Self-harm Patients Research Articles

Prospective mortality in patients with non-fatal deliberate self-harm: a national cohort study

IntroductionDeliberate self-harm (DSH) is a strong indicator of psychological distress and constitutes a significant risk factor for subsequent mortalities.ObjectivesIn this study we want to gain insights into cause-specific mortalities in self-harming patients and to disentangle important factors differentiating the risks so that to inform follow-up care and mortality prevention.MethodsRetrospective data from nationwide registries were interlinked to follow all patients presenting to specialist healthcare with non-fatal DSH from January 2008 through December 2018. Data on cause of death, personal socioeconomic status, clinical features of DSH and other medical covariates were retrieved. The Fine and Gray competing risks model was used to identify significant factors impacting subsequent mortality risk by specific causes of death in the cohort.ResultsThe cohort of 43153 DSH patients comprised 24286 females and 18867 males, with 45.3% being 10-34 years old, 38.1% being 35-64 years old and 16.6% above 65 years old at index DSH episode. Of these patients, 7041 died during the follow-up period, including 2290 within the first 1-year, corresponding to a mortality rate of 31.9 per 1000 person-years in the follow-up period and 54.9 per 1000 person-years in the first year. Common causes of death included suicide (n=911), other external causes (n=1020), cancer (n=896), cardiovascular diseases (n=1523), respiratory disease (n=787) and mental and substance misuse disorders (n=463), but the causes of death varied greatly by age groups and other factors. The risk of dying by suicide was highly associated with middle-age, male gender, tertiary education, psychiatric history, and DSH by injury, clear intent of self-harm, comorbid affective or personality disorder, referral to psychiatric treatmen, as well as DSH repetition during the period of follow-up. Significant risk factors for death by other external causes included male gender, old or middle age, single marital status, lowest quartile income, history of psychiatric treatment, and DSH by injury and comorbid substance misuse. For death by natural causes, the relative risk was highest among the elderly and the middle-aged, with other significant risk factors including male gender, single marital status, low education, lowest quartile income, and comorbid substance misuse. Attendance in psychiatric treatment after DSH appeared to be beneficial reducing the risk for mortality by suicide, other external causes and natural causes as well.ConclusionsPatients with DSH represent a high-risk group for suicide, other external and natural cause mortalities. Mental healthcare is essential in follow-up care and personalized care should take into account patients´ socio-demographic background and clinical features of self-harm.Disclosure of InterestNone Declared

Suicide and mortality following self-harm in Culturally and Linguistically Diverse communities in Victoria, Australia: insights from a data linkage study.

While cultural backgrounds are well-documented to be relevant to intentional self-harm, little is known about how cultural and linguistically diverse (CALD) backgrounds affect mortality outcomes following self-harm. This study aimed to compare the risk of all-cause mortality and suicide after intentional hospital admissions for self-harm among people from CALD (vs. non-CALD) backgrounds. Linked hospital and mortality data in Victoria, Australia, was used to assess suicide and all-cause death after hospital admissions for self-harm among patients aged 15+ years. All-cause death was identified by following up on 42,122 self-harm patients (hospitalized between 01 July 2007 and 30 June 2019) until death or 15 February 2021. Suicide death was evaluated in 16,928 self-harm inpatients (01 January 2013 and 31 December 2017) until death or 28 March 2018. Cox regression models were fitted to compare mortality outcomes in self-harm patients from CALD vs. non-CALD backgrounds. During the follow-up periods, 3,716 of 42,122 (8.8%) participants died by any cause (by 15 February 2021), and 304 of 16,928 (1.8%) people died by suicide (by 28 March 2018). Compared to the non-CALD group, CALD intentional self-harm inpatients had a 20% lower risk of all-cause mortality (HR: 0.8, 95% CI: 0.7-0.9) and a 30% lower risk of suicide (HR: 0.7, 95% CI: 049-0.97). Specifically, being from North Africa/Middle East and Asian backgrounds lowered the all-cause mortality risk; however, the suicide risk in Asians was as high as in non-CALD people. Overall, people from CALD backgrounds exhibited lower risks of all-cause mortality and suicide following hospital admission for self-harm compared to the non-CALD group. However, when comparing risks based on regions of birth, significant variations were observed. These findings underscore the importance of implementing culturally tailored background-specific suicide preventive actions. The study focussed on outcomes following hospital admission for self-harm and did not capture outcomes for cases of self-harm that did not result in hospital admission. This limits generalisability, as some CALD people might avoid accessing healthcare after self-harm due to cultural factors. Future research that not limited to hospital data is suggested to build on the results.

Pathways and transitions for patients admitted to an emergency department after self-harming events.

The frequency of people presented in emergency departments (EDs) after self-harming events is increasing. Previous studies have shown that the complexity of the disorders of patients admitted to the ED after self-harming events can be overwhelming for ED healthcare professionals (HCPs) to handle. The objective of this study was to observe and investigate the pathways for patients admitted to the ED after self-harming events to either transition or discharge. Participant observation and interviews were selected as the methods to generate insight into the pathways of patients admitted to the ED after self-harming events. The data were analysed using interpretative phenomenological analysis. A sample size of 20 patients was analysed, and a total of 213 h of observation took place during the data collection. Three main themes appeared: (1) patients' mental stress versus high expectations, (2) uncertainty about how to address the self-harming event and (3) a system of chaos. Patients admitted to the ED after self-harming events struggle with difficult mental stress. Despite this, they face high expectations that they will fit in and cooperate in the ED. The healthcare system is organised with unclear responsibilities and without systematic ways to care for self-harm patients and so provides chaotic patient pathways. There is a need for improved cross-sectional competencies, mutual agreements and systematic communication for discharge, transitions and follow-up care between those involved in the patient's pathway and care.

Self-harm in burn patients: An analysis of Finnish patient records (2011–2020)

AimTo collect data on self-harm burn patients at a national level in Finland and analyze patient characteristics. Material and methodsFirst, we went through The National Care Register for Health Care (Hilmo) records from 2011 to 2015 to find all patients in Finland with both burn and self-harm ICD10 codes. Then we investigated the medical records of all patients treated at the National Burn Centre (NBC) in Helsinki in the period 2011–2020. Patients admitted to the hospital because of self-harm burn injuries were compared to those without self-harm injuries. Patients below 18 years old were excluded. ResultsThe Hilmo register consisted of a total of 3391 adult burn patients admitted to any healthcare unit during the study period. Compared with non-self-harm patients, self-harm patients (N = 82) had lower mean age (41 years vs 54 years, p < 0.001) and longer hospitalization (18 days vs. 6 days, p < 0.05). Two-thirds of the self-harm patients (N = 38) admitted to the NBC in the period 2011–2020 had a pre-burn history of psychiatric care (66%) and one-third of them had a previous record of self-harm or suicide attempt. Men had more severe burns than women (mean TBSA 46% vs. 14%, p < 0.05), and seven of them died during the first 48 h of care, but this was not the case for any female patient. ConclusionsSelf-harm burn patients were younger and had longer hospitalization at all care levels than other burn patients. Based on medical records of hospitalized self-harm burn patients, we found clear gender differences in the severity of the burn injury and in mortality, with men suffering more severe injuries, in some cases leading to death. Recognizing high-risk patients pre-burn could have a strong preventive impact.

A retrospective study of attempted self-harm in a secondary care setting in rural India

Background: Suicides and non-suicidal self-injuries (NSSI) pose a serious public health problem, affecting communities all over the world. Adolescents and young adults are particularly vulnerable to commit self-harm (SH). SH causes serious emotional, physical, and economic repercussions, and leads to long-term health impacts. Methods: A retrospective study was conducted in a rural secondary care hospital from Feb 2020 to March 2022. Data regarding demographics, cause and type of SH, and treatment provided to 190 patients were analysed. Results: Majority of patients were in the 16-35 years age group. Poison consumption was the commonest method used. Pesticides and pills were the commonly-used agents. Agricultural activities and pre-existing illness in families facilitated access to these agents, as did the unregulated availability and unsafe storage. 31 patients disclosed the reason for SH, with the commonest reason being strained relationships. Emotional states described by the patients which pushed them to SH included dejection, hopelessness, anger, recklessness, altered mood, lack of purpose in life, cynicism and a sense of lack of support. 16% were discharged against medical advice. Conclusions: The study identified the need for methodical documentation, referral and follow-up of patients, with adequate psychiatric and counselling support. Access to care for SH patients is lacking especially in rural areas, and is at best available only for management of the SH event. SH should be considered not as a disease by itself, but as an outcome of stress due to socio-economic and other factors. Multi-stakeholder convergent approaches are needed to tackle this challenge in a holistic manner.

Mental health disorders, functioning and health-related quality of life among extensively hospitalized patients due to severe self-harm - results from the Extreme Challenges project.

Severe self-harm leading to extensive hospitalization generates extreme challenges for patients, families, and health services. Controversies regarding diagnoses and health care often follow. Most evidence-based treatments targeting self-harm are designed for borderline personality disorder (BPD). However, current knowledge about mental health status among individuals with severe self-harm is limited. To investigate psychopathology among patients extensively hospitalized due to severe or frequent self-harming behaviors. A cross sectional study (period 2019-2021) targeting psychiatric inpatients (>18 years) with frequent (>5) or long (>4 weeks) admissions last year due to self-harm. The target sample (N = 42, from 12 hospitals across all Norwegian health regions) was compared to individuals admitted to outpatient personality disorder (PD) treatment within specialist mental health services in the same period (N = 389). Clinicians performed interviews on self-harm and psychopathology, supplemented by self-report. The target sample were young adults, mainly female, with considerable hospitalization and self-harming behaviors, both significantly more extensive than the comparison group. The majority in both groups reported self-harm onset <18 years. The target sample reported increasing severity of self-harm acts and suicidal intention over time. Both samples had high levels of childhood trauma, impaired personality functioning, and a majority fulfilled criteria for PD. In the target sample, comorbid depression, PTSD, anxiety disorders, and substance use occurred more frequently and in 50%, psychosis/dissociative disorder/autism spectrum disorder/ADHD was reported (outpatient comparison sample: 9%). 35% in the target sample screened over cut-off for possible intellectual disability. The target sample reported poor psychosocial functioning and health-related quality of life - greater impairment than the outpatient comparison sample. The study reveals that severe self-harm inpatients have complex psychopathology and highlights the importance of individualized and thorough assessment among patients with severe and/or repetitive self-harm.

Psychiatric disorders among adult deliberate self-harm patients and subsequent risk of dying by suicide, mental and behavioural disorders and other external causes

IntroductionDeliberate self-harm (DSH) treated in general hospital is a well-established risk factor for suicide and other cause mortality. However, few studies have used population data to investigate the differential impact of specific psychiatric disorders on the risk of subsequent suicide, by sex and age of the patient in the context of previous DSH episodes. MethodAll patients aged 18 and older treated for DSH in general hospitals during the period 2008–2018 were identified through national registers. Cox proportional hazards regression was used to ascertain the associated risk of death by suicide, mental and behavioural disorder and other external causes. ResultsThe cohort consisted of 39 479 patients of which 878 died by suicide, 461 by mental and behavioural disorders and 1037 by other external causes. Overall, schizophrenia spectrum disorders, affective disorders and personality disorders increased the risk of suicide. Large gender and age differences were identified in the risk of suicide associated with personality disorders and affective disorders. Alcohol use disorders and dementia increased the risk of dying by mental and behavioural disorders and alcohol use disorders and other substance use disorders increased the risk of death by external causes. ConclusionSchizophrenia spectrum disorders, affective disorders and personality disorders increased the risk of suicide among DSH patients, but the effect varied by gender, age and history of previous DSH. Psychiatric evaluation of all DSH patients and treatment tailored to the patient's specific needs is essential to reduce the risk of premature death.

Repeat self-harm and mental health service use after self-harm in Culturally and Linguistically Diverse communities: Insights from a data linkage study in Victoria, Australia.

To examine the associations between Culturally and Linguistically Diverse backgrounds (vs non-Culturally and Linguistically Diverse) and in-hospital death due to self-harm, repeat self-harm and mental health service use after self-harm. A retrospective study of 42,127 self-harm hospital inpatients aged 15+ years in Victoria, Australia, from July 2008 to June 2019. Linked hospital and mental health service data were used to assess in-hospital death, repeat self-harm and mental health service use in the 12 months following index self-harm hospital admission. Logistic regression and zero-inflated negative binomial regression models were used to estimate associations between cultural background and outcomes. Culturally and Linguistically Diverse people accounted for 13.3% of self-harm hospital inpatients. In-hospital death (0.8% of all patients) was negatively associated with Culturally and Linguistically Diverse background. Within 12 months, 12.9% of patients had self-harm readmission and 20.1% presented to emergency department with self-harm. Logistic regression components of zero-inflated negative binomial regression models showed no differences in the odds of (hospital-treated) self-harm reoccurrence between Culturally and Linguistically Diverse and non- Culturally and Linguistically Diverse self-harm inpatients. However, count components of models show that among those with repeat self-harm, Culturally and Linguistically Diverse people (e.g. born in Southern and Central Asia) made fewer additional hospital revisits than non-Culturally and Linguistically Diverse people. Clinical mental health service contacts following self-harm were made in 63.6% of patients, with Culturally and Linguistically Diverse people (Asian backgrounds 43.7%) less likely to make contact than the non-Culturally and Linguistically Diverse group (65.1%). Culturally and Linguistically Diverse and non-Culturally and Linguistically Diverse people did not differ in the likelihood of hospital-treated repeat self-harm, but among those with self-harm repetition Culturally and Linguistically Diverse people had fewer recurrences than non-Culturally and Linguistically Diverse people and utilised mental health services less following self-harm admissions.

Physical distancing and emergency medical services utilization after self-harm in Korea during the early COVID-19 pandemic: A nationwide quantitative study.

People experienced various stress and psychological responses to the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to examine the changes in emergency medical services (EMSs) utilization by self-harm patients in early pandemic and the impacts of physical distancing measures on the EMSs utilization by self-harm patients. Data for all patients presenting to emergency departments (EDs) after self-harm injuries including self-poisoning were collected from the National ED Information System (NEDIS). Characteristics of patients in two study regions (urban versus rural) were compared. Weekly and annual ED visit rates after self-harm (VRSH) per 100,000 population were calculated. Mobile phone mobility index (MPMI) was calculated by dividing a region's aggregated mobile phone mobility by mid-year population. Joinpoint regression analysis was conducted to assess changes in 2020 over pre-pandemic years. Test for presence of joinpoint at the end of 2019 was performed. A cross-correlation function was used to estimate the maximal morphological similarity and lag time between changes in MPMI and VRSH. In 2020, in early phases of the pandemic, there was a moderate decline in self-harm-related ED visits to 30,797 from a continuously increasing trend seen in previous years. However, proportions of young people (50.1%) and females (62.3%) increased over previous years. VRSHs among women and young people aged 15-34 years showed higher levels in 2020 than in previous five years. There was a significant decrease in the proportion of patients transported directly from the scene. In addition, there was a polarization of mental state upon ED arrival from alert and unresponsive. The median correlation coefficient between MPMI values and VRSH values was 0.601 (interquartile range [IQR]: 0.539-0.619) in urban regions and 0.531 (IQR: 0.454-0.595) in rural regions, showing no statistically significant difference between the two. Physical distancing measures adopted to prevent the spread of transmittable diseases following the pandemic had the effect of decreasing ED visits due to self-harm. When the pandemic has ended, and daily life has been restored, it will be particularly important to pay attention to the increased numbers of self-harm patients expected to visit EDs compared to during the pandemic.

Depression, Anxiety and Social Support as Predictors of Suicide Intent among Self-Harm Inpatients

Objective: to examine depression, anxiety and social support as predictors of suicide intent among self-harm inpatients.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Foundation University, Rawalpindi Pakistan, from Jun 2019 to Oct 2020.&#x0D; Methodology: A clinical sample of 220 self-harm patients aged 18 to 35 years was collected from different mental health departments of Rawalpindi, Jhelum and Multan hospitals. Beck Suicide Intent Scale, Depression and Anxiety subscales of DASS-42 and Multidimensional Scale of Perceived Social Support were administered to assess suicide intent, depression, anxiety and social support.&#x0D; Results: Results of current research revealed that depression and anxiety had a significant positive correlation with suicide intent (r = 0.71 &amp; 0.29, respectively). Moreover, depression and anxiety were significantly positively predicted by suicide intent. Social support had a significant negative correlation with suicide intent and significantly negatively predicted suicide intent.&#x0D; Conclusion: The study revealed that depression and anxiety were significant positive predictors of suicide intent among selfharm inpatients, whereas social support was a significant negative predictor of suicide intent and, thus, contributed to the continued growth of exploring an etiological model of self-harm.

Physical distancing and emergency services utilization by self-harm patients in Korea during the early COVID-19 pandemic: A nationwide quantitative study

Physical distancing and emergency services utilization by self-harm patients in Korea during the early COVID-19 pandemic: A nationwide quantitative study

Physical distancing and emergency services utilization by self-harm patients in Korea during the early COVID-19 pandemic: A nationwide quantitative study

Physical distancing and emergency services utilization by self-harm patients in Korea during the early COVID-19 pandemic: A nationwide quantitative study

Assessing knowledge, attitudes, and practices of emergency department staff towards patients with suicidal behaviors in Pakistan

The study aimed to assess knowledge, attitudes and practices of Emergency Department staff towards patients with suicidal behaviors at a tertiary care hospital in Karachi Pakistan. An online survey found that majority of respondents were unaware of the law regarding suicide and self-harm (SH) in Pakistan. Majority had not received any specific training in management of suicidal patients. About 50 % of doctors and 16 % of nurses felt that SH patients are treated 'less seriously than patients with medical problems.' Institutional policy on management and pathway to care for suicidal patients should be disseminated and monitored for its implications in clinical practice.

Impact of mood disorders and personality disorders on suicide intent among self-harm patients.

The present research examined the impact of mood disorder and personality disorders on suicide intent among self-harm patients using cross sectional research design. A clinical sample of 220 self-harm inpatients with age of 18 to 35 years was collected through purposive sampling technique from different mental health departments of Rawalpindi, Jhelum and Multan hospitals. Study was conducted from June 2019 till November, 2021. Data was compiled in three steps. In step-I, rapport was established with patients and identification of intent was carried out by administering Beck Suicide Intent Scale. In step-II, mental illness was identified by administering Mood Disorder Questionnaire, Personality Diagnostic Questionnaire and subscale of Depression from Depression Anxiety and Stress Scale. In step-III, in order to confirm his / her responses and diagnosis, a detailed semi-structured clinical interview was carried out with each participant who responded positively to Personality Diagnostic Questionnaire. Results revealed that bipolar spectrum disorder, depression and antisocial personality disorder were significantly positive predictors of suicide intent among self-harm patients. On the other hand, narcissistic personality disorder and borderline personality disorder were found to be significantly negative predictors of suicide intent among self-harm patients. Results of current research highlighted those predisposing factors that discriminate self-harm from attempted suicide. The study has important implications for identification of intent of self-harm patients, which could help in devising a proper treatment plan for the management of such challenging patients.

Development and Validation of the ‘Self-Efficacy in Dealing with Self-Harm Questionnaire’ (SEDSHQ)

Clinicians find it challenging to engage with patients who engage in self-harm. Improving the self-efficacy of professionals who treat self-harm patients may be an important step toward accomplishing better treatment of self-harm. However, there is no instrument available that assesses the self-efficacy of clinicians dealing with self-harm. The aim of this study is to describe the development and validation of the Self-Efficacy in Dealing with Self-Harm Questionnaire (SEDSHQ). This study tests the questionnaire's feasibility, test-retest reliability, internal consistency, content validity, construct validity (factor analysis and convergent validity) and sensitivity to change. The Self-Efficacy in Dealing with Self-Harm Questionnaire is a 27-item instrument which has a 3-factor structure, as found in confirmatory factor analysis. Testing revealed high content validity, significant correlation with a subscale of the Attitude Towards Deliberate Self-Harm Questionnaire (ADSHQ), satisfactory test-retest correlation and a Cronbach's alpha of 0.95. Additionally, the questionnaire was able to measure significant changes after an intervention took place, indicating sensitivity to change. We conclude that the present study indicates that the Self-Efficacy in Dealing with Self-Harm Questionnaire is a valid and reliable instrument for assessing the level of self-efficacy in response to self-harm.

When to discharge and when to voluntary or compulsory hospitalize? Factors associated with treatment decision after self-harm

Clinicians assessing suicidal patients in emergency departments (EDs) must decide whether to admit the person to a psychiatric ward with voluntary or compulsory hospitalization or to discharge him/her as an outpatient. This cross-sectional study aimed to identify independent predictors of this decision among a large sample of self-harm (SH) patients. It used data from all patients admitted to four Swiss EDs between 2016 and 2019. Socio-demographic, clinical, and suicidal process-related characteristics data were evaluated against the decision for voluntary or compulsory hospitalization using t-tests, Chi-Square tests and logistic multiple regression. 2142 episodes from 1832 unique patients were evaluated. Independent predictors of decision to hospitalize included: male gender, advanced age, hospital location, depression and personality disorders, substance use, a difficult socio-economic condition, a clear intent to die, and a serious suicide attempt. Significant variables that emerged as independent predictors of compulsory hospitalization were hospital location, not having anxiety and personality disorders, being retired, having a clear intent to die, and making a serious suicide attempt. Hospital EDs had different rates of compulsory psychiatric admission. However, the decision to admit a patient for hospitalization, either voluntary or compulsory, was mainly based on clinical factors.

The Effectiveness of 6 versus 12 Months of Dialectical Behavior Therapy for Borderline Personality Disorder: A Noninferiority Randomized Clinical Trial

Introduction: Evidence-based psychotherapies for borderline personality disorder (BPD) are lengthy, posing a barrier to their access. Brief psychotherapy may achieve comparable outcomes to long-term psychotherapy for BPD. Evidence is needed regarding the comparative effectiveness of short- versus long-term psychotherapy for BPD. Objective: The aim was to determine if 6 months of Dialectical Behavior Therapy (DBT) is noninferior to 12 months of DBT in terms of clinical effectiveness. Methods: This two-arm, single-blinded, randomized controlled noninferiority trial with suicidal or self-harming patients with BPD was conducted at two sites in Canada. Participants (N = 240, M (SD)_age = 28.27 (8.62), 79% females) were randomized to receive either 6 (DBT-6) or 12 months (DBT-12) of comprehensive DBT. Masked assessors obtained measures of clinical effectiveness at baseline and every 3 months, ending at month 24. DBT-6 and DBT-12 were outpatient treatments consisting of weekly individual therapy sessions, weekly DBT skills training group sessions, telephone consultation as needed, and weekly therapist consultation team meetings. Results: The noninferiority hypothesis was supported for the primary outcome, total self-harm (6 months: margin = −1.94, M_diff [95% CI] = 0.16 [−0.14, 0.46]; 12 months: margin = −1.47, M_diff [95% CI] = 0.04 [−0.17, 0.23]; 24 months: margin = −1.25, M_diff [95% CI] = 0.12 [−0.02, 0.36]). Results also supported noninferiority of DBT-6 for general psychopathology and coping skills at 24 months. Furthermore, DBT-6 participants showed more rapid reductions in BPD symptoms and general psychopathology. There were no between-group differences in dropout rates. Conclusions: The noninferiority of a briefer yet comprehensive treatment for BPD has potential to reduce barriers to treatment access.

Reducing the Pressure on Mental Health Team by Improving Post-Discharge Follow-Up of Self-Harm or Suicidal Patients in Primary Care

AimsNorthern Ireland has had the highest suicide and self-harm rate in the UK since 2012 according to National Statistics Office with 12.5 deaths per 100,000 population compared to 10.5 in the rest of the country. Evidence shows that the risk of suicide hugely increases following self-harm, and the greatest risk is immediately after the self-harm episode. Better access to health care, especially to primary care, in this period, can actively reduce the risk to this vulnerable patient group. Patients assessed for self-harm in the emergency department are often followed up by the mental health/crisis team. Due to lack of resources and staff shortages this is often not possible in a timely fashion. NICE suggests that patients should be offered a follow-up appointment in primary care within 48 hours of discharge. We aimed to ensure 70% of patients discharged from secondary care following an episode of suicidal ideation or self-harm are contacted proactively by mental health practitioner (MHP) or GP within 48 hours of communication from secondary care.MethodsThe project underwent two PDSA cycles. An electronic workflow was created to provide easy patient identification, assessment and follow-up. A process mapping was done after discussion with the GPs, administrative team, practice nurses and MHP. Outcome was measured by finding out percentage of patients: 1) Contacted within 48 hours of communication following an episode of self-harm 2) Appropriately coded 3) Comprehensively assessed 4) Risk stratified and minimized following each cycle.ResultsOver a period of three months, following two PDSA cycles, the frequency of these contacts increased from 0 to 80% (median) with an average 3.8 (83%) patients reviewed per week. The patient experience and satisfaction also improved significantly.ConclusionGeneral practice (GP) has long been known as the next of kin for patients in the health care system. As GP is mostly the first point of contact for the patients, it can contribute significantly to ease the rising pressure on the mental health team. Also, a small number of weekly contacts from each GP can make a huge difference in nationwide patient safety and experience. We hope this intervention will significantly improve patient safety and reduce further self-harm presentation to ED in the long run.

Factors influencing the successful connection of deliberate self-injury patients to community-based mental health centers.

The emergency department (ED) is a good place to start preventing actions for suicide attempters. As a preventive factor, early intervention, follow-up management, and connection with community-based mental health care are important. We aimed to determine which factors were important for a successful connection to community-based mental health care services. This study was conducted at two tertiary teaching hospitals from January 2018 to December 2020. There were 1016 deliberate self-harm patients who received the four weeks of follow-up intervention. There were 166 patients in the connected group and 850 patients in the non-connected group. In the logistic regression analysis for the successful connection to community-based mental health care, married patients had an odds ratio (OR) 1.627 (95% CI 0.960-2.758), 1.314 OR (95% CI 0.619-2.790) of separated patients and 5.317 OR (CI 1.864-15.168) of widowed patients compared to single patients. And face-to-face follow-up management had 2.630 OR (95% CI 1.815-3.811) to the successful connection rate to community-based mental healthcare compared to the patients in non-face-to-face management. When deliberately self-injured patients who visited the ED received short-term follow-up intervention after emergency treatment, face-to-face follow-up intervention had a higher connection rate to community-based mental healthcare centers than non-face-to-face follow-up intervention. In the future, for deliberate self-harm patients who visit the ED, the ED staff should manage deliberate self-harm through early detection and face-to-face follow-up intervention, and other methods that can compensate for face-to-face follow-up intervention.

Staff attitudes, beliefs and responses towards self-harm: a systematised literature review

Introduction/AimsSelf-harm is a growing issue and remains a complex phenomenon in contemporary society. Understanding this behaviour may present challenges to staff providing care and support to patients who self-harm. There is an absence of a detailed review on staff attitudes, beliefs and responses towards self-harm. The aim of this review was to explore and critically appraise research on how staff attitudes impact on care provision.MethodsElectronic databases were searched and relevant literature were critically analysed to gather evidence to address this review.ResultsThis review identified lack of training, staff support and limited resources as contributory factors to negative attitudes and hostility towards self-harm patients.ConclusionsReasons for self-harm may be misconstrued, resulting to unhelpful responses and patients being ascribed stigmatising labels. Understanding factors that contribute to these unhelpful responses allows for the development of core strategies that enhances effective care.