Psychosocial assessments for self-harm: are we continuing to comply? 

Aim and Hypothesis: An audit to determine compliance with NICE Guidelines on management of self-harm (2004) by evaluating whether psychosocial assessments are received by patients presenting with self-harm at University Hospital of North Tees, Stockton-On-Tees and any trends associated with this implementation. Background Services for self-harm are expected to be commissioned from and coordinated across all relevant agencies, to encompass comprehensive care. This includes assessments of physical health, mental health, social circumstances, safeguarding concerns, risks of repetition and suicide. All patients are expected to receive a comprehensive psychosocial assessment. Adherence to current guideline is delivered through the Integrated Care Pathway (ICP) in our trust. Methodology 50 patients were randomly selected from presentations in September 2014. Information evaluated were the number of patients placed on the ICP on admission, numbers that received psychosocial assessment prior to discharge, method of self-harm, method of hospital presentation, SAD PERSONS score recorded, gender, length of hospital stay and discharge outcome. Results The sample comprised 32 (64%) females and 18 (36%) males. 49 patients presented with self-poisoning. 42 (84%) presented via ambulance, 7 (14%) self-presented and 1 (2%) was brought by police. 43 (86%) were assessed by Liaison team and discharged within the 48 hours of presentation to Accident & Emergency. Only 28 (56%) of patients had their SAD score recorded. 39 (78%) of patients who presented with self-harm were referred to Liaison Psychiatry. 29 (58%) patients were seen by the Liaison services even before they were deemed medically fit. Only 16 (32%) patients were previously known to the secondary mental health services. Conclusions/Recommendations The Integrated Care Pathway continues to ensure that compliance with practice guideline is achieved. Patients presenting at North Tees Accident & Emergency can expect to receive a good quality of care. Improvement in practice through the recording of SAD score in the relevant assessment booklet was recommended . Acknowledgements Dr W Karzan and Mr. Kayode Adeboye of Accident & Emergency Department of University Hospital of North Tees, Stockton-on-Tees, participated in this project. Bibliography Patterson WM, Dohn HH, Bird J, Patterson GA. Evaluation of suicidal patients: The SAD PERSONS scale. Psychosomatics.24(4):348-9. Kripalani M, Nag S, Nag S, Gash A. Integrated care pathway for self-harm: our way forward. Emergency Medicine Journal. 2010;27(7):544-6.