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UK study sheds light on hospital care for self-harm

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Admission to a psychiatric ward is associated with the highest risk of suicide among patients admitted to hospital for self-poisoning and self-injury, suggests a UK study.

However, the researchers suggested the finding may indicate that patients most at risk were being given the most intensive treatments, rather than suggesting psychiatric admission was “harmful”.

“Clearly we need to do more to find out what works following self-harm and how it works”

Nav Kapur

The Manchester University study has, for the first time, investigated the association between the treatment patients receive in hospital and their subsequent risk of death.

It followed 38,415 adult patients who had self-harmed and attended five hospital emergency departments between 2000 and 2010.

The researchers found that within 12 months, 261 had died by suicide and a further 832 had died from other causes.

The study also examined the type of management which patients received, including assessment by a mental health specialist, admission to medical or psychiatric beds and referral to a specialist community team.

The findings showed that most types of management were associated with higher risk of death but the highest risks were associated with admission to a psychiatric bed.

Lead author Professor Nav Kapur, from Manchester University and Manchester Mental Health and Social Care Trust, said: “Hospitals have a number of strategies to use when people attend with self-harm, but no one has looked at the association of these with mortality risk on a large scale before.

“We need to be clear that these findings indicating higher risk of death do not mean these treatments are harmful – instead it looks like health services are reserving the most intensive treatments for the patients at greatest need,” he said.

“Doing the simple things well could improve services for patients and may ultimately reduce the number of deaths”

Nav Kapur

The researchers said they were also able to take into account the difference in the characteristics of patients receiving different forms of management.

They suggested different interventions might have greater impact in particular patient groups. For example, psychiatric admission may have had a greater effect on reducing deaths among men, those aged 65 and over, and those who had self-harmed previously.

Professor Kapur said: “Clearly we need to do more to find out what works following self-harm and how it works.

“Attendance at hospital represents an opportunity for services to address underlying issues such as mental health problems, difficult life circumstances, and alcohol use which contribute to self-harm,” he said.

“Our research suggests routine aspects of care can be really helpful – doing the simple things well could improve services for patients and may ultimately reduce the number of deaths,” he added.

The research was funded by the Department of Health and published in the journal Lancet Psychiatry.

It carried out as part of a collaborative study between the universities of Oxford, Manchester and Nottingham, with Derbyshire Healthcare NHS Foundation Trust.

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