title: Needs and fears of young people presenting at accident and emergency department following an act of self-harm: secondary analysis of qualitative data.
abstract: BACKGROUND
  Presentation at an accident and emergency (A&E) department is a key opportunity to engage with a young person who self-harms. The needs of this vulnerable group and their fears about presenting to healthcare services, including A&E, are poorly understood.
  
  
  OBJECTIVE
  To examine young people's perceptions of A&E treatment following self-harm and their views on what constitutes a positive clinical encounter.
  
  
  METHODS
  Secondary analysis of qualitative data from an experimental online discussion forum. Threads selected for secondary analysis represent the views of 31 young people aged 16-25 with experience of self-harm.
  
  
  RESULTS
  Participants reported avoiding A&E whenever possible, based on their own and others' previous poor experiences. When forced to seek emergency care, they did so with feelings of shame and unworthiness. These feelings were reinforced when they received what they perceived as punitive treatment from A&E staff, perpetuating a cycle of shame, avoidance and further self-harm. Positive encounters were those in which they received 'treatment as usual', i.e. non-discriminatory care, delivered with kindness, which had the potential to challenge negative self-evaluation and break the cycle.
  
  
  CONCLUSIONS
  The clinical needs of young people who self-harm continue to demand urgent attention. Further hypothesis testing and trials of different models of care delivery for this vulnerable group are warranted.
authors.affiliation: Christabel Owens, PhD, Lorraine Hansford, MSc, University of Exeter Medical School, Exeter, UK; Siobhan Sharkey, PhD, RMN, Plymouth University Peninsula School of Medicine & Dentistry, Plymouth, UK; Tamsin Ford, PhD, MRCPsych, University of Exeter Medical School, Exeter, UK c.v.owens@exeter.ac.uk.
authors.forename: Christabel
authors.initials: C
authors.lastname: Owens
authors.affiliation: Christabel Owens, PhD, Lorraine Hansford, MSc, University of Exeter Medical School, Exeter, UK; Siobhan Sharkey, PhD, RMN, Plymouth University Peninsula School of Medicine & Dentistry, Plymouth, UK; Tamsin Ford, PhD, MRCPsych, University of Exeter Medical School, Exeter, UK.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Hansford
authors.affiliation: Christabel Owens, PhD, Lorraine Hansford, MSc, University of Exeter Medical School, Exeter, UK; Siobhan Sharkey, PhD, RMN, Plymouth University Peninsula School of Medicine & Dentistry, Plymouth, UK; Tamsin Ford, PhD, MRCPsych, University of Exeter Medical School, Exeter, UK.
authors.forename: Siobhan
authors.initials: S
authors.lastname: Sharkey
authors.affiliation: Christabel Owens, PhD, Lorraine Hansford, MSc, University of Exeter Medical School, Exeter, UK; Siobhan Sharkey, PhD, RMN, Plymouth University Peninsula School of Medicine & Dentistry, Plymouth, UK; Tamsin Ford, PhD, MRCPsych, University of Exeter Medical School, Exeter, UK.
authors.forename: Tamsin
authors.initials: T
authors.lastname: Ford
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005239:Fear; D005260:Female; D000066505:Help-Seeking Behavior; D006801:Humans; D020407:Internet; D008297:Male; D036301:Qualitative Research; D012647:Self-Assessment; D016728:Self-Injurious Behavior / Q000523:psychology* / Q000628:therapy; D012752:Shame; D055815:Young Adult