harmer's experience during crisis is not a catalogue of unhelpful encounters. This paper is an account of an action research project concerned with the assessment and management of self-harming patients in one accident and emergency department. The project aimed to enhance departmental policies and procedures for managing this group of patients. Practical problems can inhibit the introduction of even the most desirable of innovations. Action research provides a way of overcoming these problems whilst doing research at the same time.

The role of women's self‐injury support‐groups: a grounded theory

“…Incorporating support-groups into self-injury services in accordance with RCP (1994) guidelines could reduce self-injury A&E admissions and, ultimately, pressure on NHS finance, time and resources. A proposed A&E risk-assessment (McElroy & Sheppard, 1999) could refer women to support-groups as a first point of call in contrast to the usual automatic referral to medically-trained staff (Currie & Blennerhassett, 1999), often creating further distress for women and escalating the possibility of repeated self-injury (Pembroke, 1994). Indeed, it has been argued that a misapplication of the medical model of 'illness' to self-injury has accounted for much of the problem, as articulated by Johnstone (1997, p. 425) who asserted that: 'The underlying philosophy of the medically-based psychiatric approach can be summarized as tending to remove power and control from the person who self-injures, to deny her feelings and to ignore the meanings behind her actions.…”

Caring for patients with suicidal behaviour: an exploratory study

“…This point is supported by Kinmond and Bent (2000) who suggest that that the ED is not the appropriate place for such an assessment to take place and that ED staff have not the expertise to undertake it. McElroy and Sheppard (1999) however suggest that the psychosocial assessment of patients presenting to Emergency Departments with suicidal behaviour can be undertaken by ED nursing staff. Furthermore, Guthrie et al (2001) contend that psychosocial assessments and brief psychological interventions by nurses can reduce suicidal ideation and repeated incidences of suicidal behaviour.…”

“…However, several studies have highlighted that there is wide variation in the quality of assessment and management of clients in EDs who have engaged in suicidal behaviour (Kapur et al, 1998;Hughes et al, 1998;McElroy & Sheppard, 1999). Most EDs now have a dedicated psychiatric liaison service which responds to requests from staff for psychosocial assessments of clients presenting with suicidal behaviour.…”

“…However Hickey et al's (2001) study found that this is not being carried out as the majority of nonadmitted DSH patients in their study who left an ED appeared to have no psychosocial assessment or intervention carried out by staff in these departments. McElroy & Sheppard (1999) recommend that a systematic psychosocial assessment of all patients presenting with suicidal behaviour be undertaken prior to discharge from an ED. Furthermore, they contend that this can be administered by ED nursing staff.…”

Advances in crisis management of the suicidal patient: Perspectives from patients

“…Care providers may respond with anxiety, anger, and an absence of empathy, as the repetitiveness of the behavior often can provoke frustration in the inability to "cure the person," and staff perceives this group as neither making appropriate use of the ED nor being "rewarding" to care for [7]. Malone's [8] study of people who are known as "frequent flyers" and self-injurers identified that staff frustration and disappointment can foster further stigmatization toward this population.…”