Establishing a self-harm surveillance register to improve care in a general hospital

Abstract

Self-harm is a common reason for admission to general hospitals, accounting for 200 000 admissions in the UK annually. To discover who these patients were, why they were attending and what their care pathway was, we set up a self-harm surveillance register, which now collects data across two general hospitals and a children's hospital for a UK city. Here, we describe the method of setting up the register, and show what is collected and how it can be used to understand self-harm presentations to the general hospital and how it can be used to improve care. Key findings were that paracetemol was the most common medication used in overdose, and that 80% of patients had previously self-harmed. One of the important findings was that only 59% of patients were receiving a mental health assessment in the emergency department—despite the risk of repeat self-harm and rate of completed suicide being far higher than the general population. This information led to funding for a seven-day psychiatric service.