Assessing young people who deliberately harm themselves.
BACKGROUND
Many young people who harm themselves have chronic mental health or social problems or are at risk of future self-harm or even suicide. The accident and emergency (A&E) clinic is an important gateway to treatment.


OBJECTIVE
To describe the psychosocial assessment of 12- to 24-year-old patients attending A&E clinics following deliberate self-harm (DSH) and to identify features of service management and provision which maximise specialist assessment.


METHODS
A postal questionnaire was sent to a sample of one in three A&E departments in England. In a representative sample of 18 of these hospitals, staff were interviewed and 50 case notes per hospital were examined.


RESULTS
Psychosocial assessment by non-specialist doctors in A&E departments tended to be of variable quality, focused on short-term risk. Around 43% of patients aged 12-24 were assessed by a specialist; specialist assessment was associated with high admission rates and the presence of on-site psychiatric departments and DSH teams.


CONCLUSIONS
Young DSH patients at risk often go unidentified; as a result their psychological problems may not be treated. Hospitals are frequently unaware of the proportion of patients discharged without adequate assessment.
Hurry
J
J
Institute of Education, London.
Storey
P
P
D000293:Adolescent; D000328:Adult; D002648:Child; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000592:standards*; D018579:Patient Selection; D011570:Psychiatry / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D018570:Risk Assessment; D016728:Self-Injurious Behavior / Q000175:diagnosis* / Q000523:psychology