{"id":2187,"date":"2023-03-14T14:27:48","date_gmt":"2023-03-14T14:27:48","guid":{"rendered":"https:\/\/sites.manchester.ac.uk\/mash-project\/?page_id=2187"},"modified":"2024-08-27T12:47:53","modified_gmt":"2024-08-27T11:47:53","slug":"is-hospital-management-of-self-harm-improving","status":"publish","type":"page","link":"https:\/\/sites.manchester.ac.uk\/mash-project\/is-hospital-management-of-self-harm-improving\/","title":{"rendered":"Is hospital management of self-harm improving?"},"content":{"rendered":"

[et_pb_section bb_built=”1″ admin_label=”section” fullwidth=”on” next_background_color=”#000000″ _builder_version=”3.17.6″ global_module=”322″][et_pb_fullwidth_menu global_parent=”322″ _builder_version=”3.0.106″ menu_id=”7″ submenu_direction=”downwards” fullwidth_menu=”off” background_layout=”dark” module_class=”main-navigation” \/][\/et_pb_section][et_pb_section bb_built=”1″ fullwidth=”off” specialty=”off” transparent_background=”off” allow_player_pause=”off” inner_shadow=”off” parallax=”off” parallax_method=”on” make_fullwidth=”off” use_custom_width=”off” width_unit=”on” make_equal=”off” use_custom_gutter=”off” custom_padding=”0px||0px|” custom_css_main_element=”padding-top:0px” module_class=”header-image-section” prev_background_color=”#ffffff” next_background_color=”#ffffff”][et_pb_row allow_player_pause=”off” parallax=”off” parallax_method=”on” parallax_1=”off” parallax_method_1=”off” make_fullwidth=”off” use_custom_width=”off” width_unit=”on” use_custom_gutter=”off” make_equal=”off” custom_margin=”||0px|” custom_padding=”||0px|” module_class=”header-image” background_position=”top_left” background_repeat=”repeat” background_size=”initial”][et_pb_column type=”4_4″][et_pb_image src=”https:\/\/sites.manchester.ac.uk\/mash-project\/wp-content\/uploads\/sites\/277\/2023\/03\/Untitled-1.jpg” show_in_lightbox=”off” url_new_window=”off” use_overlay=”off” align=”left” always_center_on_mobile=”on” use_border_color=”off” force_fullwidth=”off” custom_margin=”0px|||” animation_direction=”left” show_bottom_space=”off” border_color_all=”#ffffff” _builder_version=”3.17.6″ \/][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section bb_built=”1″ fullwidth=”off” specialty=”off” transparent_background=”off” allow_player_pause=”off” inner_shadow=”off” parallax=”off” parallax_method=”on” make_fullwidth=”off” use_custom_width=”off” width_unit=”on” make_equal=”off” use_custom_gutter=”off” custom_padding=”||0px|” prev_background_color=”#ffffff” next_background_color=”#ffffff”][et_pb_row allow_player_pause=”off” parallax=”off” parallax_method=”on” parallax_1=”off” parallax_method_1=”off” make_fullwidth=”off” use_custom_width=”off” width_unit=”on” use_custom_gutter=”off” make_equal=”off” custom_margin=”||0px|” custom_padding=”||0px|” module_class=”breadcrumbs-row” background_position=”top_left” background_repeat=”repeat” background_size=”initial”][et_pb_column type=”4_4″][et_pb_text admin_label=”Breadcrumbs (do not remove)” background_layout=”light” text_orientation=”left” use_border_color=”off” border_color=”#ffffff” border_style=”solid” module_class=”breadcrumbs” custom_css_main_element=”border-bottom: 1px solid #ececed;” module_alignment=”left” background_position=”top_left” background_repeat=”repeat” background_size=”initial”]<\/p>\nThe Manchester Self-Harm Project<\/a><\/span><\/span>\n

[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section bb_built=”1″ fullwidth=”off” specialty=”on” transparent_background=”off” allow_player_pause=”off” inner_shadow=”off” parallax=”off” parallax_method=”on” parallax_1=”off” parallax_method_1=”off” parallax_2=”off” parallax_method_2=”off” make_fullwidth=”off” use_custom_width=”off” width_unit=”on” make_equal=”off” use_custom_gutter=”on” gutter_width=”2″ prev_background_color=”#ffffff” next_background_color=”#1d1d1d”][et_pb_column type=”1_3″][et_pb_sidebar admin_label=”Left Nav Sidebar” area=”et_pb_widget_area_1″ orientation=”left” remove_border=”on” background_layout=”light” module_id=”left-nav-menu” show_border=”off” \/][\/et_pb_column][et_pb_column type=”2_3″ specialty_columns=”2″][et_pb_row_inner admin_label=”Row”][et_pb_column_inner type=”4_4″ saved_specialty_column_type=”2_3″][et_pb_text _builder_version=”3.17.6″]<\/p>\n

Is hospital management of self-harm improving?<\/h1>\n

The NICE guidelines on short and longer term management of self-harm were published in 2004 and 2011. They had an impact on care that people who self-harm receive in the emergency department.<\/p>\n

In a study carried out by Cooper et al (2013), hospital management of self-harm in a national sample of general hospitals in 2010-2011 was compared with management at the same hospitals during 2001-2002. The chart below shows some of the key results from the study.<\/p>\n

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Although very little had changed in terms of practical management, such as the percentage getting a psychosocial assessment or psychiatric admission, this study also made an assessment of overall service quality in the hospitals via interviews with clinical staff at each site.<\/p>\n

In assessments of service quality for people who attended the emergency department after self-harm, there were increases in quality in 75% of the hospitals included in the study.<\/p>\n

It is recognised that there are challenges to implementing NICE guidelines, and NICE have taken steps to improve implementation of guidelines via publication of Quality Standards.<\/p>\n

There is some evidence that bespoke training and eLearning resources on management of self-harm have a positive impact on helping to implement guidelines in clinical practice (de Beurs et al., 2015), and work to improve the implementation is on-going.<\/p>\n

Psychosocial assessment<\/h2>\n

Our research suggests\u00a0that\u00a0psychosocial assessment\u00a0following hospital presentation for self-harm could\u00a0reduce the risk of repetition by\u00a040%\u00a0(Kapur\u00a0et al, 2013).<\/p>\n

But in 31 hospitals investigated,\u00a0only just over\u00a0half of patients received an assessment, though guidelines state\u00a0this should be\u00a0100%\u00a0(Cooper et al, 2013).<\/p>\n

Alcohol use<\/h2>\n

Alcohol misuse\u00a0and alcohol at the time of self-harm is associated with an increased risk of\u00a0death by suicide, but\u00a0people who are intoxicated are less likely to receive a psychosocial\u00a0assessment\u00a0(Ness et al, 2015).<\/p>\n

A thorough psychosocial assessment may help with\u00a0early\u00a0identification of alcohol problems\u00a0and help to identify appropriate\u00a0interventions\u00a0(Bergen et al, 2014).<\/p>\n

Contacting general practitioners<\/h2>\n

Information regarding assessment is sent to GPs following only 36% of episodes, even though national guidelines state that this should be\u00a0100%\u00a0(Cooper et al, 2013).<\/p>\n

The\u00a0breadth\u00a0and\u00a0depth\u00a0of\u00a0information sent to GPs was found to be\u00a0poor, particularly from ED staff\u00a0(Bergen et al, 2014).<\/p>\n

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In the Mash Learning<\/a> section:<\/strong><\/p>\n