Deliberate self-harm cases: a primary care perspective.
OBJECTIVE
To observe case ascertainment and one-year outcome among patients presenting with deliberate self-harm (DSH) in an urban practice.


METHODS
In this exploratory study, primary care team members recorded all DSH episodes presenting over six months and then tracked their pattern of care over the next 12 months using practice IT systems, patient records and discussions with staff who were involved with patients meeting inclusion criteria. Interviews were held with primary care team members, secondary care staff and voluntary sector staff. Patients were also offered an interview with the community psychiatric nurse, using local NHS trust global assessment and community department risk assessment tools. Relevant data from these sources were then collated and cross-referenced to identify any patterns.


RESULTS
Twenty five patients aged between 15 and 44 (19 females) presented at the practice during the six-month period, 15 had taken a drug overdose, nine had self-cut, and one had involved self-stabbing. Most had a long history of similar episodes and substance use and misuse was almost universal. All patients were still alive after 12 months. Of the 13 patients initially in contact with secondary care services, only one established ongoing care. The remainder had very high use of GP services, often in a chaotic manner.


CONCLUSIONS
DSH could best be regarded as a long-term health condition. Support services and intervention opportunities should be configured from within, not outside, general practice. There should be greater liaison between primary and secondary care and increased support for the primary care team.
Poustie
Anne
A
Threshold Day Services, Dundee. anne.poustie@tpct.scot.nhs.uk
Neville
Ron G
RG
D000293:Adolescent; D000328:Adult; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009042:Motivation; D020380:Needs Assessment; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000401:mortality / Q000534:rehabilitation*; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology