"When you're in the hospital, you're in a sort of bubble." Understanding the high risk of self-harm and suicide following psychiatric discharge: a qualitative study.
BACKGROUND
Individuals are at a greatly increased risk of suicide and self-harm in the months following discharge from psychiatric hospital, yet little is known about the reasons for this.


OBJECTIVE
To investigate the lived experience of psychiatric discharge and explore service users' experiences following discharge.


METHODS
In-depth interviews were undertaken with recently discharged service users (n = 10) in the UK to explore attitudes to discharge and experiences since leaving hospital.


RESULTS
Informants had mixed attitudes to discharge, and those who had not felt adequately involved in discharge decisions, or disagreed with them, had experienced urges to self-harm since being discharged. Accounts revealed a number of factors that made the postdischarge period difficult; these included both the reemergence of stressors that existed prior to hospitalization and a number of stressors that were prompted or exacerbated by hospitalization.


CONCLUSIONS
Although inferences that can be drawn from the study are limited by the small sample size, the results draw attention to a number of factors that could be investigated further to help explain the high risk of suicide and self-harm following psychiatric discharge. Findings emphasize the importance of adequate preparation for discharge and the maintenance of ongoing relationships with known service providers where possible.
<location>School of Social and Community Medicine, University of Bristol, UK</location>
Amanda
A
Owen-Smith
<location>School of Social and Community Medicine, University of Bristol, UK</location>
Olive
O
Bennewith
<location>School of Social and Community Medicine, University of Bristol, UK</location>
Jenny
J
Donovan
<location>School of Social and Community Medicine, University of Bristol, UK</location>
Jonathan
J
Evans
<location>Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK</location>
Keith
K
Hawton
<location>Centre for Suicide Prevention, University of Manchester, UK</location>
Nav
N
Kapur
<location>Somerset Partnership NHS Foundation Trust, Somerset, UK</location>
Susan
S
O'Connor
<location>School of Social and Community Medicine, University of Bristol, UK</location>
David
D
Gunnell
D000328:Adult; D005260:Female; D006760:Hospitalization; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy; D008875:Middle Aged; D010351:Patient Discharge; D036301:Qualitative Research; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000209:etiology / Q000523:psychology*; D013405:Suicide / Q000523:psychology*; D055815:Young Adult
in-depth interview; psychiatric discharge; qualitative; self-harm; suicide