Informing practice and policy to enhance the management of patients following a self-harm episode

People who have harmed themselves are at much higher risk of subsequently dying by suicide, and self-harm is among the commonest reasons for emergency department (ED) attendance.

Around 250,000 people a year receive hospital treatment after harming themselves. Clinical management of self-harm also varies considerably.

During the initial phase of the COVID-19 pandemic, far fewer people presented to healthcare services following a self-harm episode, as evidenced by a large population-based study that was conducted by our researchers.

We examine hospital ED databases via an ongoing multicentre investigation, in collaboration with the University of Oxford. We have also worked with nationally representative datasets such as the Clinical Practice Research Datalink, which links primary and secondary electronic health records with national mortality records.

Our research has directly informed the evidence-base for the management of self-harm and has led to improved services by:

• ensuring that patients receive a psychosocial assessment;
• enhancing access to psychological treatment;
• reducing reliance on risk assessments that have little predictive value.

Our research findings have influenced clinical practice by improving the overall quality of self-harm services. We have also shown that, although risk assessment tools are still utilised, they are now less frequently used in the absence of wider assessment, and that clinicians’ perceptions about their usage are becoming more evidence-based.

Our findings have also been translated into national policy, with 30 of our papers cited in the National Institute for Health and Care Excellence Self-harm guidelines (2004 and 2011). The National Suicide Prevention Strategy for England contains multiple references to our research.

Our work has also:

• directly informed the NHS England community programme;
• been incorporated in the Suicide Prevention Programme;
• informed a Commissioning for Quality and Innovation (CQUIN) health service target introduced in 2022.

Relevant publications

• Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study.
• Which are the most useful scales for predicting repeat self-harm? A systematic review evaluating risk scales using measures of diagnostic accuracy.
• Suicide risk assessment in UK mental health services: a national mixed-methods study.