Monday 17 December 2018

Comment - Making people feel comfortable is crucial first step in self-harm cases

Due to stigma, and feelings of shame and guilt, some people may not feel comfortable in an emergency department. (stock photo)
Due to stigma, and feelings of shame and guilt, some people may not feel comfortable in an emergency department. (stock photo)

Prof Ella Arensman

The quality of the hospital emergency department setting is very important in the care of people who present with self-harm.

It is associated with the quality of care they receive.

Due to stigma, and feelings of shame and guilt, some people may not feel comfortable in an emergency department.

This can happen when there is a lack of privacy to complete an assessment.

Therefore, it is pertinent that rooms are available for conducting assessments, or soundproof curtains as is the case in some other countries.

A senior nurse, a junior doctor and a liaison nurse may be able to assess risk of repeated self-harm or suicide.

They can assess risk if they have received training from the clinical nurse specialists who have been trained to deliver this instruction in the hospital setting.

However, a full biopsychosocial assessment can only be conducted by mental health professionals. These include a psychiatrist, trainee doctor in psychiatry, or a senior nurse with a mental health background.

Involving patients' next of kin in the assessment and management of a person who has engaged in self-harm would be recommended.

This is in order to obtain a more complete picture of risk and protective factors associated with self-harm, and continuity of care. However, this may not always be possible due to complex situations, such as domestic violence and sexual abuse.

Communication with the GP is paramount but a new report said that in only 61pc of presentations was a letter sent to the GP within 24 hours of discharge. "It is recommended that the proportion be increased to 100pc for those who have a GP," said the report.

This is a crucial recommendation in order to ensure continuity of care for people with self-harm, and to reduce gaps between services. This will contribute to reducing risk of repeated self-harm and suicide following an act of self-harm.

Prof Ella Arensman is the chief scientist of the National Suicide Research Foundation

Irish Independent

Today's news headlines, directly to your inbox every morning.

Don't Miss