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