Patients who present to hospital after self-harm are at a high risk of subsequent death by suicide, with suicide risk being particularly high immediately after their hospital visit.
The investigators of this study, Suicide following presentation to hospital for non-fatal self-harm in the Multicentre Study of Self-harm: a long-term follow up study, have highlighted the need for improved clinical management of these patients in hospital and in the community to try and mitigate this risk, including a comprehensive assessment of the patients' problems and treatment needs, a follow-up care plan to address their ongoing difficulties and needs, and the agreement of a safety plan.
The study further showed that men were more likely to die by suicide after attending hospital for self-harm, as were older patients, those who visited hospital for self-harm more than once, patients using certain methods of non-fatal self-harm, and patients from areas considered less socioeconomically deprived. However, the authors stress that while awareness of risk factors are important as part of a comprehensive assessment which should be offered to all patients attending clinical services for self-harm, they warn against relying on them to indicate subsequent suicide risk as they have poor predictive value.
The peak in risk of suicide which follows immediately after discharge from hospital underscores the need for provision of early and effective follow-up care. Presentation to hospital for self-harm offers an opportunity for intervention, yet people are often discharged from hospital having not received a formal assessment of their problems and needs, and without specific aftercare arrangements. As specified in national guidance, a comprehensive assessment of the patients' mental state, needs, and risks is essential to devise an effective plan for their follow-up care. - Dr Galit Geulayov, Centre for Suicide Research, University of Oxford.
"Good care for patients who self-harm needs to involve healthcare providers in hospital and very importantly, in the community, as most patients are discharged thereafter self-harm. While in hospital, healthcare practitioners need to assess the patient in order to devise their follow-up care plan, this should address the patients' problems and needs after they are discharged from hospital, so community services and hospital services need to be well-coordinated. However, in addition to aftercare, there should be a safety plan in place for patients, which is developed with the patient, and focuses on supporting them to identify resources for helping them to cope with subsequent suicidal crises," said Professor Keith Hawton, Director of the Centre for Suicide Research, University of Oxford.
The study is published in The Lancet Psychiatry journal.