Examining the potential of general practice to support young people with self-harm behaviour: a systematic review and qualitative study

Self-harm in young people is a national priority. General practitioners see young people who self-harm the most often in the National Health Service (NHS), and episodes of self-harm in young people presenting to general practice are rising. General practice, therefore, offers an important avenue of support for young people who self harm, yet the potential of general practice to support young people remains unexplored. This thesis examines the potential of general practice to support young people with self-harm behaviour. Two studies were conducted. First, a systematic review and narrative synthesis on the role of the general practitioner (GP) in self-harm management was conducted in accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. Second, in-depth semi-structured interviews were undertaken with 13 young people who self-harmed (aged 16-25 years). Data collection stopped at data saturation and data were analysed thematically applying principles of constant comparison. Based on evidence from 12 studies of moderate overall quality, the role of the GP was found to be multidimensional and flexible across the journey of a patient with selfharm, and encompasses frontline assessment and treatment, referring to specialist care, and ongoing management in primary care. Young people reported avenues of help-seeking and reflected on how they perceived GP care. Young people’s candidacy and recursivity for seeking help was recognised. Barriers for young people accessing general practice care, such as preconceptions of GP care, and fear of hospitalisation, were identified. Findings highlight the important role GPs have, and the need for GPs to tailor care to young people who self harm. Maximising the potential of the GP consultation is crucial in supporting young people who self-harm. General practices are encouraged to be flexible when booking appointments for young people, to facilitate access to care, and elevate the potential of general practice to support young people who selfharm