Healthcare practitioners' views of self-harm management practices in older adults in Ireland: A qualitative study

ObjectivesTo explore healthcare practitioners' views on management practices of self-harm in older adults.MethodsSemi-structured interviews were conducted with healthcare practitioners, including consultant psychiatrists, general practitioners, clinical psychologists, psychotherapists, clinical nurse specialists and social workers. Purposeful sampling was used to recruit participants in the Republic of Ireland ensuring diverse perspectives of healthcare practitioners were included. Healthcare practitioners were recruited advertising via professional and clinical research networks, social media, and snowballing methods. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis.ResultsWe conducted interviews with 20 healthcare practitioners from April to July 2023. Three main themes were generated: first, a perceived greater risk of suicide, and increased awareness of complexity in older adults' self-harm presentations. Second, integrated care as an avenue for improving the management of self-harm in older adults. Third, the importance of safety planning in risk assessments of older adults.ConclusionsHealthcare practitioners viewed self-harm in older adults as complex, challenging, and associated with high suicide risk, approaching patients with care and caution. The need for integrated support and improved collaboration between relevant healthcare practitioners was identified. Suggestions were made for primary care having a lead role in identifying and managing older adults after self-harm. Increased mental health promotion and awareness of mental health and self-harm in this age group would help address current stigma and shame. Self-harm in older adults is viewed by healthcare practitioners as complex, multifactorial, and with increased risk of suicide, necessitating a comprehensive and integrated approach to supporting this age group. Presentations of self-harm in older adults may be disguised through physical complaints, or not be readily apparent, therefore, training on diverse presentations in older age should be offered on a structural basis in the curriculum of healthcare practitioners supporting this age group. Primary care was identified as a setting that older adults often access and where identification, support, and prevention can be offered to this group, with more complex cases being referred to specialist services. Provision of care needs to be improved nationally through providing a greater range and consistency of supports, while also redressing disparities in access to mental health care for older adults after self-harm due to age cut offs.