GENERAL PRACTITIONERS AND ANTE-NATAL WORK
Authors: H. L. Cronk
Journal: BMJ (1931)

<h3>Background</h3> Hospital management of self-harm is an essential component of suicide prevention. Patients presenting to hospital for self-harm involving highly lethal methods or with high suicidal intent are a subgroup of self-harm patients at high risk of suicide. Investigating healthcare service provision from the patients‘ perspective is integral to the design and implementation of better quality care. The current study explored patients’ experiences of engaging with healthcare services after a high risk self-harm presentation to hospital. <h3>Methods</h3> A sequential transformative mixed-methods design was used. Quantitative information was obtained by interview administered questionnaires (including internationally validated scales, closed and open-ended questions) 0–3 months following a high risk self-harm presentation to a hospital emergency department (n=67). Semi-structured follow-up interviews were conducted 6–9 months later providing qualitative data (n=31). Follow-up interviews were recorded, transcribed and thematically analysed using NVivo software. Quantitative information was analysed in SPSS Version 25. Both methodologies were integrated during the interpretation of the results. <h3>Results</h3> After the self-harm presentation, 85.7% of patients reported receiving follow-up care with public outpatient mental health services and 61.8% attended their general practitioner for mental health related concerns. Satisfaction with follow-up care was dependant on participants’ relationships with healthcare professionals and their perception of the continuity and comprehensiveness of care they received. Positive experiences of care included <i>‘compassionate and supportive relationships’</i>, <i>‘timely and comprehensive follow-up care’</i> and ‘<i>inpatient care as a safe haven’.</i> The establishment of trust in the services encouraged <i>‘seeking help in crisis’</i> and <i>‘acceptance of and adherence to psychotropic medication’</i>. Conversely, themes reflecting negative experiences of care included <i>‘superficial and unsupportive relationships’</i> and <i>‘care lacking continuity and comprehensiveness’</i> leaving some participants feeling isolated and unsupported. Unsupportive experiences within the services contributed to ‘<i>inhibited help-seeking’</i> and <i>‘reluctance or lack of adherence to psychotropic medication’</i>. Participants with a history of self-harm and those with recent engagement with mental health services prior to the self-harm episode were more likely to report dissatisfaction with their interactions with healthcare professionals and with the level of care provided. Furthermore, those who described unsupportive or unsatisfactory care more frequently reported repeated self-harm, increased alcohol misuse and hopelessness for the future at follow-up. <h3>Conclusion</h3> The study findings indicate that satisfaction with services, help-seeking and adherence to treatment may be improved by ensuring the consistent provision of timely, comprehensive and supportive aftercare following a high risk self-harm presentation. Absence of these aspects of care may contribute to ongoing distress and further suicidal behaviour.