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
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
The report makes a series of key
recommendations to improve the provision of services.
- 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
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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.