Management Of Deliberate Self-harm Research Articles

Does Lent affect rates of deliberate self-harm?

Research has shown that religious affiliation has a protective effect against deliberate self-harm. This is particularly pronounced in periods of increased religious significance, such as periods of worship, celebration, and fasting. However, no data exist as to whether this effect is present during the Christian period of Lent. Our hypothesis was that Lent would lead to decreased presentations of self-harm emergency department (ED) in a predominantly Catholic area of Ireland. Following ethical approval, we retrospectively analysed data on presentations to the ED of University Hospital Limerick during the period of Lent and the 40 days immediately preceding it. Frequency data were compared using Pearson's chi-squared tests in SPSS. There was no significant difference in the overall number of people presenting to the ED with self-harm during Lent compared to the 40 days preceding it (χ2 = 0.75, df = 1, p > 0.05), and there was no difference in methods of self-harm used. However, there was a significant increase in attendances with self-harm during Lent in the over 50's age group (χ2 = 7.76, df = 1, p = 0.005). Based on our study, Lent is not a protective factor for deliberate self-harm and was associated with increased presentations in the over 50's age group. Further large-scale studies are warranted to investigate this finding as it has implications for prevention and management of deliberate self-harm.

Lived Experiences of Legal Guardians of Adolescents Who Deliberate Self-Harm

Objectives: To explore and understand the lived experiences of the legal guardians of adolescents who engaged in Deliberate Self-Harm while inves-tigating the need for further education and support. Method: Four participants and one pilot study were purposively sampled from the Child Guidance Unit in Malta— all recruited participants were the biological mothers of self-harming adolescents. Each participant was interviewed twice. Semi-structured interviews were conducted to collect the participants’ ex-periences and subjective perspectives, and they were all digitally recorded. All necessary ethical authorisations were collected. Sample: Participants were parents of adolescents who deliberately self-harmed and were receiving care at the Child Guidance Unit. None of the mothers were living with the adolescents’ biological father. Results: The super-ordinate themes identified were: Guardian’s depths of despair, Guardians weathering the storm and Hope in the midst of despair. Themes flowed from the discovery of Deliber-ate Self-Harm and initial reactions to the hopes and skills developed to deal with their respective circumstances. Conclusion: The need to develop better understanding of the traumatisation and difficult scenarios experienced by legal guardians was identified while further support, education and man-agement of Deliberate Self-Harm have been identified. Limited qualitative research exists that has investigated the phenomenon of DSH, especially from the legal guardians’ perspective. This research hopefully would assist involved legal guardians how to identify such phenomenon, how to educate themselves about it, and manage it successfully.

Deliberate self‐harm and suicide by pesticide ingestion in the Sundarban region, India

To examine the clinical epidemiology, including case fatality and determinants of self-harm in six island blocks of the Sundarban region of West Bengal, India. We examined the clinical records of 1277 patients admitted for deliberate self-harm (DSH) to the six island hospitals from 1999 to 2001. 77.7% of the patients survived their attempt, 11.9% died and for 10.4% the outcome was not recorded. Women accounted for 65.2% of the DSH admissions and 67.1% of the deaths. Pesticides were the most commonly used means (88.7%). The case fatality of self-harm reported in these hospitals ranged from 6.0% to 50.0% (mean 13.3%; CI, 11.3-15.3). The age group 55-64 years was at highest risk of death, the age group 15-24 years at lowest risk. Higher lethality of pesticide ingestion compared to other methods was suggestive but not significant. Case fatality within the region varied but was high compared to industrialized nations. Case records and management of DSH were poor. Effective DSH prevention in the Sundarban region would require better surveillance at clinical facilities and an intersectoral approach, linking the agricultural interests of pesticide safety and mental health interests for preventing DSH.

Peer responses to perceived stress in the Royal Navy

Various organizations, including the Armed Forces, regularly place their personnel into potentially traumatic environments. Exposure to such events can lead to the development of psychological distress and organizational inefficiencies. It follows that the Armed Forces need to consider how best to address and prevent trauma-related problems both from duty of care and organizational effectiveness viewpoints. To investigate how Royal Navy personnel report they would deal with distress including the possibility of Deliberate Self-Harm (DSH) in peers. In total, 142 interview transcripts were examined to see how military personnel would respond to a vignette which was concerned with how they would help a distressed peer. Interviews were analysed using content analysis and inclusive inductive categorization. The majority of individuals would interact positively with a peer who appeared to be 'under stress', and refer them on if problems did not resolve. Most respondents reported they would take positive action regarding immediate management of DSH, referring to either medical or management staff. The majority thought that reporting ideas of DSH would impact upon the potential harmer's career. Lower ranked personnel were more likely to report a negative impact. The results are generally encouraging; the majority of those interviewed would actively involve themselves in the care of their peers and refer them on appropriately if the situation deteriorated. Most individuals interviewed saw DSH as a real, predominately medical problem that required immediate active intervention. However, many felt that help seeking could be detrimental to one's career within the services.

Variations in time of hospital presentation for deliberate self-harm and their implications for clinical services

Background Variation in number, characteristics and management of deliberate self-harm (DSH) patients presenting to hospital during the 24-h cycle and day of the week may have implications for patient services. We have investigated how patient characteristics and clinical management of DSH episodes vary according to hour and day of presentation. Methods Time of presentation was studied in 5348 DSH patients who presented to a general hospital following 9101 episodes during a 6-year period. Patient characteristics were identified through routine clinical monitoring. Results Presentations varied markedly during the 24-h cycle, ranging from a peak between 8 pm and 3 am (average hourly rate of 6.6% of all episodes) to a low between 4 am and 10 am (1.4%). The majority (72.0%) occurred outside office hours. DSH associated with alcohol use and interpersonal problems was more frequent during the late evening or night, and at the weekend. A greater proportion of daytime presentations involved high suicide intent (although a larger number of high intent acts presented at other times), and more were admitted and assessed. Limitations This study was based on DSH presentations to one hospital. Time and date of presentation and of psychosocial assessment, not time of DSH, were available for analysis. Conclusions Peak times for DSH presentations are at night and the weekend, suggesting that specialist DSH services in general hospitals should be available 24 h a day, 7 days a week. Time of presentation should not be used as a proxy measure of suicide intent.

Deliberate Self-Harm: Have We Scratched the Surface?

AbstractThis article presents the current state of knowledge in deliberate-self harm (DSH). DSH presents as a comorbidity with a number of personality disorders and psychopathologies, but is also relatively common in the psychologically healthy population. Over the past 10 years, attention has shifted from the investigation of DSH as a cardinal or comorbid symptom of psychopathology to an attempt to understand the behaviour itself, without reference to other psychopathological processes. It is argued that this development in understanding the aetiology of DSH has not been matched by developments in treatment or management of DSH, with the majority of treatment programs targeting larger syndromes of which DSH is a symptom. Treatment regimes aimed at reducing DSH appear to be either untested or demonstrably unsuccessful.

Understanding resolution of deliberate self harm: qualitative interview study of patients' experiences

ObjectiveTo explore the accounts of those with a history of deliberate self harm but who no longer do so, to understand how they perceive this resolution and to identify potential...

Clinical Management of Deliberate Self-Harm in Young People: The Need for Evidence-Based Approaches to Reduce Repetition

To examine the evidence for the effectiveness of clinical interventions designed to reduce the repetition of deliberate self-harm (DSH) in adolescents and young adults. Electronic databases were searched for papers describing randomised and clinical control trials (RCTs) and quasi-experimental studies of interventions targeting adolescents and young adults presenting to clinical services following DSH or suicidal ideation. Three RCTs, four clinical control trials and three quasi-experimental studies were identified. Group therapy, trialled in a RCT, was the only specific programme which led to a significant reduction in rates of repetition of self-harm. Attendance at follow-up did not improve significantly regardless of the intervention, while one clinically controlled trial of intensive intervention resulted in poorer attendance at follow-up. One quasi-experimental study of family therapy resulted in a significant reduction in suicidal ideation. The evidence base for treatments designed to reduce the repetition of self-harm in adolescents and young adults is very limited. Expensive interventions such as intensive aftercare offer no clear benefit over routine aftercare. Given that deliberate self-harm among young people is a common clinical problem further good quality treatment studies are warranted. Careful consideration should be given to process evaluation to determine which individual components of any given intervention are effective.

Where Is the Evidence for Treatments Used in Pesticide Poisoning? Is Clinical Toxicology Fiddling While the Developing World Burns?

Where Is the Evidence for Treatments Used in Pesticide Poisoning? Is Clinical Toxicology Fiddling While the Developing World Burns?

Management in Accident and Emergency (A&E) of Children and Adolescents Presenting with Deliberate Self-Harm (DSH)

Guidelines prepared in the UK by the Royal College of Psychiatrists regarding the management of deliberate self-harm (DSH) in children and adolescents have existed for around 20 years. Although recently revised, they remain largely unchanged. They recommend admission to a suitable ward and assessment by Child and Adolescent Mental Health Services (CAMHS) in all cases. This article examines the disparity between recommendations and practice in an Accident and Emergency (A&E) department. In two-thirds of cases the young person was not admitted and one third were discharged without any discussion with or assessment by CAMHS. This may be avoided by the development of a locally agreed policy of admission complemented by a dedicated DSH service provided by CAMHS. Nationally agreed guidelines prepared in collaboration with all the relevant specialities may be more influential in changing local practice.

Staff perceptions of care for deliberate self-harm patients in rural Western Australia: a qualitative study.

Suicide has been a major community concern in Esperance, a geographically isolated port on the south coast of Western Australia. This study explores the views of regional health staff on barriers to the effective management of deliberate self-harm (DSH) and ways in which those barriers could be addressed. Semi-structured interviews were tape-recorded, transcribed and subjected to qualitative content analysis. Interviewees included 77% of general practitioners (n = 7), 18% of nurses (n = 13) and 55% of mental health professionals (n = 5). The most important barrier was a lack of structure to treating DSH, resulting in deficiencies and inconsistencies in its management. Suggestions to improve the management of DSH included better communication between services, support for nurses in raising the issue of suicide, use of a simple risk assessment tool, the development of a nurse liaison position, and a multidisciplinary planning group. The higher rates of DSH and completed suicide in rural and remote regions compared with metropolitan areas make secondary prevention particularly important.

General practice based intervention to prevent repeat episodes of deliberate self harm: cluster randomised controlled trial

Objectives: To evaluate the impact of an intervention based in general practice on the incidence of repeat episodes of deliberate self harm.Design: Cluster randomised controlled trial in which 98 general...

Developing A&E nursing responses to people who deliberately self-harm: the provision and evaluation of a series of reflective workshops.

Accident & Emergency (A&E) departments and Medical Admission Units (MAUs) are an essential part of emergency mental health care in the UK. Deliberate self-harm and attempted suicide are particular challenges to nursing staff in such departments. Two registered mental nurses with experience of education facilitated a series of workshops with nurses from four A&E departments, two Minor Injuries Units and two MAUs. These were focused upon the assessment and management of deliberate self-harm and attempted suicide. During the workshops, participants provided systematic information on presentations of deliberate self-harm and attempted suicide, and on their professional responses to such presentations. These accounts provided invaluable information on deliberate self-harm and attempted suicide as seen by nursing staff in A&E and MAUs. Critical reflection upon nursing responses to these presentations revealed particular concerns nurses had relating to their experience with this client group which might inform future practice. Evaluation of the workshops indicated a subsequent decrease in work-related stress, which was probably a consequence of improved professional coping responses by the nurses concerned.

Deliberate self-harm in children: the nurse's therapeutic style.

This article examines child health nursing skills in the management of deliberate self-harm in children and young people. In order for education to be effective (i.e. so that it changes practice) it must address the belief systems of the practitioner. It is suggested that such belief systems are embedded in collectively held tribal stories. The more challenging the patient's behaviour, the more powerful the influence of the tribal narrative--possibly as a defensive strategy. The authors outline strategies aimed at increasing the range and depth of the therapeutic response to episodes of self-harm, and outline nursing interventions in the management of self-harming children.

Is suicide risk taken seriously in heavy drinkers who harm themselves?

The aim of the study was to examine whether a known history of heavy drinking adversely influences the assessment and management of deliberate self-harm (DSH) by accident and emergency department staff. Standard assessment forms on a consecutive series of 909 DSH cases were examined. Estimated suicide risk and clinical management were compared in patients who reported high (more than 7 units per day) and low/moderate alcohol intake. Heavy drinkers had higher rates of several risk factors for suicide. They were more likely to be judged as at high risk of suicide and further self-harm, and were more likely to receive clinical management appropriate to people at high risk. However, a logistic regression analysis revealed that it was not alcohol use itself but risk factors that were more common in heavy drinkers that predicted clinical management. The results suggest that heavy drinkers are in general judged to be at higher risk of suicide and managed accordingly. However, training for accident and emergency department staff should emphasize the importance of alcohol as an independent risk factor for suicide.

A dedicated district poisons treatment unit: response to the College guidance on the management of deliberate self-harm

Aims and methodAn examination of the activities of a district-wide dedicated admission unit for poisoned patients in Cardiff, Wales, between 1987 and 1997. Number of admission episodes, gender, drugs taken. intent, psychiatric diagnosis and disposal were recorded.ResultsAlthough the number of admission episodes almost doubled over the 10–year period, the median length of stay fell by almost half.Clinical implicationsThe results suggest that a dedicated unit is a cost-effective model for the management of poisoned patients.

Deliberate self harm: Results of an integrated team approach in a teaching hospital

The objective of the Self Harm Intervention Project (S.H.I.P.) at Sir Charles Gairdner Hospital is to obtain information and identify significant issues which will assist in the management and contribute towards effective hospital and community care of patients who present with deliberate self-harm. A team of two workers was employed to gather data on all patients who presented to Sir Charles Gairdner Hospital with deliberate self-harm and to monitor their assessment and management until they were linked back to the community. Follow-up agencies were contacted to confirm a patient's attendance and counselling offered to those who did not receive any follow-up. The Self Harm Intervention Project has shown that a team targeting deliberate self-harm patients is useful in terms of gathering data, monitoring the population group and providing direct clinical service. This multi-faceted approach contributes towards ‘best practice’ in the management of deliberate self-harm.

Training and supervision of deliberate self-harm assessments

Over a decade has now elapsed since the last national guidelines from Government health departments about the management of deliberate self-harm, although the scale of the problem has remained unchanged. Three years ago the Royal College of Psychiatrists issued a consensus statement which set standards for suitability of staff, particularly with regard to training, experience and supervision, the available facilities for assessment, the range of appropriate management options, communication of these and management of services. This postal questionnaire study in one health region of England of all senior house officers and registrars working in psychiatry found that levels of training and supervision varied widely and often fell below those suggested.

An examination of the accident and emergency management of deliberate self harm.

OBJECTIVE: To examine the adequacy of assessment and management of deliberate self harm (DSH) undertaken by accident and emergency (A&E) medical staff. METHODS: The records for attendances to the Leicester...

Management of Deliberate Self-Harm in Children and Young People

Management of Deliberate Self-Harm in Children and Young People