title: Short shrift for the sane? The hospital management of self-harm patients with and without mental illness.
abstract: In recent years the British government has sought to target service provision both on people with severe enduring mental illness and on those considered to be at risk of suicide. The study reported here suggests these policies may have had unforeseen repercussions on services for people who self-harm but have no identifiable mental illness. This paper compares the hospital management of self-harm patients with and without mental illness. Over the years 1996-2000, a total of 4,329 self-harm patient attendances were recorded at the accident and emergency department of a British hospital. Whilst patients in 63.7% of attendances could reasonably have been considered to have some form of mental illness, we found that in the remaining 36.3% of attendances (where patients had no indicator of mental illness) a particularly poor standard of service was given. We suggest that if government targets for a reduction in the suicide rate are to be met, it is crucial that there should be marked improvements in services for all self-harm patients presenting at accident and emergency departments. However, in improving services we must be vigilant to the danger that targeting those with a mental illness may mean we fail to provide even basic levels of care for others.
authors.affiliation: Health and Community Care Research Unit, University of Liverpool, Brownlow Hill, Liverpool L69 3GB, UK. walb@liv.ac.uk
authors.forename: W
authors.initials: W
authors.lastname: Barr
authors.forename: M
authors.initials: M
authors.lastname: Leitner
authors.forename: J
authors.initials: J
authors.lastname: Thomas
mesh_terms: D003156:Community Mental Health Services / Q000592:standards; D004637:Emergency Services, Psychiatric / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology / Q000451:nursing; D011567:Psychiatric Department, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D011568:Psychiatric Nursing / Q000592:standards*; D012017:Referral and Consultation; D012189:Retrospective Studies; D016728:Self-Injurious Behavior / Q000453:epidemiology / Q000628:therapy*; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology