The British Journal of Psychiatry (2000) 176: 495
© 2000 The Royal College of Psychiatrists
Assessment and discharge following deliberate self-harm
A. M. Bailey
River View Child & Family Consultancy, Mount Gould Hospital, Mount
Gould, Plymouth, Devon PL4 7QD
EDITED BY LOUISE HOWARD
The paper by Hurry & Storey
(2000) raises some important
points pertaining to the psychosocial assessment of young people presenting
with deliberate self-harm (DSH) to accident and emergency (A&E)
departments. It is disconcerting that only 54% of children in the 12-15 age
group received a specialist assessment prior to discharge from A&E.
Department of Health and Social Security guidelines
(1984) state that admission to
hospital is desirable in most cases in this age group. It is interesting that
the rate of specialist assessment was not dependent upon the existence of
on-site psychiatric facilities, which in many cases will be based in the
community child and adolescent mental health services (CAMHS). The finding
that although senior clinicians believe that admission and subsequent
specialist assessment is the rule, in practice nearly half the young people in
the 12-15 age group are discharged, highlights the need for good liaison
between CAMHS and A&E. As minors, most 12- to 15-year-olds will be
accompanied by carers, and will be discharged to their care. It is difficult
to envisage a situation where a casualty officer would consider discharging a
minor following DSH without the involvement of a responsible carer. In the
absence of onsite specialist assessment, and with a favourable short-term risk
assessment, a casualty officer may be justified in discharging a young person
if he or she can be confident that rapid specialist follow-up has been
arranged, and that the carer has given an undertaking to ensure that the young
person attends. It is, therefore, important that casualty officers receive
training in the assessment of short-term risk following DSH, and in
communicating with the families of young people.
Such training, regularly undertaken, is the responsibility of senior
clinicians in A&E and their psychiatric colleagues. It should ensure
awareness of DSH guidelines and the route to fail-safe follow-up, and address
the situation reported by Hurry & Storey
(2000) of junior doctors who
are believed to be "...ill-equipped to make such assessments
adequately...", owing to "... lack of experience or lack of
concern with the psychological aspects of treatment".
REFERENCES
Department of Health and Social Security (1984)
The Management of Deliberate Self-Harm. HN(84).
London: DHSS.
Hurry, J. & Storey, P. (2000) Assessing
young people who deliberately harm themselves. British Journal of
Psychiatry, 176,
126-131.[Abstract/Free Full Text]
