Conference paper
ASSESSMENT OF SELF HARM IN AN ACCIDENT AND EMERGENCY SERVICE - THE DEVELOPMENT OF A PROFORMA TO ASSESS SUICIDE INTENT AND MENTAL STATE IN THOSE PRESENTING TO THE EMERGENCY DEPARTMENT WITH SELF HARM
Sophia Ul Haq
; South Essex Partnership University Foundation NHS Trust, UK
D. Subramanyam
; Bedford Hospital NHS Trust, UK
Mark Agius
; South Essex Partnership University Foundation NHS Trust, UK;Department of Psychiatry University Of Cambridge, UK
Abstract
Introduction: The UK has one of the highest rates of self harm in Europe, around 400 per 100,000 people (Horrocks et al.
2002). It accounts for 150,000 attendances to the Emergency department each year and is one of the top five causes of acute medical
admissions in the UK (NICE 2002).
Aims: Objectives included to explore the method of self harm and the demographic factors of those presenting the Emergency
department with self harm. In addition we wanted to review the exploration of suicide risk factors and suicide intent by the
Emergency department doctor and ascertain whether a psychiatric assessment with full mental state examination had been
conducted with referral to psychiatric services if deemed necessary. We wanted to explore the current practice around self harm
presentations in the Emergency department accordance with NICE guidelines.
Methods: Data was collected retrospectively from February to August 2009. Twenty-five sets of medical notes were collated at
random for patients who had presented with self harm to the Emergency department. Notes were reviewed for evidence of
exploration of the event, psychiatric assessment, risk factors for suicide and further referral.
Results: 14 of the 25 patients presented having taken an overdose. 9 had inflicted some other form of self injury, namely
lacerations to self. In 2 cases a mixed presentation was found.
Previous psychiatric history was documented in 16 cases. 11 had a previous history of depression or anxiety disorder; 1 was
known to have bipolar affective disorder; 1 was diagnosed in the past with borderline personality disorder; and 3 patients had no
previous history. In 9 cases previous history was not documented.
Discussion: Twenty-five sets of medical notes were reviewed from February to August 2009 for individuals presenting to the
Emergency department with self harm. Of those, 12 fell into the over 25 age group. 17 were female and 8 were male. The majority of
patients were of white British ethnicity. 14 had taken an overdose; 9 had inflicted some other form of self injury; and 2 had a mixed
presentation. Suicide risk factors and suicidal intent was poorly documented with mental state examination found not to be
documented in all 25 cases reviewed. 18 were deemed medically fit in the Emergency department and were referred for psychiatric
review. These unfortunate findings may be a reflection on the time pressures faced by Emergency department doctors, namely the
four hour targets, and perhaps lack of adequate training in psychosocial risk assessment. With such poor documentation made by the
Emergency department doctors, a proforma was produced which incorporates suicide risk factors and assessment of suicide intent in
addition to a brief version of the mental state examination.
Conclusion: Concerns have been raised by the recent Royal College of Psychiatrists report on self harm, that current level of
care provided to service users fall short of the standards set out in policies and guidelines, with poor assessments, unskilled staff and
insufficient care pathways (Royal College of Psychiatrists. Report CR 158. 2010). Indeed evidence suggest that appropriate training
and intervention given to A&E staff can lead to improvements in the quality of psychosocial assessment of patients with deliberate
self harm (Crawford et al. 1998).
Keywords
accident and emergency service; self harm; suicide; psychiatric assessment; psychosocial assessment.
Hrčak ID:
262365
URI
Publication date:
14.9.2010.
Visits: 560 *