Hospital management of patients who self-harm in England has barely changed in the past 10 years despite the introduction of clinical guidelines a new study shows.
Researchers from The University of Manchester found 40% of those attending hospital after an overdose or other self-injury did not get a specialist psychosocial assessment.
The treatment patients received also varied according to where they lived -- suggesting a postcode lottery was still in operation.
The researchers looked at 6442 individuals who presented at 32 hospitals with 7689 episodes of self-harm over a three-month period and investigated how people were treated and followed up. They also measured the quality of self-harm services using a 21-item measure. The team compared their results with an earlier survey carried out in 2001.
Dr Jayne Cooper, from the University's Centre for Suicide Prevention who led the study, said: "Hospitals varied markedly in their management of self-harm. The proportion of episodes that received a psychosocial assessment in line with national guidance varied from 22% in some hospitals to 88% in others. Overall we found the level of assessment had remained more or less static over the last 10 years."
But the study did show some evidence that the quality of health services for patients who self-harmed may have improved, she added.
The study, funded by the National Institute for Health Research (NIHR) and published in BMJ Open, provides the most detailed information on services for self-harm available nationally.
Professor Nav Kapur, senior author for the study and chair of the recent National Institute for Health and Care Excellence (NICE) self-harm guideline, said: "We were surprised to find that despite national guidelines and policy initiatives, the management of self-harm in English hospitals is as variable as ever. This is important because the treatment patients get in hospital affects their outcome.
Professor Kapur, who is also an Honorary Consultant in Psychiatry at Manchester Mental Health and Social Care Trust, added: "It remains to be seen how the more recent guidance and the linked quality standards for self-harm services will impact on care. Hopefully, people who self-harm will increasingly get the assessment and treatment they need."
- J. Cooper, S. Steeg, O. Bennewith, M. Lowe, D. Gunnell, A. House, K. Hawton, N. Kapur. Are hospital services for self-harm getting better? An observational study examining management, service provision and temporal trends in England. BMJ Open, 2013; 3 (11): e003444 DOI: 10.1136/bmjopen-2013-003444
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