Making a difference through doing research is really important to us and in order to do this we need to publish our research! We know that many members of the general public don’t tend to read scientific papers, so we made this paper more accessible by creating a video. Alternatively you can read the blog post below the video. 😀

Experiences of care for self-harm in the emergency department. 

In the first research paper we looked at experiences of receiving or delivering care in emergency departments for self-harm. This is really important because each year, 220 000 episodes of self-harm are managed by emergency departments in England. These people at risk of suicide. Receiving the right care can save lives.  

We used both one-to-one interviews and discussion groups to find out about people’s experiences. We included the experiences of 79 people – 19 people who had self-harmed (including 7 young people and 12 adults), 8 carers, 37 mental health professionals who work in the emergency department (ED) and 15 medical staff working in the main  ED. We used an approach specially designed to compare the views of different stakeholder groups (called framework analysis) to analyse the data.  

Everyone agreed that people who self-harm are being failed by the wider system. People who self-harm are frequently excluded from services and so typically can only access crisis support. This can mean that they become stuck in unhelpful cycles of repeatedly attending the emergency department as there is no other support from services available to them. Carers told us that they felt ill-equipped to keep the person safe and like there was a lot of responsibility falling on them.  

We found that there are unhelpful cycles which can make everyone feel stuck and helpless. Practitioners working in emergency departments with people who self-harm feel powerless to really help. Finding this experience very difficult to cope with, they become hardened to patients. This leads to patients feeling judged for seeking help. Feeling judged exacerbates their distress.  

At the same time, patients need a human connection to offer hope when life feels hopeless, but practitioners underestimate the power of helpful conversations. In addition, practitioners are fearful of blame if someone takes their life and use formulaic question-and-answer risk assessments which feels safer than trying to have a human connection. For patients, the formulaic questions get in the way of the conversation feeling like there is a human connection. The formulaic questions also do not necessarily generate a valid assessment of patient’s risk or their needs.  

To improve this situation it’s really important that staff build a human connection with patients and validate their distress. This offers hope when life feels hopeless – this is what patients value most leaving the ED. Services must also offer specialist, evidence-based approach for helping people to stop or reduce self-harm. 

You can find more information using the link below.  

O’Keeffe, S., Suzuki, M., Ryan, M., Hunter, J., & McCabe, R. (2021). Experiences of care for self-harm in the Emergency Department: a comparison of perspectives of patients, carers and practitioners. BJPsych Open, 7(5), e175. https://doi.org/10.1192/bjo.2021.1006