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We should assess all patients regardless of method
- Danielle Kirwan, Edwina RL Williams, Mythili Jayasundaram, Joanie Preston, Ryan Fuller, Jose C Catalan.Psychological Medicine Unit, South Kensington & Chelsea Mental Health Centre, Central and North West London NHS Foundation Trust, 1 Nightingale Place, SW10 9NG (6 November 2008)
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Danielle Kirwan, Formerly FY1 in Liaison Psychiatry Psychological Medicine Unit, SK&C, 1 Nightingale Place, SW10 9NG, Edwina RL Williams, Mythili Jayasundaram, Joanie Preston, Ryan Fuller, Jose C Catalan.Psychological Medicine Unit, South Kensington & Chelsea Mental Health Centre, Central and North West London NHS Foundation Trust, 1 Nightingale Place, SW10 9NG
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j.catalan{at}nhs.net Danielle Kirwan, et al.
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A recent multicentre comparison by Lilley et al reported that hospital services offer less to people who have cut themselves than those who have self-poisoned, despite these patients being more likely to self- harm again. We agree with the recommendation that hospital attendance following a self-harm episode should result in psychosocial assessment of needs, regardless of the method used. We would like to describe how we achieve close to 100% contact with people who have self-harmed. Psychological Medicine at South Kensington and Chelsea Mental Health Unit (CNWL Foundation Trust) offers a 24hr psychiatric liaison service to the Emergency Department and the wards of the Chelsea and Westminster Foundation Trust. All psychiatric referral including self-harm from the ED are offered psychosocial assessment by this liaison team, which comprises liaison psychiatry nurses and/or doctors. Care plans are developed following full psychosocial assessment. They may include referral to the GP, Crisis Resolution and Assessment Teams, or follow up by staff of the Psychological Medicine Unit. Every week, Psychological medicine staff scrutinise all ED attendances for the previous week. This process takes relatively little time because it utilises computer systems to generate a list which gives the presenting complaint and discharge diagnoses. All patients who presented to ED with psychosocial difficulties including self harm are identified and those not referred Psychological Medicine Unit are contacted and offered an appointment, or their GP is alerted to their presentation. A recent departmental audit revealed that between 20th November 2007 and 31st March 2008, 949 patients presented to the ED with psychiatric complaints, of which 146 (15%) presented with deliberate self-harm. Of them only 9 (6%) had not been assessed by the psychological medicine team and they were offered appointments. Psychological medicine staff aim to offer psychosocial assessment to all patients presenting to ED or admitted to the Acute Trust with mental health issues, including self-harm. This is in keeping with the recommendations of the NICE guidelines on self-harm (July 2004). Reviewing ED attendances and following up those who do not receive a psychosocial assessment is a simple mechanism for implementing the NICE guidelines and significantly adds to the quality of the service we provide to the ED. Lilley R, Owens D, Horrocks J, House A, Noble R, Bergen H et al Hospital care and repetition following self-harm: multicentre comparison of self-poisoning and self-injury British Journal of Psychiatry 2008; 192: 440-445. National Institute for Health and Clinical Excellence. Self-harm: The Short term Physical and Psychological Management and Secondary Prevention of Self- harm in Primary and Secondary care. NICE, 2004. |
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