Psychiatric Staff Research Articles

A Modern Approach to Assessing the Satisfaction of Medical Staff in a Psychiatric Institution with the Quality of Medical Services

Purpose: The aim of the study is to develop a methodology for assessing the quality of mental health services. Research material - The participation of psychiatric staff in a sociological study of the availability and quality of mental health services. Refusal of psychiatric staff to participate in the survey. The necessary questionnaires were provided to record the psychiatric staff's responses to the survey. The questionnaires were completed by the surveyed nurses as workplace respondents. In order not to violate the anonymity of the survey, the last name or first name of the respondent should not be indicated in the questionnaire. The study involved 100 people. Results - A social survey of patients in psychiatric institutions is of great importance and highlights a number of questions aimed at improving it. Thus, in order to improve the work of the hospital, first of all, the results of a sociological survey conducted among psychiatric workers should be taken into account. Employees are very incompetent to involve family members in the treatment of patients - 20%. Conclusion - There is no doubt that future solutions to the main problems identified in this paper will help improve the quality of mental health care.

Cologne Questionnaire on Attitudes Towards Coercive Measures (KEZ)

To develop a psychometric instrument for the assessment of the attitude of psychiatric staff towards the use of coercion. Based on a literature search, interviews (37 open questions) were carried out by representatives each of doctors and nurses. A first version was developed, all doctors and nurses in a psychiatric clinic were asked to answer the questionnaire anonymously. 226 employees took part (response rate 32.3 %). A test-theoretical analysis led to a 39 item set with a high consistency of the overall scale (Cronbach's α =0 .904) and three factors: 1) Acceptance of coercive measures without questioning (Cronbach's α = 0.797); 2) Meaningfulness and legitimation of coercive measures (Cronbach's α = 0.812); and 3) Security and order through coercive measures (Cronbach's α = 0.791). With the KEZ an instrument is available that holistically presents the various aspects of the attitudes of psychiatric staff to the use of coercion.

Staff and resident perceptions of mental and behavioural health environments

ABSTRACT The purpose of this study was to explore clinical staff and resident perceptions regarding the importance, as well as effectiveness, of environmental qualities and features in mental and behavioural health (MBH) facilities. The study evaluated inadequacies in environmental attributes, as perceived by staff and residents, in four MBH facilities in the United States. The Psychiatric Staff Environmental Design tool and the Psychiatric Patient Environmental Design tool were used to capture perceptions and facility assessments. We examined the importance of various environmental attributes, the differences between the importance and how effectively these attributes were achieved, and the differences between psychiatric staff and resident responses. The most important qualities for residents were a well-maintained environment and suicide resistance. For staff, the most important qualities were staff safety and security and suicide resistance. Rated across all facilities, staff reported significant differences between importance and effectiveness of environmental attributes (p < .0001) whereas residents did not report differences. Significant differences were found between staff and patient ratings of existing facilities (p = .004), with staff reporting more inadequacies than residents. Findings suggest a strong need for more supportive physical MBH environments, particularly from the perspective of staff. Though residents reported fewer inadequacies, more evidence-based design guidelines for MBH environments are needed.

Does Case Management Provide Support for Staff Facing Frequent Users of Emergency Departments? A Comparative Mixed-Method Evaluation of ED Staff Perception

ObjectiveFrequent users of emergency departments (FUED) account for a disproportionate number of emergency department (ED) visits and contribute to a wide range of challenges for ED staff. While several research has documented that case management (CM) tailored to FUED leads to a reduction in ED visits and a better quality of life (QoL) among FUED, whether there is added value for ED staff remains to be explored. This study aimed to compare, among staff in two academic EDs in Switzerland (one with and one without CM), the FUED-related knowledge, perceptions of the extent of the FUED issue, FUED-related work challenges and FUEDs’ legitimacy to use ED.MethodMixed methods were employed. First, ED physicians and nurses (N = 253) of the two EDs completed an online survey assessing their knowledge and perceptions of FUEDs. Results between healthcare providers working in an ED with CM to those working in an ED without CM were compared using independent two-sided T-tests. Next, a sample of participants (n = 16) took part in a qualitative assessment via one-to-one interviews (n = 6) or focus groups (n = 10).ResultsBoth quantitative and qualitative results documented that the FUED-related knowledge, the extent FUED were perceived as an issue and perceived FUEDs’ legitimacy to use ED were not different between groups. The level of perceived FUED-related challenges was also similar between groups. Quantitative results showed that nurses with CM experienced more challenges related to FUED. Qualitative exploration revealed that lack of psychiatric staff within the emergency team and lack of communication between ED staff and CM team were some of the explanations behind these counterintuitive findings.ConclusionDespite promising results on FUEDs’ QoL and frequency of ED visits, these preliminary findings suggest that CM may provide limited support to ED staff in its current form. Given the high burden of FUED-related challenges encountered by ED staff, improved communication and FUED-related knowledge transfer between ED staff and the CM team should be prioritized to increase the value of a FUED CM intervention for ED staff.

Content Analysis of an In-Depth Interview With Psychiatric Staff: Considerations for OT Services During Acute Hospitalization

Abstract Date Presented 04/19/21 OT is a treatment for acute psychiatric hospitalization in Taiwan, providing purposeful activities for patients with severe mental illness based on the Model of Human Occupation (MOHO) and the OT Practice Framework. Through in-depth interviews with staff, three key themes of OT services were identified: OT service challenges with MOHO, communication experience of OT services with team members, and a comprehensive index and continuity of treatment effects. Primary Author and Speaker: Shu-Chun Lee Additional Authors and Speakers: Yi-Ching Wu Contributing Authors: David Leland Roberts, Kuang-Pei Tseng, and Wen-Yin Chen

Virtual Reality Human-Human Interface to Deliver Psychotherapy to People Experiencing Auditory Verbal Hallucinations: Development and Usability Study.

BackgroundDigital technologies have expanded the options for delivering psychotherapy, permitting for example, the treatment of schizophrenia using Avatar Therapy. Despite its considerable potential, this treatment method has not been widely disseminated. As a result, its operability and functionality remain largely unknown.ObjectiveWe aimed to study the usability of a therapeutic virtual reality human–human interface, created in a game engine.MethodsParticipants were psychiatric hospital staff who were introduced to the therapeutic platform in a hands-on session. The System Usability Scale (SUS) was employed for evaluation purposes. Statistical evaluation was conducted using descriptive statistics, the chi-square test, analysis of variance, and multilevel factor analysis.ResultsIn total, 109 staff members were introduced to the therapeutic tool and completed the SUS. The mean SUS global score was 81.49 (SD 11.1). Psychotherapists (mean 86.44, SD 8.79) scored significantly higher (F2,106=6.136; P=.003) than nursing staff (mean 79.01, SD 13.30) and administrative personnel (mean 77.98, SD 10.72). A multilevel factor analysis demonstrates a different factor structure for each profession.ConclusionsIn all professional groups in this study, the usability of a digital psychotherapeutic tool developed using a game engine achieved the benchmark for an excellent system, scoring highest among the professional target group (psychotherapists). The usability of the system seems, to some extent, to be dependent on the professional background of the user. It is possible to create and customize novel psychotherapeutic approaches with gaming technologies and platforms.Trial RegistrationClinicaltrials.gov NCT04099940; http://clinicaltrials.gov/ct2/show/NCT04099940

Psychiatric staff training in managing medical emergencies: re-audit

AimsIn the UK, people with severe mental illness at a greater risk of poor physical health and have higher premature mortality than the general population, highlighting the importance of responding to physical health problems among patients suffering from psychiatric conditions. However, training for staff on inpatient psychiatric units to meet patients’ physical health needs is sometimes overlooked and has not always been effective.According to NICE Clinical Guideline 25 (2005) and NPSA Rapid Response Report (2008/RRR010), staff on any psychiatric inpatient setting must be capable of monitoring, measurement, and interpretation of vital signs. They must have both adequate information and skills to identify signs indicating worsening of patients’ health and respond effectively to severely ill patients.Hence, we aim to re-audit the results of a similar audit carried out in 2016 to review the level of medical emergency training (in terms of life support training) of clinical staff across the inpatient psychiatric wards at our local hospital - Stepping Hill Hospital- in Stockport.Our hypothesis is that there will be a gap in meeting the required standards for training.MethodA questionnaire including 6 questions (role of the staff member, level of their life support training, when was their training last updated, whether they know the location of the crash trolley, whether they know the local hospital emergency number and whether they should resuscitate the patient if their training is out of date) was given to staff on acute inpatient psychiatric units in Stepping Hill Hospital.ResultThe sample included 49 staff members from all the 3 wards included in the audit. The level of training of nursing staff on the 3 wards was meeting standards except for nursing staff who were new to the wards or coming back to work from prolonged leaves. There was also a gap identified in the level of training of other staff members on the ward as well as on the remaining standards measured by the audit.ConclusionA gap was identified in meeting the required standards of training on the inpatient psychiatric units. Reasons identified for this gap are mainly due to the fact that new or bank staff are asked to cover the wards without providing them with appropriate training and without orientating them about the location of different equipments and policies on the ward.

Training inpatient psychiatric nurses and staff to utilize CBTp informed skills in an acute inpatient psychiatric setting

ABSTRACT Background The aim of this study was to investigate the impact of a novel, brief CBTp-informed skills training, called Positive Practices for working with Psychosis (PPP), on recovery-orientation of frontline inpatient psychiatric staff, and on staff knowledge of and confidence using skills informed by Cognitive Behavior Therapy for psychosis. Methods Twenty five providers participated in 12 hours of PPP training. We examined changes in providers’ skills in delivering recovery-oriented care (focusing on skills advocacy, evidence based practice, stigma, optimism, and client preference), and providers’ knowledge of, and confidence in using CBTp informed skills, using the Competency Assessment Instrument (CAI) and the Knowledge and Confidence Using CBTp Skills Scale (KC-CBTp). Results were analyzed using paired-sample t-tests. Results: Significant gains (p < .001) in self-rated knowledge and confidence using CBTp skills were seen on 8 of 9 domains measured. On the CAI, significant gain in optimism was seen (p = .004). Discussion Brief CBTp informed PPP training is a potential intervention for frontline staff, associated with significant gains in knowledge of, and confidence in using, evidence based CBTp-informed skills, and increased optimism in attitudes towards recovery. Limited change on recovery based competencies of staff was seen in other domains and requires further investigation.

Psychotische symptomen bij ontregelde insulineafhankelijke diabetes mellitus: gedwongen opname vermijdbaar?

Psychotic symptoms in dysregulated insulin-dependent diabetes mellitus: could coercive hospitalisation have been avoided? This case report describes the medical history of a 64-year-old man brought to the emergency department in a combined psychotic and delirious state due to dysregulated diabetes mellitus (DM). Because of the prominent psychotic symptoms, he was hospitalised in the psychiatric ward. Compliance was compromised as the patient, being under satanic influence, had delusional thoughts of the psychiatric staff. His blood sugar dysregulated further and the patient needed to be transferred to the diabetology department, where he showed good compliance. His blood sugar was regulated and the patient could leave the diabetology department, although the psychotic symptoms persisted. Retransfer to the psychiatric ward was suggested. Because of aggressive acting-out, coercive hospitalisation was proposed. He was transferred to another hospital for a second psychiatric expertise, where he agreed with the proposed antipsychotic treatment and a psychiatric hospitalisation. Consequentially, a coercive hospitalisation was no longer indicated. One day later, he was discharged and the psychotic symptoms resolved shortly after. The correlation between psychosis and dysregulated DM is discussed and the demand for coercive measures re-examined. If the symptoms had been considered as part of an integrated health problem, allowing the patient to continue his stay on the diabetology department, the demand for coercive measures could have been avoided.

Post-traumatic stress disorder and professional quality of life among psychiatric staff

IntroductionPsychiatric staff could be exposed to various types of violence that might have potential consequences on their psychological balance.ObjectivesTo detect post-traumatic stress disorder (PTSD). To assess the professional quality of life among psychiatric hospital workers.MethodsA descriptive cross-sectional study was conducted in the psychiatric department of the Hedi Chaker University Hospital in Sfax. The questionnaire study had three major components: the baseline participant characteristics,the post-traumatic stress disorder Checklist (PCL-5) for which a total symptom severity score cutoff of 38 was recommended as the cutoff for a positive screening test and the Professional Quality of Life Scale (ProQOL).ResultsThirty-one participants completed the questionnaire. The sex-ratio was 0.93. The mean age was 41.5 years. All participants were exposed to physical or verbal assault. Physical aggression was the most traumatic behavior reported by 39.3% of psychiatric professionals. A feeling of insecurity when performing professional tasks was reported by 93.3% of participants. Among participants, 41.9% expressed the desire to change workplace. The mean score on the PCL-5 was 21.6 ± 15.35. Five participants (16.7%) had a PCL-5 score ≥ 38. The Compassion Satisfaction mean score was 37.48 ± 5.64. The burnout mean score was 26.41 ± 7.3 and the mean score at the secondary traumatic stress scale was 27 ±6.7.ConclusionsPTSD could result from stressful events encountered in the course of managing patients in mental health departments. Attention to post-traumatic event interventions may be useful both to reduce the rate of PTSD and to improve the professional quality of life among psychiatric staff.

The challenges of psychopharmacological treatment during the COVID-19 pandemic in lombardy

Introduction: Public Mental Health Services in Lombardy (Italy) has 27 Departments for Mental Health and Addiction Services and a number of private residential facilities. With the reorganization of the entire Healthcare system to deal with COVID-19, Regional Health Authorities recognized mental health as a priority and authorized the continuation of mental health services for the general population. Objectives: To review the initiatives and procedures implemented in Lombardy during the Covid-19 pandemic in relation to the organization of Psychiatric Services and continuity of psychopharmacological treatment. Results: Hospital admissions for acute psychiatric disorders in patients positive for COVID-19 required a dedicated area in the psychiatric ward or alternatively, a medical ward supported by psychiatric staff. Psychiatric hospital activity for patients negative for Covid-19 has been maintained as usual. The activity in the Mental Health Centers has been maintained in patients suffering from severe mental disorders as well as in those with serious social problems or judicial sentences. Particular attention was paid to patients’ clinical monitoring and drug administration. Long-acting Injection antipsychotics were often preferred to oral treatment to ensure adherence and continuity of care. Appropriate e-health technologies were used to reach patients and their families, for monitoring patients and avoiding drop-outs of patients with serious diseases. Conclusions: Maintaining continuous monitoring of patients in contact with mental health services is essential for a careful assessment of their condition from both a psychopathological and medical point of view during pandemic.DisclosureNo significant relationships.

Experiences of fear in hospital settings from the perspectives of mental health service users and informal caregivers

IntroductionIn the literature, service users and informal caregivers have been critical towards psychiatric inpatient care. However, little is known about their fears related to hospital care.ObjectivesWe describe service users’ and informal caregivers’ experiences of fear in psychiatric hospital settings.MethodsThe data were collected from seven mental health associations located in six Finnish cities. Focus group interviews (f=8) were conducted (2015–2016) with service users (n=20) and informal caregivers (n=15), and were guided to focus on violence and challenging situations in psychiatric care. In a secondary analysis, experiences of fear were extracted from the transcriptions and analyzed using inductive content analysis.ResultsBoth groups’ experiences of fear focused on themes related to staff, treatment and fellow patients. Additionally, service users had experiences of fear related to the hospital environment. Fears related to staff involved intimidating personnel using force or acting in threatening ways. Participants also described staff seemingly being afraid of patients and care givers. Three types of fears related to treatment were described: fear of not being admitted to hospital even if needed, fear of being admitted to hospital, and fear of coercive methods used in care. Fear of fellow patients involved being afraid of aggressive, unpredictable behaviors, which could cause, e.g., a lack of sleep at night for service users. Fears related to the environment itself were also discussed.ConclusionsBeing hospitalized can be a difficult experience for service users and informal caregivers. These results can help psychiatric healthcare staff acknowledge areas in care that may potentially cause feelings of fear.DisclosureNo significant relationships.

Tidier. e-sport; a recovery oriented intervention in forensic psychiatry

IntroductionRecently video gaming, have attracted considerable attention for its possible beneficial therapeutic effects, the possibility for testing behavior in safe artificial environments and as a tool for professionals and patients to build specific competencies for the everyday life. Also, a substantial amount of research suggests that videogaming might improve the participants social and cognitive skills and emotional regulation. There is little or no evidence that videogaming increases long term aggression or leads to physical aggression. At a medium secure forensic psychiatric in-patient ward, the patients and staff engage in weekly E – Sport sessions (primarily counterstrike) to further the recovery process.ObjectivesTo provide a standardized description of how E-sport is organized and used in the recovery process among forensic psychiatric patients.MethodsThe Template for Intervention Description and Replication (TIDieR) checklist and guide is widely used to in health research to describe interventions in clinical trials and other health research contexts. By use of TIDieR we describe a newly developed E-sport intervention, in which staff members and patients in a medium secure forensic psychiatric ward engage in weekly E-Sport sessions (primarily counterstrike) to improve patient–staff relationship.ResultsThe E-sport intervention is detailed by use of the 12 TIDieR items and practical experiences and insights will be described.ConclusionsThis standardized and detailed description of how is used in a recovery-oriented process in forensic psychiatry can be used for future studies that wishes to implement the intervention or for research studies replicating the treatment.Conflict of interestNo significant relationships.

Therapeutic isolation in psychiatry

IntroductionTherapeutic seclusion, consist of locking a patient alone in a room dedicated to this type of care. It poses real questions about respect for fundamental rights, in particular the right to liberty.ObjectivesThe objectives of our work were to evaluate the practices of psychiatric doctors and nurses in seclusion.MethodsOur study is descriptive-based. Using a self-questionnaire, a set of questions about the decision of seclusion, its prescription, its means, its surveillance, the information of the patient and his relatives as well as the characteristic of the seclusion room, were asked. Our target population consisted of medical and paramedical staff working in the HMPIT Psychiatry Department.ResultsOur study covered eleven doctors and fourteen nurses. The average age was 35 years with 52% having more than 5 years of psychiatric experience. Fifty-two percent used seclusion while 72% had no specific training. Twelve (12%) percent felt that no accidents could occur in seclusion. Twenty percent (20%) did not find it necessary to transcribe the monitoring parameters on the medical file.ConclusionsOur study showed that the psychiatric staff lack sufficient exposure to in the area of therapeutic seclusion. A seclusion protocol has been drawn up to guarantee patient safety.

Resources and Workforce in Top-Tier Psychiatric Hospitals in China: A Nationwide Survey.

Objectives: Mental healthcare has gained momentum and significant attention in China over the past three decades. However, many challenges still exist. This survey aimed to investigate mental health resources and the psychiatric workforce in representative top-tier psychiatric hospitals in China.Methods: A total of 41 top-tier psychiatric hospitals from 29 provinces participated, providing data about numbers and types of psychiatric beds, numbers of mental health professionals, outpatient services and hospitalization information covering the past 3 years, as well as teaching and training program affiliation.Results: Significant variations were found among participating hospitals and across different regions. Most of these hospitals were large, with a median number of psychiatric beds of 660 (range, 169-2,141). Child and geriatric beds accounted for 3.3 and 12.6% of all beds, respectively, and many hospitals had no specialized child or geriatric units. The overall ratios of psychiatrists, psychiatric nurses, and psychologists per bed were 0.16, 0.34, and 0.03, respectively. More than 40% of the hospitals had no clinical social workers. Based on the government's staffing guidelines, less than one third (31.7%) of the hospitals reached the lower limit of the psychiatric staff per bed ratio, and 43.9% of them reached the lower limit of the nurse per bed ratio.Conclusion: Although some progress has been made, mental health resources and the psychiatric workforce in China are still relatively insufficient with uneven geographical distribution and an acute shortage of psychiatric beds for children and elderly patients. In the meantime, the staffing composition needs to be optimized and more psychologists and social workers are needed. While addressing these shortages of mental health resources and the workforce is important, diversifying the psychiatric workforce, promoting community mental health care, and decentralizing mental health services may be equally important.

When Our Work Hits Home: Trauma and Mental Disorders in Correctional Officers and Other Correctional Workers.

Background: International estimates suggest that up to one in three public safety personnel experience one or more mental disorders, including post-traumatic stress disorder (PTSD). Canadian data have been sparse until very recently, and correctional officers and forensic psychiatric staff have rarely been included. Working as a correctional officer is associated with negative health outcomes and increased work-related stress, with several variables affecting reported levels of stress. Healthcare staff also report higher rates of PTSD, especially those who are exposed to aggression in their workplace. In the present study, we compare current symptoms of diverse staff working in correctional occupations.Method: Data were collected from a Canadian national online survey of public safety personnel, including employees of correctional services at the federal level. Correctional officers and wellness services staff were compared for prevalence of mental disorders and suicidal ideation.Results: Correctional officers self-reported statistically significantly more exposure to potentially psychologically traumatic events than wellness services employees. Correctional officers also self-reported higher rates of symptoms of mental disorders, including PTSD, social anxiety, panic disorder, and depression. There were no statistically significant differences in reports of suicidal thoughts, plans, or attempts.Contribution to Society: Correctional and forensic staff contribute to society by working with justice-involved individuals in correctional institutions. Trauma-related disorders and other mental health problems threaten the well-being of correctional and forensic staff. Mental health likely impacts the ability of correctional and forensic staff to develop a therapeutic or working alliance with persons in custody. Staff well-being must be recognized and addressed to ensure that prisoners and staff receive optimal treatment in prison.Conclusion: Our results add to the limited knowledge about the well-being of staff, particularly wellness staff in prisons, who provide daily treatment and care for prisoners with serious mental disorders. Our work is a step toward identifying avenues for promoting staff well-being.

Brief videoconference-based Dialectical Behaviour Therapy skills training for Covid-19-related stress in acute and crisis psychiatric staff

Covid-19 has increased stress for psychiatric staff. This study reports the positive impact of brief videoconference-based Dialectical Behaviour Therapy skills training for acute psychiatric staff. It was delivered by clinical psychologists as a staff support response to Covid-19-related stress.

Containment of a COVID-19 Outbreak in an Inpatient Geriatric Psychiatry Unit.

OBJECTIVES: The first known COVID-19 outbreak in a long-term care facility in the United States was identified on February 28, 2020, in King County, Washington. That facility became the initial U.S. epicenter of the COVID-19 pandemic when they discovered 129 cases associated with the outbreak (81 residents, 34 staff members, and 14 visitors) and 23 persons died. The vulnerability of the elderly population, shared living and social spaces, suboptimal infection control practices, and prolonged contact between residents were identified as contributing factors to the rapid spread of the disease. The first known case of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in a U.S. inpatient geriatric psychiatry unit was also in King County, Washington, and occurred soon afterward on March 11th, 2020. Between March 11 and March 18, nine inpatients and seven staff members were confirmed to have SARS-CoV-2 infection. This article examines how the swift identification and isolation of confirmed patients, an enhanced infection prevention protocol, and engagement of frontline psychiatric care staff prevented a catastrophic outcome in a vulnerable population. METHODS: Here we describe infection control and nursing-led interventions that were quickly enacted in response to this SARS-CoV-2 outbreak in an inpatient geriatric psychiatry unit. RESULTS: The interventions effectively contained the outbreak, with no further patients and only one staff member testing positive for SARS-CoV-2 over the subsequent 2-month time period. CONCLUSIONS: We share our learnings and preventative infection control measures that can be adapted to a variety of settings to prevent or contain future outbreaks of COVID-19.

Understanding Factors Relevant to Self-Injurious Behavior in a High-Risk Secure Psychiatric Sample: Developing the Theory-Driven Measure of Self-Injurious Behavior Engagement.

A measure for the assessment of self-injurious behavior is developed. Commencing with a Delphi composed of 33 experts: detached experts (academics), experts by exposure (staff), and experts by experience (patients), the Theory-driven Measure of Self-Injurious Behavior Engagement is outlined. This is then examined in two samples: high-secure psychiatric male patients (n = 76) and high-secure psychiatric nursing staff (n = 100; 50 men, 50 women). We predicted that all components of the Theory of Planned Behavior and the capacity, belongingness, and burdensomeness elements of the Interpersonal Psychological Theory of Suicidal Behavior would be confirmed as important inclusions. Results initially showed the importance of including intention, perceived behavioral control, affect, capacity, and burdensomeness. The role of environmental and individual factors, such as coping, was captured as additional variables of value. However, the structure of items differed between patients and staff. Being valued consistently represented a core consideration, as did capacity and affect. Directions for future research are indicated.

Factors explaining variation in recommended care pathways following hospital-presenting self-harm: a multilevel national registry study

People who present to hospital following self-harm are at high risk of suicide. Despite this, there are considerable variations in the management of this group across hospitals and the factors influencing such variations are not well understood. The aim of this study was to identify the specific hospital and individual factors associated with care pathways following hospital-presenting self-harm. Data on presentations to hospitals by those aged 18 years and over were obtained from the National Self-Harm Registry Ireland for 2017 and 2018. Factors associated with four common outcomes following self-harm (self-discharge, medical and psychiatric admission and psychosocial assessment before discharge) were examined using multilevel Poisson regression models. Care pathways following self-harm varied across hospitals and were influenced by both hospital and individual factors. Individual factors were primarily associated with self-discharge (including male gender, younger age and alcohol involvement), medical admission (older age, drug overdose as a sole method and ambulance presentations) and psychiatric admission (male gender, methods associated with greater lethality and older age). The hospital admission rate for self-harm was the only factor associated with all outcomes examined. The availability of psychiatric in-patient facilities and specialist mental health staff contributed to variation in psychiatric admissions and psychosocial assessments prior to discharge. Hospital factors explained the majority of observed variation in the provision of psychosocial assessments. Characteristics of the presenting hospital and hospital admission rates influence the recommended care pathways following self-harm. Provision of onsite mental health facilities and specialist mental health staff has a strong impact on psychiatric care of these patients.