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Original papers: Leah Hughes and Nick Kosky Meeting NICE self-harm standards in an accident and emergency department Psychiatr Bull 2007; 31: 255-258 [Abstract] [Full text] [PDF]

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Assessment of self harm in A & E

Shalini Agrawal   (26 July 2007)

Assessment of self harm in A & E 26 July 2007
Shalini Agrawal, SHO in Psychiatry South Essex Partnership NHS Foundation Trust Send letter to journal: Re: Assessment of self harm in A & E shaliniagraw{at}gmail.com Shalini Agrawal	The audit by Hughes et al makes for impressive reading. The results of using a specific proforma for self-harm behaviour in A & E are very obvious from this article. However there are limitations to applying these kinds of tools specially in day-to-day practice. It is not clear from the article how much extra time and effort it took to fill in these forms. Another good indicator would be the user friendliness of this proforma and staff attitude towards filling in these forms. From the viewpoint of a psychiatric SHO covering busy A & E departments, it would be very useful to receive appropriate referrals with some psychiatric assessment done before referral. There can be prejudice in A & E when dealing with patients presenting with self-harm. The A & E staff sometimes feel that they have to deal with physical problems only and the rest is up to the psychiatrist. Also some of our clients, who have a pattern of repeated self-harm, build a reputation for themselves in local A & E departments. The difficulty is in designing a proforma for the range of mental health problems that people present with. The other risk is too much reliance on the scores rather than the mental state of the patient, which might give obvious clues not made evident by scores. Although completing such proforma does improve clinical practice, what is more important is to change the attitudes and perceptions of staff dealing with people presenting with not just self harm but with any link to mental health services.