Variation between hospitals in inpatient admission practices for self-harm patients and its impact on repeat presentation

Abstract

PurposeSelf-harm patient management varies markedly between hospitals, with fourfold differences in the proportion of patients who are admitted to a medical or psychiatric inpatient bed. The current study aimed to investigate whether differences in admission practices are associated with patient outcomes (repeat self-harm) while accounting for differences in patient case mix.MethodsData came from the National Self-Harm Registry Ireland. A prospective cohort of 43,595 self-harm patients presenting to hospital between 2007 and 2012 were included. As well as conventional regression analysis, instrumental variable (IV) methods utilising between hospital differences in rates of hospital admission were used in an attempt to gain unbiased estimates of the association of admission with risk of repeat self-harm.ResultsThe proportion of self-harm patients admitted to a medical bed varied from 10 to 74 % between hospitals. Conventional regression and IV analysis suggested medical admission was not associated with risk of repeat self-harm. Psychiatric inpatient admission was associated with an increased risk of repeat self-harm in both conventional and IV analyses. This increased risk persisted in analyses stratified by gender and when restricted to self-poisoning patients only.ConclusionsNo strong evidence was found to suggest medical admission reduces the risk of repeat self-harm. Models of health service provision that encourage prompt mental health assessment in the emergency department and avoid unnecessary medical admission of self-harm patients appear warranted. Psychiatric inpatient admission may be associated with a heightened risk of repeat self-harm in some patients, but these findings could be biased by residual confounding and require replication.

Recommended next care following hospital-treated self-harm: Patterns and trends over time

“…[ 9 – 11 ] Clinical management and recommended next care of self-harm has also been shown to vary both by patient characteristics such as method of self-harm,[ 12 ] as well as by the presenting hospital. [ 13 ] Furthermore, there is limited evidence to suggest that clinical management of self-harm is associated with improved outcomes for self-harm patients. [ 14 ]…”

Expelling the Spirit of Niter: The Differential Diagnosis and Treatment of a Young Male With Non-Suicidal Self-Injury Behavior and Psychosis.

“…There was found to be no difference between patients treated in hospital or as out-patients followed up in clinics (10). Carroll, et al found an increase in self-mutilation in hospitalized patients (11). In fact, self-mutilating patients need to be assessed for a requirement of in-hospital monitoring regardless of the type of mental illness or the method of self-harm utilized.…”

Reduksjon av unngåelsesatferd og innleggelser grunnet villet egenskade etter Basal Eksponeringsterapi

“…suicidologi nr 1/2017 FAGARTIKKEL VILLET EGENSKADE (VE; ramme 1) er et utbredt folkehelseproblem både nasjonalt og internasjonalt (Briere & Gil, 1998;Klonsky et al, 2003;Ystgaard et al, 2003). Pasienter med VE legges inn i både somatiske sykehus og døgnseksjoner i psykisk helsevern (Carroll et al, 2016;Gunnell et al, 2008;Mellesdal et al, 2010;2014). Risikoen for å bli lagt inn gjentatte ganger grunnet VE er saerlig stor for kvinnelige pasienter og pasienter med depressive lidelser, personlighetsforstyrrelser, ruslidelser eller angst/stresslidelser (Gunnell et al, 2008;Mellesdal et al, 2014).…”

“…Risikoen for å bli lagt inn gjentatte ganger grunnet VE er saerlig stor for kvinnelige pasienter og pasienter med depressive lidelser, personlighetsforstyrrelser, ruslidelser eller angst/stresslidelser (Gunnell et al, 2008;Mellesdal et al, 2014). Det er ikke dokumentert at gjentatt døgninnleggelse reduserer VE (Carroll et al, 2016;Hawton et al, 2015Hawton et al, , 2016. I nasjonale retningslinjer advares det mot at pasienter med repetitiv VE gjentatte ganger legges inn i døgnavdelinger i psykisk helsevern fordi dette kan hindre etableringen av en langsiktig behandlingsplan og behandlingsallianse (Sosial-og helsedirektoratet, 2008).…”