A Qualitative Account of Young People’s Experiences Seeking Care from Emergency Departments for Self-Harm

Abstract

Many young people who engage in self-harm do not seek help from health services. For those that do, emergency departments (EDs) are a key point of contact. Substantial gaps remain in current knowledge related to young consumers’ experiences and views on optimal treatment of self-harm in the ED. In this study, semi-structured interviews were conducted with thirteen young people (Mage = 21.2 years), who were engaged with care at headspace early intervention centers and had presented to an ED with a self-inflicted physical injury. Participants were asked to describe their experience in the ED and the care they received. Data were analyzed thematically. Three inter-related themes were identified: 1. The ED was experienced through a lens of significant distress, 2. The ED environment and processes were counter-therapeutic, and 3. Staff were perceived to be disinterested, dismissive, and lacking in knowledge. The study highlights the overwhelmingly negative nature of participants’ experiences, and presents recommendations for service and practice improvements, such as the provision of staff training and increased aftercare.

Experiences of care for self-harm in the emergency department: comparison of the perspectives of patients, carers and practitioners

“…9,16 This fits with recent findings from the perspective of young people in Australia, who emphasised how emergency department care was countertherapeutic. 10 In line with previous findings about what matters from the perspective of young people and adults seeking help, we found that helpful treatment in the emergency department is being respected, believed and taken seriously. 10,17 The therapeutic value of having someone to talk to was emphasised by patients and carers alike – which is essential for people to fully disclose their experiences to practitioners and for practitioners to conduct a valid risk assessment.…”

“…10 In line with previous findings about what matters from the perspective of young people and adults seeking help, we found that helpful treatment in the emergency department is being respected, believed and taken seriously. 10,17 The therapeutic value of having someone to talk to was emphasised by patients and carers alike – which is essential for people to fully disclose their experiences to practitioners and for practitioners to conduct a valid risk assessment. 18 A human connection was considered most important for patients, where a therapeutic encounter could instil hope at a time when life does not feel worth living, and can potentially be life-saving, as reported in previous studies.…”

“…Previous research has explored staff views on different kinds of liaison services in integrating physical and mental healthcare, 7 along with patients’, 8,9 young people 10 and carers’ 11 perspectives of care for self-harm in the emergency department. The aim of this study was to compare and integrate the perspectives of generalist emergency department practitioners, liaison practitioners, adult patients, young people and carers on delivering and receiving care for self-harm in emergency departments in England.…”

They Told Me “This Isn’t a Hotel”: Young People’s Experiences and Perceptions of Care When Presenting to the Emergency Department with Suicide-Related Behaviour

“…Experiences of the ED can be overwhelmingly negative, and staff can be dismissive, disinterested and lacking in knowledge [38]. This was reiterated by the young people in this study, especially those who had made repeat presentations to EDs.…”

‘A Safe Place Where I Am Welcome to Unwind When I Choose to’—Experiences of Brief Admission by Self-Referral for Adolescents Who Self-Harm at Risk for Suicide: A Qualitative Study

“…Limited perceived influence, a sense of not being understood and distress due to uncertainty was described to create a sense of resistance to care. This appeared to have fostered negative beliefs regarding psychiatric inpatient care, which is well recognized [ 44 ] and a known barrier to help-seeking among adolescents with self-harm [ 45 ]. Conversely, being welcomed by professionals with empathy and encouragement, in combination with parental support, was experienced to facilitate the tendency to seek BA in the present study.…”