Scales for predicting risk following self-harm: an observational study in 32 hospitals in England

Abstract

ObjectiveTo investigate the extent to which risk scales were used for the assessment of self-harm by emergency department clinicians and mental health staff, and to examine the association between the use of a risk scale and measures of service quality and repeat self-harm within 6 months.DesignObservational study.SettingA stratified random sample of 32 hospitals in England.Participants6442 individuals presenting with self-harm to 32 hospital services during a 3-month period between 2010 and 2011.Outcomes21-item measure of service quality, repeat self-harm within 6 months.ResultsA variety of different risk assessment tools were in use. Unvalidated locally developed proformas were the most commonly used instruments (reported in n=22 (68.8%) mental health services). Risk assessment scales were used in one-third of services, with the SAD PERSONS being the single most commonly used scale. There were no differences in service quality score between hospitals which did and did not use scales as a component of risk assessment (median service quality score (IQR): 14.5 (12.8, 16.4) vs 14.5 (11.4, 16.0), U=121.0, p=0.90), but hospitals which used scales had a lower median rate of repeat self-harm within 6 months (median repeat rate (IQR): 18.5% vs 22.7%, p=0.008, IRR (95% CI) 1.18 (1.00 to 1.37). When adjusted for differences in casemix, this association was attenuated (IRR=1.13, 95% CI (0.98 to 1.3)).ConclusionsThere is little consensus over the best instruments for risk assessment following self-harm. Further research to evaluate the impact of scales following an episode of self-harm is warranted using prospective designs. Until then, it is likely that the indiscriminant use of risk scales in clinical services will continue.

Suicide risk assessment in the emergency department: An investigation of current practice in Scotland

“…Although two‐thirds of clinicians surveyed are using suicide risk assessment tools to assess for risk, there is a wide variation in the type of tools being used. This concurs with prior research that found little consistency in suicide risk assessment practice following‐self harm in hospitals in England . Of the emergency departments sampled in the current research that had more than one respondent within the same department, almost half disagreed as to whether the use of a suicide risk assessment tool was a requirement or not.…”

“…Five surveys were sent to each participating emergency department between March and September 2016 to allow multiple clinicians in one department to complete the survey. The survey was developed based on prior research and examined: demographic information; whether participants currently use a suicide risk assessment tool in their workplace, and to list them if applicable; whether this was a requirement in their workplace; and whether they would assess a child or adolescent differently to an adult.…”

Self-harm and life problems: findings from the Multicentre Study of Self-harm in England

“…Indeed, subsequent research from this multicentre study based on individual level data has shown that receiving an assessment may have a protective effect and reduce the likelihood of repeated self-harm [20], although a recent systematic review using aggregate data from studies from a range of countries suggests less positive evidence for the effectiveness of psychosocial assessment [6], but evidence for the thoroughness of assessment and type of aftercare provided was not available. Cooper and colleagues [21] found that there are significant variations in assessment practices and a recent study in the UK demonstrated a significant lack of consensus of the most effective risk assessment to be employed as part of the psychosocial assessment for self-harm [22]. The third implication is that a range of clinical services will be required by many self-harm patients given the multiple and complex problems they are facing.…”

Suicide risk assessment and intervention in people with mental illness

“…In a representative sample of hospitals in England, it was the most commonly used scale. 66 A recent systematic review showed that only three studies have examined its ability to predict suicide outcomes, and none of these found it to be predictive. 67 The PPV of the SAD PERSONS scale to predict repeat self harm in emergency department patients at six months was 5%, and its sensitivity for predicting suicide at one year follow-up was 23%.…”