‘Relieved to be seen’—patient and carer experiences of psychosocial assessment in the emergency department following self-harm: qualitative analysis of 102 free-text survey responses

Abstract

ObjectivesWe sought to explore patient and carer experiences of psychosocial assessments following presentations to hospital after self-harm.DesignThematic analysis of free-text responses to an open-ended online survey.SettingBetween March and November 2019, we recruited 88 patients (82% women) and 14 carers aged ≥18 years from 16 English mental health trusts, community organisations, and via social media.ResultsPsychosocial assessments were experienced as helpful on some occasions but harmful on others. Participants felt better, less suicidal and less likely to repeat self-harm after good-quality compassionate and supportive assessments. However, negative experiences during the assessment pathway were common and, in some cases, contributed to greater distress, less engagement and further self-harm. Participants reported receiving negative and stigmatising comments about their injuries. Others reported that they were refused medical care or an anaesthetic. Stigmatising attitudes among some mental health staff centred on preconceived ideas over self-harm as a ‘behavioural issue’, inappropriate use of services and psychiatric diagnosis.ConclusionOur findings highlight important patient experiences that can inform service provision and they demonstrate the value of involving patients/carers throughout the research process. Psychosocial assessments can be beneficial when empathetic and collaborative but less helpful when overly standardised, lacking in compassion and waiting times are unduly long. Patient views are essential to inform practice, particularly given the rapidly changing service context during and after the COVID-19 emergency.

What are the experiences and the perceptions of service users attending Emergency Department for a mental health crisis? A systematic review

“…2020; Quinlivan et al . 2021). Psychosocial assessment in ED can be supportive or harmful dependent on the attitude and approach of the healthcare worker in ED (Quinlivan et al .…”

“A Sustained, Productive, Constructive Relationship with Someone Who Can Help”—A Qualitative Exploration of the Experiences of Help Seekers and Support Persons Using the Emergency Department during a Suicide Crisis

“…Additionally, negative and stigmatising interactions including absence of compassion and empathy may reinforce the negative self-evaluations typically seen in individuals experiencing a suicide crisis, such as low self-worth, a sense of burdensomeness, and hopelessness [22]. Negative interactions with ED staff, particularly those displaying stigma directed towards suicide and those in a suicide crisis have been shown to exacerbate feelings of shame and decreases the likelihood of engaging in future help seeking behaviours [7,9]. ED staff are often the first, and most easily accessed, healthcare providers for individuals in a suicidal crisis, so appropriate interactions with help seekers is vital, especially when there is limited or no access to community services.…”

“…The chaotic nature of the physical ED environment made the ED presentation difficult for help seekers and, in some cases, lead some help seekers to leave the ED prematurely. The ED environment has repeatedly been found to be challenging for individuals presenting with suicide crises [6,9,16]. Even though EDs may not be currently meeting the needs of people with suicidal distress, they remain an important part of the service landscape and as such reforms are essential.…”

“…A large portion of help seekers are prompted to attend the ED by someone in their support network, be that family, friends, or a member of their health care team [6,8,9], and this person often accompanies them during this experience. The presence of support persons at the ED can help to mitigate the emotional distress experienced whilst in hospital and improve communication between help seekers and healthcare providers [10].…”

Patient and Public Involvement in Dermatology Research: A Review

“…Despite the establishment of PPI within a diverse range of methodological approaches, there remains a surprising lack of patient input into the research question design of qualitative research in dermatology. As this approach gains momentum in qualitative research outside of dermatology, including in dementia [ 76 ] and emergency medicine [ 77 ], it is possible that an influx of PPI into dermatology qualitative scholarship is imminent; however, this will likely require close collaboration between patients and the qualitative dermatology research community [ 78 ].…”