[Psychiatric treatment of deliberate self-harm in the out-of-hours services].
BACKGROUND
Patients who harm themselves are often considered difficult to treat. There are no evidence-based approaches available for the emergency setting. General practitioners should nevertheless be able to offer interventions directed towards emotional needs in self-harm patients. In this article we suggest how to intervene in such situations.


METHODS
Based on experience from Oslo psychiatric out-of-hours service and with elements from Dialectic Behavioural Therapy, we present a five-step model for treatment of these patients in an out-of-hours service within the primary health care services.


RESULTS
The aim of this model is to bring the patient out of the acute crisis and to arrange for further treatment. Assessment, validation or confirmation, problem-solving, avoiding unnecessary hospitalisation, and focus on continuing established treatment, are important elements in the proposed intervention. This can all be carried out in 60 - 90 min.


CONCLUSIONS
The model may be suitable for training general practitioners to meet and care for patients with self-harm behaviour in the out-hours-services. We have positive experience with the intervention, but systematic research is necessary to assess the effect of the model.
Walby
Fredrik A
FA
Psykiatrisk legevakt, Psykiatrisk divisjon, Oslo universitetssykehus, Ullevål.
Ness
Ewa
E
D039602:After-Hours Care; D001521:Behavior Therapy; D003419:Crisis Intervention; D004502:Education, Medical, Continuing; D004630:Emergencies; D005194:Family Practice; D006801:Humans; D008605:Mental Health Services; D009664:Norway; D011340:Problem Solving; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*