NHS services ‘failing to support people who self-harm’

Embargoed until 07 July 2010

Many people who harm themselves are failing to receive the help they need because of a ‘patchy’ provision of services across the UK and a lack of supervision and training of NHS staff, the Royal College of Psychiatrists (RCPsych) says.

In a new report, Self-harm, suicide and risk: helping people who self-harm, the RCPsych examines the current provision of care for people at risk from self-harm and suicide, and makes a series of recommendations to improve standards of care.

Self-harm is defined as an intentional act of self-poisoning or self-injury, and includes suicide attempts. While there has been a downward trend in the number of completed suicides in recent decades, the incidence of self-harm in the UK has continued to rise over the past 20 years. An estimated 4 in 1,000 people have self-harmed, and the rate of self-harm in the UK’s young people is among the highest in Europe.

As part of the report, the RCPsych surveyed over 1,500 of its members. Less than half the respondents felt that they or their team had sufficient training to undertake assessments of people who had harmed themselves.                                              

Many respondents reported that junior doctors and other inexperienced health professionals are left – often at night – to assess and manage the complex and potentially life-threatening situations of people who have harmed themselves or attempted suicide. The survey suggests the situation is particularly bad in accident and emergency departments.

Lord John Alderdice, who chaired the working group which produced the report, said: “Our report highlights examples of excellent best practice, where dedicated staff are providing innovative, effective and humane services to people who harm themselves.  However, overall the evidence painted a worrying picture of standards of care in UK hospitals. This situation is unacceptable by any reasonable standard. Lives may be at stake. Well-being certainly is.”

Lord Alderdice continued: “When a person turns up to hospital having harmed themselves, this may well be the first time they have had contact with the health service. Failure to deal effectively with a person at this stage can have major repercussions. It may discourage them from returning in a later crisis and stop them getting the care they need. Experienced clinicians need to be involved from the outset, and psychiatrists need to be available to take a lead role in the process of helping people who harm themselves.  I must emphasize that this is not because all of these people are suffering from mental illness, which is not the case, but because a sophisticated assessment is necessary to ensure the right management of the person and their problems.”

The report makes a series of key recommendations to improve the provision of services. Recommendations include:

• NHS services, particular in A&E, to be managed in a way which ensures people who have self-harmed or attempted suicide have proper access to care and treatment by fully-trained clinical staff, and that the NICE guideline on self harm is implemented.
• A change to the culture of NHS services, so that staff who encounter people who self-harm are trained and supported.
• A proper public health strategy to cover self-harm, and for the suicide prevention strategy to remain a priority in all nations of the UK.
• More funding of research on self-harm, which has been neglected and overlooked.

Joe Ferns, director of policy at Samaritans and member of the working group, said: “This report is a timely reminder that good care for people at risk of self-harm and suicide can lead to a reduction in the nation’s suicide rate. There is strong evidence of a link between economic hardship and suicide; figures released last week show that, in the Republic of Ireland, people taking their own lives in 2009 increased by 24 per cent, compared to the previous year.

“Meanwhile, 2008 UK figures showed the number of suicides and the suicide rate increased slightly compared to 2007. This could indicate the start of an upward trend continuing until there is an improvement in economic conditions. In the current economic climate, and against a backdrop of budget cuts, it is vital that the government is committed to a suicide prevention strategy.”

References:

CR158 Self-harm, suicide and risk: helping people who self-harm, was published by the Royal College of Psychiatrists in June 2010.

Note to editors:

The report was produced by a working group, chaired by Lord John Alderdice. It was compiled with the help of expert evidence from health professionals, third sector providers, policy professionals, service users and carers, as well as members of the Royal College of Psychiatrists.