Healthcare professionals’ implementation of national guidelines with patients who self-harm

Abstract

Background National guidelines for the short-term management of self-harm are aimed at healthcare professionals who may be involved in the care of people who have self-harmed. However, evidence from small-scale studies globally suggest there is a lack of awareness of such guidelines among some groups of healthcare professionals. For the first time in a large representative sample of patient-facing healthcare professionals, we aimed to identify: (a) which healthcare professionals are aware of guidelines for the management of self-harm; (b) the perceived availability of training; (c) the use of risk screening tools; and (d) the extent to which healthcare professionals implement guidelines for the management of self-harm. Methods 1020 UK healthcare professionals completed a cross-sectional survey online. Results 85.6% (873/1020) of the sample had heard of the national guidelines, but only 24.3% (248/1020) knew “a fair amount” or more about them. Of the respondents who had previously encountered a patient who had self-harmed or was at risk of repeat self-harm, the guidelines were implemented in fewer than 50% (M = 43.89%, SD = 38.79) of encounters. 31% (312/1020) of the sample had received training in managing self-harm and, contrary to guidelines, 2.25% (23/1020) of the sample had used self-harm risk screening tools. Conclusions Our findings highlight a need to improve knowledge of self-harm management guidelines, and identifies professional groups where awareness and knowledge is currently low. Further work is required to develop interventions to change healthcare professional practice with respect to the implementation of self-harm management guidelines.

Acceptability of a Brief Web-Based Theory-Based Intervention to Prevent and Reduce Self-harm: Mixed Methods Evaluation

“…By making the tool easier to engage with, the tool may also be useful as part of long-term support strategies, such as when the urge to self-harm may not be at their height. It is encouraging that no gender differences in acceptability were found, and thus future research could explore the extent to which brief interventions for self-harm could be delivered by health care professionals, for example, research suggests that more emphasis should be placed on improving self-harm care for patients, with a focus on improving the implementation of self-harm management guidelines [ 40 ]. One possible route is to explore the use of the VHS alongside GP care, given that the recognition of primary care is an important place to potentially help people reduce repeat self-harm [ 41 ].…”

Cost-effectiveness of psychosocial assessment for individuals who present to hospital following self-harm in England: a model-based retrospective analysis

“…Current national clinical guidance on management of self-harm recommends psychosocial assessment should be offered to all individuals each time they present at hospital after self-harm (2, 6). However, there is evidence of great variation in receipt of assessment in English hospitals (7, 8, 33). While studies have not been designed to evaluate the effectiveness of psychosocial assessment alone, some studies have suggested that assessment may be associated with reduced future risk of hospital-presenting self-harm.…”

“…Psychosocial assessment is recommended for all hospital presenting self-harm in England (2, 6). On average around 50-60% of people presenting to accident and emergency (A&E) departments with self-harm receive a full psychosocial assessment, although this proportion varies across sites (7, 8). This clinical procedure, typically carried out by psychiatric liaison staff, includes assessing patients’ problems, mental state, risk factors and needs, and arranging appropriate aftercare.…”

Strategies to Strengthen Mental Health Services in Hospital during Covid-19

“…There has been a decrease in the number of visits so that medical personnel can take turns working (Roncero et al, 2020). Leather et al, (2020) developed internal training protocols for staff, training recommendations based on the Competency Suicide and Suicide Prevention Framework providing the gold standard for resource development. They were also recommending refresher training for professionals who rarely encounter self-injurious patients and to change the behaviour of health workers (Leather et al, 2020).…”

“…Leather et al, (2020) developed internal training protocols for staff, training recommendations based on the Competency Suicide and Suicide Prevention Framework providing the gold standard for resource development. They were also recommending refresher training for professionals who rarely encounter self-injurious patients and to change the behaviour of health workers (Leather et al, 2020). Staff in emergency departments should learn more about mental health care, screening patients for suicidal intent, especially among children with prior emotional/behavioural problems (McBride, 2020) so that they are trained to detect early warning symptoms (Chevance et al al., 2020).…”