Liaison psychiatry practitioners’ views on accessing aftercare and psychological therapies for patients who present to hospital following self-harm: multi-site interview study

Abstract

Background Timely provision of aftercare following self-harm may reduce risks of repetition and premature death, but existing services are frequently reported as being inadequate. Aims To explore barriers and facilitators to accessing aftercare and psychological therapies for patients presenting to hospital following self-harm, from the perspective of liaison psychiatry practitioners. Method Between March 2019 and December 2020, we interviewed 51 staff members across 32 liaison psychiatry services in England. We used thematic analyses to interpret the interview data. Results Barriers to accessing services may heighten risk of further self-harm for patients and burnout for staff. Barriers included: perceived risk, exclusionary thresholds, long waiting times, siloed working and bureaucracy. Strategies to increase access to aftercare included: (a) improving assessments and care plans via input from skilled staff working in multidisciplinary teams (e.g. including social workers and clinical psychologists); (b) supporting staff to focus on assessments as therapeutic intervention; (c) probing boundaries and involving senior staff to negotiate risk and advocate for patients; and (d) building relationships and integration across services. Conclusions Our findings highlight practitioners’ views on barriers to accessing aftercare and strategies to circumvent some of these impediments. Provision of aftercare and psychological therapies as part of the liaison psychiatry service were deemed as an essential mechanism for optimising patient safety and experience and staff well-being. To close treatment gaps and reduce inequalities, it is important to work closely with staff and patients, learn from experiences of good practice and implement change more widely across services.

Accessing psychological therapies following self-harm: qualitative survey of patient experiences and views on improving practice

“…Similar to the findings of Punton et al 16 and third-sector reports, 15,17,18 our results demonstrate the detrimental and unacceptable implications of struggling to access psychological therapies on patients. We found that waiting for too long was especially pernicious for people's mental health following an episode of selfharm.…”

“…group, individual). Above all, and consistent with other studies, [11][12][13][14][15] participants highlighted the importance of compassionate, empathetic and hopeful responses from any staff working with people who have self-harmed (Fig. 3).…”

“…Our findings are consistent with third-sector reports of poor patient experiences when accessing aftercare and the use of exclusionary thresholds. 15 Reports of punitive treatment towards people who have self-harmed when accessing aftercare were also common in our data. Participants reported exclusion from psychological therapies when on waiting lists owing to perceived further self-harm risk and/or emotional instability.…”

“…not taken seriously, exclusion). 15 Although unmet needs for talking therapies and good quality aftercare are indicated, we know little about the consequences of these experiences for patients or about strategies to improve services from the perspective of people who have selfharmed. We previously investigated aftercare following self-harm from the perspective of liaison psychiatry practitioners referring patients into services.…”

“…3 However, there are few services dedicated to this group in the UK and other countries. 3,9,10 Several studies have investigated patient experiences of healthcare services following self-harm [11][12][13][14][15] and/or access to psychological therapies generally. [16][17][18] However, few have specifically focused on access to psychological therapies following self-harm.…”