These findings from Professor Keith Hawton’s team at Oxford University Centre for Suicide Research complement previous qualitative work describing the negative experiences of patients who self-harm when seen at general hospitals. Those accounts have tended to be critical of psychiatrists’ assessments as rushed or impersonal, while experiencing psychiatric nurses’ assessments as more collaborative.
Psychosocial assessment after self-harm is a therapeutic intervention when conducted by a skilled communicator, involving not just information-gathering and collaborative care-planning, but also responding to the emotional content of what the patient describes. Psychiatric liaison nurses’ training reinforces a collaborative, personalised approach, and they tend to be familiar with a wide range of local community resources.
The team therefore predicted that the probability of repeat self-harm might be reduced after psychosocial assessment by a psychiatric nurse compared to that conducted by a psychiatrist. They also aimed to explore whether aftercare planning might explain any associations of professional background with repeat self-harm, predicting that nurses would be more likely than psychiatrists to refer for community-based aftercare arrangements.
The study, Comparing short-term risk of repeat self-harm after psychosocial assessment of patients who self-harm by psychiatrists or psychiatric nurses in a general hospital, published in the Journal of Affective Disorders, was based on analysis of data collected through the Oxford Monitoring System for Self-harm.
The team analysed data on 12,652 patients who had presented to the general hospital in Oxford following self-harm between 2000 and 2014. They found no differences in the proportions of patients who repeated self-harm according to whether they received psychosocial assessment from a psychiatrist or a psychiatric nurse, and also found no differences between psychiatrists and psychiatric nurses in their use of community resources. Whilst it is possible that nurses have greater experience in developing collaborative care plans and utilising appropriate community resources, this was not manifested in a reduced probability of repeat self-harm presentation among patients they assessed. This study therefore shows that even when taking into account potential confounders, the background and training of the assessor does not differentially influence the therapeutic effect of the psychosocial assessment.
Psychosocial assessment of people who self-harm is essential for helping understand their problems and how best to meet their needs. This research confirms that the practice of having a multidisciplinary team carry out these assessments is the right approach.Professor Keith Hawton, Directer of the Centre for Suicide Research.
Dr Alexandra Pitman, Clinical Associate Professor of Psychiatry in the UCL Division of Psychiatry, first author on the study said:
'This work found that the professional background of the mental health professional conducting a psychosocial assessment does not differentially influence its therapeutic effect in reducing repeat self-harm. However, it also highlighted the need to understand more about the actual practice of psychosocial assessment in ED settings and how individuals differ in the way that they establish a therapeutic relationship with the patient and collaborate on developing a risk management plan.'
Access the full study on 'Comparing short-term risk of repeat self-harm after psychosocial assessment of patients who self-harm by psychiatrists or psychiatric nurses in a general hospital: Cohort study'.