A Study of Patients Referred Following an Episode of Self-harm, a Suicide Attempt, or in a Suicidal Crisis Using Routinely Collected Data

Self-harm and suicide prevention remain a priority of public health policy in the UK.
Clinicians conducting psychosocial assessments in Accident and Emergency
Departments are confronted with a complex and demanding task. There is a paucity
of research into the content of psychosocial assessments and the experiences of
clinicians conducting psychosocial assessments in Accident and Emergency
Departments. This study examines the experiences of people who presented in an
Accident and Emergency Department following self-harm or with suicidal ideation, as
those are documented in the psychosocial assessments. Furthermore, the study
explores the attitudes, feelings and experiences of clinicians working in a Psychiatric
Liaison Team, as well as the process of making decisions about aftercare plans. In
order to achieve this, qualitative methods were employed. A sample of sixty-one
psychosocial assessments was collected and analysed using thematic analysis. The
coding of the data was done inductively and deductively with the use of the
categories of the Orbach and Mikulincer Mental Pain Scale. Two focus groups with
clinicians were conducted and analysed with a grounded theory oriented approach.
Stevens’ framework was applied in order to analyse the interactional data in the
focus groups. Key themes emerging from the focus groups were shared with serviceusers
who offered their own interpretation of the data and findings.
The study draws on psychodynamic theories to explore the experiences of
clinicians assessing and treating patients with self-harm and suicidal ideation in an
Accident and Emergency Department and to make sense of the needs of the
patients. The findings are that suicidal ideation and self-harm were assessed and
treated in similar ways. Difficulties in relationships and experiences of loss or trauma
in childhood and/or adulthood were the two most common themes emerging in the
psychosocial assessments. Decisions about aftercare plans were guided by patients’
presentation and needs in conjunction with available resources. Clinicians were
found to have various emotional responses to patients’ painful experiences with
limited space to reflect upon these at work.
Clinicians and service-users commented upon the therapeutic aspect of
psychosocial assessments, which in light of the painful experiences reported in the
psychosocial assessments could be used to generate more sensitive and meaningful
approaches to the care of this population. Providing support and a space for
clinicians to be able to think of their task and their responses seems important.