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Experiences of care for self-harm in the Emergency Department: a comparison of the perspectives of patients, carers and practitioners

O'Keeffe, S. ORCID: 0000-0002-6713-2898, Suzuki, M., Ryan, M., Hunter, J. and McCabe, R. ORCID: 0000-0003-2041-7383 (2021). Experiences of care for self-harm in the Emergency Department: a comparison of the perspectives of patients, carers and practitioners. BJPsych Open, doi: 10.1192/bjo.2021.1006


Background: Each year, 220,000 episodes of self-harm are managed by Emergency Departments (EDs) in England, providing support to people at risk of suicide.

Aims: To explore treatment of self-harm in EDs, comparing perspectives of patients, carers and practitioners. Method: Focus groups and semi-structured interviews with 79 people explored experiences of receiving/delivering care. Participants were patients (7 young people, 12 adults), 8 carers, 15 generalist ED practitioners and 37 liaison psychiatry practitioners. Data were analysed using framework analysis.

Results: We identified four themes. One was common across stakeholder groups: (1) The wider system is failing people who self-harm: They often only access crisis support as they are frequently excluded from services, leading to unhelpful cycles of attending the ED. Carers felt over-relied upon and ill-equipped to keep the person safe. Three themes reflected different perspectives across stakeholders: (2) Practitioners feel powerless and become hardened towards patients, with patients feeling judged for seeking help which exacerbates their distress; (3) Patients need a human connection to offer hope when life feels hopeless, yet practitioners underestimate the therapeutic potential of interactions; (4) Practitioners are fearful of blame if someone takes their life: formulaic question-and-answer risk assessments help make staff feel safer but patients feel this is not a valid way of assessing risk or addressing their needs.

Conclusions: ED practitioners should seek to build a human connection and validate patients’ distress, which offers hope when life feels hopeless. Patients consider this a therapeutic intervention in its own right. Investment self-harm treatment is indicated.

Publication Type: Article
Publisher Keywords: deliberate self-harm; suicide; emergency department; liaison psychiatry; qualitative research
Subjects: H Social Sciences > HM Sociology
H Social Sciences > HN Social history and conditions. Social problems. Social reform
R Medicine > RT Nursing
Departments: School of Health Sciences > Healthcare Services Research & Management
Date available in CRO: 31 Aug 2021 14:12
Date deposited: 31 August 2021
Date of acceptance: 26 August 2021
Text - Accepted Version
Available under License Creative Commons: Attribution International Public License 4.0.

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