Improved Support Following Self-Harm Needed to Reduce Suicide Risk

Research has revealed a need for early follow-up care and support when leaving hospital after self-harm

Results from an observational study spanning 16 years have today been published in The Lancet Psychiatry journal. Looking at nearly 50,000 patients aged 15 and older from across five English hospitals, the study has revealed that improved clinical management is needed for all patients to reduce the high risk of suicide following a hospital visit for self-harm.

Research suggests that, to reduce the high risk of suicide after leaving hospital for self-harm, a comprehensive assessment of the individual’s mental state, needs, and risks are needed. Further implementation of risk reduction strategies, including safety planning may also be necessary.

Dr Galit Geulayov, from the Centre for Suicide Research at Oxford University and study author said:

“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.”

New. Suicide following presentation to hospital for non-fatal self-harm in the Multicentre Study of Self-harm: a long-term follow-up study. https://t.co/cOetaKcsbq

— The Lancet Psychiatry (@TheLancetPsych) November 6, 2019

An estimated 200,000 people go to hospital emergency departments across England each year following acts of self-harm. While not all instances of self-harm are an indication of suicidal thoughts, around 50% of those who attempt suicide have a history of self-harm, with many attending hospital for self-harm shortly before they complete suicide.

During the study’s 16 year follow-up with patients, 703 (1.4%) died by suicide. Approximately a third (36%) of these deaths happened within a year of the patient attending hospital for self-harm, with the study confirming the high risk of suicide in the first year following attendance at hospital for self-harm.

Researchers revealed that individuals were most at risk during the first month following discharge from the hospital. 74 of the 703 patients who went on to complete suicide (10.5%) did so within a month of leaving hospital.

The study went on to reveal that men were found to be more likely to die by suicide after attending hospital for self-harm, as were those who sought help from hospitals following more than one non-fatal self-harm incident.

Professor Hawton from Oxford University’s Centre for Suicide Research said, “While awareness of characteristics which increase the risk of subsequent suicide can assist as part of this assessment, previous studies indicate that individual factors related to self-harm are a poor means to evaluate the risk of future suicide. These factors need to be considered together, followed by risk reduction strategies, including safety planning, for all patients.”

Earlier this year, the NHS came under fire as it was revealed mental health patients at risk of suicide were being discharged without adequate support. Some patients with complex mental health problems were being discharged from NHS care, without any support in the community awaiting them. Patients reported feeling powerless, saying they had experienced a decline in their mental health and faith in the services following their experiences.

Whilst there has been an increasing number of calls for us to open up the conversation surrounding mental health, self-harm and suicide, with social media platforms starting to do more to offer support to those seeking out distressing content and more individuals speaking out and sharing their own experiences publically, the figures we are seeing are still grim.

In September 2019, it was revealed that UK suicide rates are at their highest levels since the early 00s. One in eight of us is experiencing suicidal feelings over body image concerns, while concerns around student mental health and suicide rates remain at an all-time high.

Public and media efforts to speak openly, candidly and, most importantly, responsibly about suicide prevention, self-harm, and suicidal thoughts are only the first steps towards creating a safe space where people can feel able to seek vital help and support. Signposting support and consistently providing help throughout the UK is needed to ensure vulnerable individuals are receiving access and information to the treatment and assistance they need.

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If you or a loved one are experiencing distressing thoughts, it’s important to speak up. Help and support are available. If you are finding it difficult to speak with loved ones, call your GP to make an emergency appointment. Or, if it is outside of hours, call 111 to find help and support.

If you are worried about your immediate health and safety, call 999 or go straight to your local A&E. For more information on where you can find help, visit the NHS website.

If you need someone to talk to, Samaritans are available to listen, judgement-free, 24/7. Call them anytime day or night, free of charge on 116 123, write an email to [email protected], or visit their website, Samaritans.org to find out more.

To find out more about suicidal thoughts and how counselling can help, visit Counselling Directory to find an experienced psychotherapist near you.