title: Variations in the hospital management of self-harm and patient outcome: a multi-site observational study in England.
abstract: BACKGROUND
  Studies have shown wide variations in delivery of self-harm services but it is unclear how these relate to important outcomes such as self-harm repetition.
  
  
  METHODS
  Data were collected on self-harm presentations and hospital management from 31 hospitals in England. Key staff were interviewed about service provision for self-harm patients and responses were mapped to a 21-item service quality scale. Our main outcome was repeat hospital-presenting self-harm within six months.
  
  
  RESULTS
  6347 individuals presented with 7599 episodes of self-harm during a three month period in 2010-2011. Re-attendance with self-harm within six months of index episode occurred in 21% (1308/6347) of individuals (range between hospitals 9-27%). We found little association between clinical management at hospital level (i.e. proportion of episodes receiving psychosocial assessment, medical or psychiatric admission, and referral to statutory or non-statutory services) and repetition rate. The median score on service quality scale was 14.5 (range between hospitals 10.5-19). There was no evidence of correlation between total service quality score and repetition of self-harm (Spearman׳s r=-0.06, p=0.73) or between individual service items and repetition.
  
  
  CONCLUSIONS
  We did not explore certain aspects of service provision e.g. quality of psychosocial assessments and length of admission. Hospital presentation for repeat self-harm may not be the most reliable measure of service quality.
  
  
  CONCLUSIONS
  At aggregate level aspects of management and service structures did not appear to be associated with self-harm repetition rates. Future research should focus on better understanding the processes underlying the delivery of services at hospital level and their relationship to outcome.
authors.affiliation: Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Oxford Road, Manchester, UK. Electronic address: jayne.cooper@manchester.ac.uk.
authors.forename: Jayne
authors.initials: J
authors.lastname: Cooper
authors.affiliation: Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Oxford Road, Manchester, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Steeg
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: David
authors.initials: D
authors.lastname: Gunnell
authors.affiliation: Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Oxford Road, Manchester, UK.
authors.forename: Roger
authors.initials: R
authors.lastname: Webb
authors.affiliation: Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Hawton
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Olive
authors.initials: O
authors.lastname: Bennewith
authors.affiliation: Academic Unit of Psychiatry and Behavioural Sciences, Leeds, UK.
authors.forename: Allan
authors.initials: A
authors.lastname: House
authors.affiliation: Centre for Suicide Prevention, Centre for Mental Health and Risk, University of Manchester, Oxford Road, Manchester, UK.
authors.forename: Navneet
authors.initials: N
authors.lastname: Kapur
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital; D004739:England / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010346:Patient Care Management / Q000379:methods*; D012017:Referral and Consultation; D016728:Self-Injurious Behavior / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Emergency department; Hospital services; Psychosocial assessment; Repetition rates; Self-harm