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The British Journal of Psychiatry (2000) 176: 495
© 2000 The Royal College of Psychiatrists

Correspondence

Assessment and discharge following deliberate self-harm

J. Bolton

Department of General Psychiatry, St George's Hospital Medical School, Jenner Wing, Cranmer Terrace, London SW17 0RE

G. Zolese

Springfield Hospital, London SW17 7DJ

EDITED BY LOUISE HOWARD

Hurry & Storey (2000) highlight the relatively low rates of specialist assessment for patients who present at hospital following deliberate self-harm (DSH). One contributing factor not commented upon by the authors may be those patients who leave the accident and emergency (A&E) department prematurely.

We surveyed psychiatric presentations to an inner-London A&E department over a four-month period and found that premature discharge was taken by 32% of adult patients following an overdose and 7% of those following other forms of DSH. The majority left before assessment by a casualty officer. A survey of premature discharges from Glasgow Royal Infirmary raised a similar problem (Pennycook et al, 1992).

Identifying the reasons for premature discharge will form the basis of a future audit. Possible factors include ambivalence about seeking help, long waiting times and adverse interactions between staff and patients.

Premature discharge may have repercussions for patients, as well as medicolegal implications for A&E. Local guidelines for A&E staff are being drawn up, to minimise the rate of premature discharge by these patients. For those who do leave, there should be careful documentation of the attendance and an attempt to organise follow-up. This should at least include telephone contact with the general practitioner.

REFERENCES

Hurry, J. & Storey, P. (2000) Assessing young people who deliberately harm themselves. British Journal of Psychiatry, 176, 126-131.[Abstract/Free Full Text]

Pennycook, A. G., McNaughton, G. & Hogg, F. (1992) Irregular discharge against medical advice from the accident and emergency department - a cause for concern. Archives of Emergency Medicine, 9, 230-238.[Medline]





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