title: The Green Card Clinic: overview of a brief patient-centred intervention following deliberate self-harm.
abstract: OBJECTIVE
  The aim of this study was to present an overview of the Green Card Clinic, a novel brief intervention service for patients presenting to the emergency department following deliberate self-harm (DSH) or with suicidal ideation, to examine its effectiveness in terms of service utilization, and patient and clinician feedback, and to explore the correlates of repeated DSH.
  
  
  METHODS
  The aims and structure of the Green Card Clinic are described. We highlight our patient-centred approach involving self-identification of difficulties from a list of problem areas, coupled with tailored intervention strategies. Relevant data are presented and characteristics of repeat DSH patients are compared to the first-episode group.
  
  
  RESULTS
  Between 1998 and 2005, 456 DSH patients were referred to the clinic. Of these, 75% (n = 344) attended the first session, 43% (n = 197) the second session, 26% (n = 117) the third session, and 16% (n = 73) completed a 3-15 month follow-up. Clinic attenders (mean age 31.6 years, 57% female) reported a diverse range of self-identified problems and repeat DSH patients reported worse depression, poorer health-related behaviours, and a greater number of problems than those presenting after first-episode DSH.
  
  
  CONCLUSIONS
  The clinic achieved high rates of first session attendance. This may have been attributable to the use of a few specific strategies aimed at increasing compliance, such as the green card, next-day appointments and assertive follow-up of non-attenders. For repeat self-harmers, we advocate an approach aimed at 'lifestyle change' rather than based on current psychological stressors. The Green Card Clinic service, involving a range of interventions tailored to meet the multitude of presenting needs, appears to be an acceptable and flexible approach to brief intervention for DSH.
authors.affiliation: School of Psychiatry, University of NSW, Sydney, NSW, Australia. kwilhelm@stvincents.com.au
authors.forename: Kay
authors.initials: K
authors.lastname: Wilhelm
authors.forename: Adam
authors.initials: A
authors.lastname: Finch
authors.forename: Beth
authors.initials: B
authors.lastname: Kotze
authors.forename: Karen
authors.initials: K
authors.lastname: Arnold
authors.forename: Geoff
authors.initials: G
authors.lastname: McDonald
authors.forename: Peter
authors.initials: P
authors.lastname: Sternhell
authors.forename: Beaver
authors.initials: B
authors.lastname: Hudson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D001315:Australia; D005246:Feedback; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000379:methods*; D011614:Psychotherapy, Brief / Q000379:methods*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D016728:Self-Injurious Behavior / Q000628:therapy*