40% of self-harm patients leave A&E without mental health assessment, study finds

Four in 10 people who present to A&E departments after self-harming are discharged without receiving the specialist mental health assessment recommended in national care guidelines, a study has found.

In parts of the country less than a quarter of self-harming patients (22%) attending A&E were assessed by specialist mental health professionals before leaving hospital, researchers at the University of Manchester found. In other areas, 88% of patients received the assessments, which official guidelines state should be given to all people who self-harm.

The variation in assessments impacts follow-up patient care, the study found. Almost half of the patients (45%) who were assessed by specialist mental health professionals received follow-up support from services like community mental health teams or crisis teams. However, in cases where no assessment was carried out only 13% of patients received follow-up care.

The study, published in the BMJ Open journal, analysed treatment provided to 6,000 patients by 32 NHS hospitals in 2010/11 and compared the findings to a similar study in 2001/02. Researchers concluded that – while some indicators of care quality had improved in the 10-year period between the two studies – official guidelines introduced in the 2000s have had “little impact” on addressing widespread variation in the way hospitals respond to self-harm cases.

Professor Nav Kapur, the study’s lead author for the study and an advisor on national guidance for self-harm, wrote: “This is important because the management patients receive in hospital (particular the provision of psychosocial assessments) is associated with follow-up care and may well have an impact on patient outcomes”.

Patients had to wait an average of 11 hours for a specialist assessment. In 15% of cases patients had refused assessments or walked out before receiving them. However, the study also found that some hospitals had stopped offering private rooms where professionals could conduct assessments and no longer allowed patients to wait in hospital beds until a specialist assessment could take place.

The percentage of people offered follow-up care had fallen by 13% compared to 2001 levels, the study found. The drop could reflect pressures on mental health services or constraints on referrals due to government recommendations for community mental health teams to “focus on the severely mentally ill”, researchers said.

The frequency with which people were admitted for inpatient care after self-harming varied widely in 2010/11, the study found. In one hospital here there were no admissions, whereas in another hospital one in five episodes resulted in the patient being admitted to a psychiatric ward.

Some aspects of service quality had improved since 2001, the study found. Most hospitals now had a designated self-harm service, more hospitals had formal arrangements with social services in place to offer advice to self-harm patients and improvements had been made in supervision arrangements in place for staff members who undertook psychosocial assessments.