GPs role identifying young people who self-harm: a mixed methods study

Abstract

Background:Self-harm is common among young people and is evident in increasingly younger age groups. Many young people who self-harm do visit their GP but do not access specialist support. GP’s can find it challenging to raise and discuss this sensitive subject with young people during short consultations.Objective:To explore GP’s capabilities, motivations and opportunities for discussing self-harm and to identify barriers to and enablers for proactively discussing self-harm with young people.Design and setting:An exploratory, mixed methods study was designed comprising an online survey and a qualitative interview study with GPs in the South West of England.Methods:An online survey was completed by 28 GPs. Ten GPs took part by telephone, in semi-structured interviews. Quantitative data was analysed using descriptive statistical techniques and thematic analysis was used to analyse the qualitative data. Findings from the quantitative and qualitative analysis are synthesized to illustrate GPs’ skills, knowledge and perceptions about young people who self-harm.Results:Experienced GPs may underestimate the prevalence of self-harm in young people, particularly in the 11–14 age range. While consultations with young people and their carers can be challenging, GPs acknowledge that it is their role to provide support for young people who self-harm. GPs would welcome training for themselves and other practice staff in talking to young people and practical information about self-harm.Conclusion:All primary care staff who provide frontline support to young people should receive education and practical training in talking about self-harm.

Talk About Self-Harm (TASH): participatory action research with young people, GPs and practice nurses to explore how the experiences of young people who self-harm could be improved in GP surgeries

“…PAR also accords with the modern NHS aspiration in the UK, reflected in policies that call for "no decision about me without me" [16] As such this study extends previous research with GPs [4] and to our knowledge is the first time that PAR has been used in a general practice setting. years in the participating GP surgeries were searched to identify those with a primary EMIS code relating to self-harm (n=285).…”

“…PNs report experiences similar to those of GPs recounted in previous studies [4,8] in terms of the extent to which they feel confident and competent to engage young people in conversations about their self-harm. Taken together these pragmatic and interpersonal barriers may inadvertently lead to an unintended neglect of young people's self-harm and its aetiology.…”

“…The young people, GPs and PNs alike who participated in this study were interested and engaged with self-harm as a mental health issue from the outset and were keen to use self-help materials to promote more helpful conversations. Yet all acknowledged the difficulties presented by the time limited consultations that have been alluded to in previous research by GPs [4]. NICE guidelines advocate that self-help strategies should be promoted alongside treatment interventions for depression and associated self-harm [6] and evidence from the statistical data suggests that in terms of the latter, such interventions are being provided in GP surgeries, often without recourse to specialist mental health services.…”

“…The incidence of self-harm in young people in primary care in the UK is increasing dramatically [1] and many young people who self-harm meaning, "deliberately initiated behaviour (such as self-cutting or ingesting a toxic substance or object with the intention of causing harm to oneself with a non-fatal outcome)" [2], visit their GP as the first point of contact for help [3,4]. Incidences of self-harm are of international concern [5].…”

“…Yet there are barriers encountered by young people that influence whether they will seek and receive help from their GP surgery. Pragmatic barriers arise from the practice setting such as short consultation times that militate against clinicians building rapport with a young person [3,4]. Interpersonal barriers relate to clinicians' confidence in talking about self-harm for example GPs often report voicing concerns about what language to use when raising issues of self-harm [7,8] and young people themselves present as a heterogeneous population with differences in their ability to identify and describe emotions [8].…”