Deliberate self-harm: how feasible are the current guidelines?

Objectives: To examine the operation of a deliberate self-harm service at a large general hospital with reference to standards outlined by the Royal College of Psychiatrists. To examine the characteristics of referrals and to make recommendations for improvements to the service. Method: Data on referral and assessment characteristics were collected for 96 consecutive referrals over a three month period. Results: The services achieved the college standards in relation to the time period for assessments. Most referrals were made routinely at a predictable time but assessments were conducted on an ad hoc basis. Only a minority of those referred had a mental illness or complex problems. A significant number of patients were discharged from the A&E department without a psychiatric assessment. Assessors underemphasised the role of previous deliberate self-harm and/or the presence of mental illness in forming a judgment on the risk of suicide. After-care arrangements were predominantly medical (general practitioners or psychiatrists) with little multidisciplinary input. Conclusions: The deliberate self-harm service at the hospital could be improved by the establishment of a self-harm services planning group to oversee the delivery of the service throughout the hospital and address the deficits identified. Given the number of referrals seen within the service and the fact that deliberate self-harm is only one element of a comprehensive liaison service, consideration should be given to the establishment of a separate multidisciplinary liaison team. Once again importance is drawn to the need for all assessors to be aware of the risk factors in relation to the future risk of suicide rather than placing undue emphasis on whether the most recent attempt was planned or impulsive in nature.