scholarly journals Assessing young people who deliberately harm themselves

2000 ◽  
Vol 176 (2) ◽  
pp. 126-131 ◽  
Author(s):  
Jane Hurry ◽  
Pamela Storey
Keyword(s):  
At Risk ◽  
Young People ◽  
Service Management ◽  
Postal Questionnaire ◽  
Psychosocial Assessment ◽  
Old Patients ◽  
Admission Rates ◽  
Accident And Emergency ◽  
Patients At Risk ◽  
Self Harm

BackgroundMany young people who harm themselves have chronic mental health or social problems or are at risk of future self-harm or even suicide. The accident and emergency (A&E) clinic is an important gateway to treatment.AimsTo describe the psychosocial assessment of 12- to 24-year-old patients attending A&E clinics following deliberate self-harm (DSH) and to identify features of service management and provision which maximise specialist assessment.MethodA postal questionnaire was sent to a sample of one in three A&E departments in England. In a representative sample of 18 of these hospitals, staff were interviewed and 50 case notes per hospital were examined.ResultsPsychosocial assessment by non-specialist doctors in A&E departments tended to be of variable quality, focused on short-term risk. Around 43% of patients aged 12–24 were assessed by a specialist; specialist assessment was associated with high admission rates and the presence of on-site psychiatric departments and DSH teams.ConclusionsYoung DSH patients at risk often go unidentified; as a result their psychological problems may not be treated. Hospitals are frequently unaware of the proportion of patients discharged without adequate assessment.

scholarly journals Protocol for the assessment of self-harm in young people: initial audit and training implications

2007 ◽  
Vol 31 (6) ◽  
pp. 224-226 ◽  
Author(s):  
Sarah Huline-Dickens ◽  
Tony Adiele
Keyword(s):  
Young People ◽  
Mental State ◽  
Psychosocial Assessment ◽  
Training Requirements ◽  
Junior Staff ◽  
Accident And Emergency ◽  
Self Harm ◽  
Accident And Emergency Department ◽  
State Examination ◽  
And Training

Aims and MethodsThis paper describes the development and initial audit of a protocol for the assessment of young people up to the age of 18 years who presented to the accident and emergency department (A&E) with self-harm. A key part of the project was education and training.ResultsRegular training of senior house officers (SHOs) in A&E may have contributed to an increase in young people being admitted to a bed for proper assessment (as per the protocol), but psychosocial assessments undertaken by SHOs in A&E were still only partial, and there was no apparent use of the mental state examination.Clinical ImplicationsChild and adolescent mental health services have an important role to play in liaising with local A&E departments in training of junior staff in psychosocial assessment and the use of the mental state examination. This is especially relevant in the light of the new training requirements of the foundation years.

Information-Seeking on the Internet

Crisis ◽  
2015 ◽  
Vol 36 (3) ◽  
pp. 211-219 ◽  
Author(s):  
Vinod Singaravelu ◽  
Anne Stewart ◽  
Joanna Adams ◽  
Sue Simkin ◽  
Keith Hawton
Keyword(s):  
At Risk ◽  
Young People ◽  
Information Seeking ◽  
Significant Proportion ◽  
The Internet ◽  
Search Terms ◽  
Specific Advice ◽  
Restriction Sites ◽  
Self Harm ◽  
Negative Tone

Abstract. Background: The Internet is used by young people at risk of self-harm to communicate, find information, and obtain support. Aims: We aimed to identify and analyze websites potentially accessed by these young people. Method: Six search terms, relating to self-harm/suicide and depression, were input into four search engines. Websites were analyzed for access, content/purpose, and tone. Results: In all, 314 websites were included in the analysis. Most could be accessed without restriction. Sites accessed by self-harm/suicide search terms were mostly positive or preventive in tone, whereas sites accessed by the term ways to kill yourself tended to have a negative tone. Information about self-harm methods was common with specific advice on how to self-harm in 15.8% of sites, encouragement of self-harm in 7.0%, and evocative images of self-harm/suicide in 20.7%. Advice on how to get help was given in 56.1% of sites. Conclusion: Websites relating to suicide or self-harm are easily accessed. Many sites are potentially helpful. However, a significant proportion of sites are potentially harmful through normalizing or encouraging self-harm. Enquiry regarding Internet use should be routinely included while assessing young people at risk.

Self-harm: A guide for schools on how to respond

2019 ◽  
Vol 14 (6) ◽  
pp. 295-297
Author(s):  
Charlie Waller
Keyword(s):  
At Risk ◽  
Young People ◽  
School Nurses ◽  
School Staff ◽  
Staff Members ◽  
University Of Oxford ◽  
Self Harm ◽  
The University

A guide from the University of Oxford and the Charlie Waller Memorial Trust offers practical ways in which schools can support young people at risk from self-harm, which school nurses can share with school staff members to help them respond.

Unplanned hospital admission in patients receiving concurrent chemotherapy and radiation.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 258-258
Author(s):  
Nicholas Damico ◽  
Ellen Tiemeier ◽  
Laura Krukowski ◽  
Lucy Colo ◽  
Christine Marie Sydenstricker ◽  
...  
Keyword(s):  
At Risk ◽  
Radiation Therapy ◽  
Hospital Admission ◽  
Admission Rate ◽  
Concurrent Chemotherapy ◽  
Cancer Center ◽  
Admission Diagnosis ◽  
Unplanned Admission ◽  
Admission Rates ◽  
Patients At Risk

258 Background: Concurrent chemotherapy and radiation therapy (CCRT) has become a curative treatment for many malignancies. Many patients are ultimately cured, but at the cost of significant acute toxicity. When severe, this can require unplanned hospitalization. More research is needed to better identify patients at risk for hospitalization and how to prevent it. Methods: As part of quality improvement at the Seidman Cancer Center, patients in the University Hospitals (UH) system who underwent CCRT were identified. A review was done to determine which patients experienced an unplanned admission in the UH system during their radiation course or within 30 days and the admission diagnosis. We recognized malnutrition and dehydration as causes for hospitalization that were preventable. Several interventions were then performed to reduce these admissions. The first was standardized nutrition screening that prompts earlier dietician referrals for patients at risk of malnutrition. We also instituted hydration assessments for patients beginning in the 3rd week of radiation. Patients found to be dehydrated were scheduled to receive intravenous (IV) fluids as an outpatient for the remainder of their treatment course. Admission rates for patients undergoing CCRT have been tracked as part of this initiative and are reported here. Results: From 7/2017 to 12/2018 we identified 303 patients who completed CCRT. 78 (26%) had an unplanned hospital admission during their treatment course or within 30 days of completing radiation. This included patients with primary head and neck, CNS, GI, lung, GYN, and GU malignancies for which admission rates were 36%, 32%, 23%, 29%, 19% and 8% respectively. 18 (23%) of these patients were admitted after completing the radiation course but within 30 days. The initial admission rate prior to intervention was 34%. This has since declined to 19% (table). Conclusions: Unplanned admission rates are high in patients who undergo CCRT across disease sites. Patients remain at risk following completion of radiation therapy for up to 30 days. Some admissions may be prevented by early dietician referrals and IV hydration. [Table: see text]

scholarly journals Compliance with NICE guidelines in the management of self-harm

2010 ◽  
Vol 34 (9) ◽  
pp. 385-389 ◽  
Author(s):  
Diane Mullins ◽  
Siobhan MacHale ◽  
David Cotter
Keyword(s):  
Clinical Excellence ◽  
Psychosocial Assessment ◽  
Standards Of Care ◽  
Liaison Psychiatry ◽  
Single Male ◽  
Nice Guidelines ◽  
Accident And Emergency ◽  
Self Harm ◽  
Male Patients ◽  
Accident And Emergency Department

Aims and methodTo identify the provision of psychosocial assessments for all people attending an accident and emergency department in Ireland with a presentation indicative of self-harm over 12 months and to investigate whether the National Institute for Health and Clinical Excellence (NICE) guidelines for self-harm were met.ResultsA total of 834 attendances for self-harm were recorded. A psychosocial assessment was undertaken by a member of the liaison psychiatry team in 59% of attendances. Single male patients under 45 years of age represented 39% of those who did not receive a psychosocial assessment.Clinical implicationsSingle men under the age of 45 years represent a vulnerable group in which levels of psychosocial assessment need to be optimised in order to meet the NICE guidelines for standards of care.

scholarly journals Needs and fears of young people presenting at accident and emergency department following an act of self-harm: secondary analysis of qualitative data

2016 ◽  
Vol 208 (3) ◽  
pp. 286-291 ◽  
Author(s):  
Christabel Owens ◽  
Lorraine Hansford ◽  
Siobhan Sharkey ◽  
Tamsin Ford
Keyword(s):  
Young People ◽  
Qualitative Data ◽  
Care Delivery ◽  
Secondary Analysis ◽  
Healthcare Services ◽  
Vulnerable Group ◽  
Treatment As Usual ◽  
Online Discussion Forum ◽  
Accident And Emergency ◽  
Self Harm

BackgroundPresentation at an accident and emergency (A&E) department is a key opportunity to engage with a young person who self-harms. The needs of this vulnerable group and their fears about presenting to healthcare services, including A&E, are poorly understood.AimsTo examine young people's perceptions of A&E treatment following self-harm and their views on what constitutes a positive clinical encounter.MethodSecondary analysis of qualitative data from an experimental online discussion forum. Threads selected for secondary analysis represent the views of 31 young people aged 16–25 with experience of self-harm.ResultsParticipants reported avoiding A&E whenever possible, based on their own and others' previous poor experiences. When forced to seek emergency care, they did so with feelings of shame and unworthiness. These feelings were reinforced when they received what they perceived as punitive treatment from A&E staff, perpetuating a cycle of shame, avoidance and further self-harm. Positive encounters were those in which they received ‘treatment as usual’, i.e. non-discriminatory care, delivered with kindness, which had the potential to challenge negative self-evaluation and break the cycle.ConclusionsThe clinical needs of young people who self-harm continue to demand urgent attention. Further hypothesis testing and trials of different models of care delivery for this vulnerable group are warranted.

scholarly journals The challenges of managing self-harm effectively

2009 ◽  
Vol 15 (6) ◽  
pp. 442-443
Author(s):  
Nisha Dogra
Keyword(s):  
At Risk ◽  
Young People ◽  
Frontline Staff ◽  
What Works ◽  
Specialist Services ◽  
Self Harm

SummaryThis commentary discusses how much we appear to know about self-harm and the circumstances in which it may occur but how little we really know about what works in managing it. It reviews how suggestions for its management conflict with what we know about self-harm and the outcomes of young people. The challenge appears to be how better to identify those at risk of further self-harm and to train frontline staff in this, so that at-risk individuals may be referred to specialist services. Perhaps there is also a need to review the evidence for what actually works in reducing repetition of self-harm.

Rapid response pathway united to reduce self-harm (RUSH): a case study of a pilot pathway for children and young people

2022 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Molly Cross ◽  
Tim Clarke
Keyword(s):  
At Risk ◽  
Young People ◽  
User Satisfaction ◽  
Emergency Departments ◽  
Rapid Response ◽  
Framework Analysis ◽  
Children And Young People ◽  
Content Type ◽  
Self Harm

Purpose In response to elevated local self-harm and suicide rates, and the lack of a dedicated pathway for children and young people (CYP) who self-harm, a rapid response pathway united to reduce self-harm (RUSH) was developed and implemented within Norwich (Norfolk, England). This public health case study aims to describe the pathway model and share its outcomes, learnings, and reflections over the pilot year. Design/methodology/approach RUSH was a community-based pilot pathway aiming to support CYP, 11–18 years old, engaging in or at risk of engaging in repeated self-harm and subsequently at risk of repeated attendance at local emergency departments. From May 2020 to April 2021, RUSH supported 61 CYP using funding from NHS England and Improvement. Findings This case study shares the pathway’s outcomes, through a mixed-method evaluation. Results indicate statistically significant reductions in self-harm frequency (p = 0.01) and anxiety and depression symptomatology (p < 0.001); a statistically significant increase in progress towards goals (p < 0.001); and a general downward trend in re-attendance at local emergency departments following RUSH. Findings also illustrate high service user satisfaction. Framework analysis of focus group data highlights positive experiences with hope for recommissioning from a staff perspective. Originality/value This study will be valuable for services looking to develop and implement a similar service provision, in response to the need to tackle self-harm rates as a broader approach to suicide prevention. In light of the NHS long-term plan (2019), it also serves as an example of how to develop and use a strategic co-production group, and work collaboratively with the voluntary, community and social enterprise sectors.

scholarly journals Increasing psychosocial assessment by introducing a self-harm pathway

2006 ◽  
Vol 30 (5) ◽  
pp. 169-172 ◽  
Author(s):  
Peter Lepping ◽  
Barbara Woodworth ◽  
Lucy Roberts ◽  
Jim Turner
Keyword(s):  
Emergency Department ◽  
The Self ◽  
Psychosocial Assessment ◽  
Clinical Implications ◽  
Protocol Adherence ◽  
Steering Group ◽  
Accident And Emergency ◽  
Before And After ◽  
Self Harm ◽  
Accident And Emergency Department

Aims and MethodTo audit whether the introduction of a self-harm pathway and protocol increases the number of psychosocial assessments. All episodes of self-harm in a defined period during 2002 (n=335) and 2004 (n=390) were reviewed before and after the introduction of a self-harm pathway and protocol. Adherence to the protocol was also investigated.ResultsAfter the introduction of the self-harm pathway and protocol, the proportion of psychosocial assessments requested had risen from 57% (2002) to 85% (2004). The proportion of psychosocial assessments completed had risen from 47% to 70%. Over the 2 years, the overall number of self-harm presentations was reduced by 27%.Clinical ImplicationsThe introduction of a self-harm pathway and protocol through a self-harm steering group is feasible, was well accepted and increased the number of psychosocial assessments after self-harm. It may also contribute to a reduction in the number of overall presentations with self-harm to the accident and emergency department.

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