End the treatment lottery putting the lives of self-harming patients at risk, says RCPsych

Press release
20 February 2020

Lives are at risk because of the treatment lottery facing self-harming and suicidal patients, according to the Royal College of Psychiatrists.

It is calling for every acute hospital to provide NICE recommended psychosocial assessments and for closer working between hospitals and community mental health teams after treatment.  

The call comes in the week that Love Island presenter, Caroline Flack, died by suicide and follows huge increases in the numbers of self-harming under-30s.

Research has found that many self-harming patients do not receive the assessment, even though it halves the rate of repeating self-harm, with a Select Committee report on suicide prevention saying that it is unacceptable that so few patients presenting at emergency departments for self-harm are receiving a psychosocial assessment1.

The College is also calling for all frontline staff who may come into contact with a patient who has self-harmed, or is feeling suicidal, to be trained in writing a Safety Plan with the patient to lessen the risk of suicide and repeating self-harm.

Dr Huw Stone, chair of the Patient’s Safety Group at the Royal College of Psychiatrists, said: “Self-harming patients are being let down because many of them are not receiving an assessment that is proven to dramatically reduce repeating self-harm.

“With hospital admissions for self-harming under-30s more than doubling in the last 10 years, there has never been a more important time to ensure patients are getting the care that they need.  

“The College believe that every person who has self-harmed or is having suicidal thoughts should have a Safety Plan written by them with their health professional, as the Plans are shown to lessen the risk of suicide.”

A Safety Plan is written with the patient and is an agreed set of activities to support them, strategies to instil hope, and people and organisations to contact for social and crisis support if someone becomes suicidal. It should also include explicit reference to removal or lessening of means of suicide or self‑harm.

Simon, from Derbyshire, whose recovery from suicide attempts was better when writing a Safety Plan, said: “I tried to take my own life on multiple occasions and ended up in hospital each time.

“I didn’t write a Safety Plan after every attempt on my life, because they weren’t always offered. But on the occasions I did, I was better able to manage the bumps in the road which are always there when you’re recovering.

“Having a meaningful plan, one that is personal and tailored to the circumstances of the individual, is vital to reducing the risk of suicide.”

The assessment is carried out by a specialist mental health professional and evaluates the social, psychological and motivational factors behind the self-harming and assesses current suicidal intent.

It also evaluates the risk levels of repeat self-harm and identifies any demographic and psychological features – such as mental state - associated with an increased risk. 

Mary, from Devon, who has a history of self-harming, said: “My Safety Plan really helped me understand my repeat self-harming by stepping back to see patterns in my thinking and behaviour.

“It’s not so much about the document itself, it’s about the care, empathy and consideration that is put into creating the Safety Plan with you. It’s what it represents.”

Hospital admissions for self-harming under-30s have more than doubled in the last 10 years, from 4,749 in 2008-09, to 10,168 in 2018-192.

2.  Hospital admissions for intentional self poisoning and self harm amongst young people (link no longer valid as of 2024-04-24: https://digital.nhs.uk/data-and-information/find-data-and-publications/supplementary-information/2019-supplementary-information-files/hospital-admissions-for-intentional-self-poisoning-and-self-harm-amongst-young-people)

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