Supporting people with appropriate care in the critical days and weeks after an emergency presentation for self-harm remains an untapped opportunity to reduce the risk of further self-harm and suicide, newly published research from Orygen has found.
The study, which focused on the care received by 4,668 people who presented to the Royal Melbourne Hospital Emergency Department (ED) for self-harm between 2012-2019, found that for 69 per cent of people, their pattern of healthcare use remained largely unchanged after their emergency presentation.
Despite the heightened risk represented by the crisis presentation, after their ED visit:
- Most people had no substantive change in the types of healthcare service they received;
- 1 in 5 people had no treatment contacts in the following 28 days;
- 1 in 8 had no healthcare contacts in the year after their self-harm presentation.
Lead author from Orygen, Associate Professor Katrina Witt, said this was important because it suggested that an at-risk group were not always provided with the support that they needed after a crisis.
“We know that there’s a critical intervention window for the 12 months after discharge, so these ED presentations offer a vital opportunity to identify those at risk and change the course of their care, and ultimately their lives,” A/Prof. Witt said.
“It’s not just specialist mental health support that’s important after an acute episode of self-harm, it’s also things like alcohol and other drug (AOD) services, GPs, pharmacists and physical health services – and we need coordination between these services to ensure they’re meeting a person’s specific needs.
“What our research shows is that acute responses to self-harm crises appear short-lived, which means that these emergency presentations often don’t lead to meaningful changes in peoples’ care long-term – which is a major missed opportunity.”
The study looked at two key periods after an emergency presentation – the 28 days after an ED visit, and the following 12 months.
Results showed a small sub-group were provided with care from specialist mental health services after an episode of self-harm, but remained at high suicide risk, while one-in-ten remained disengaged from health services altogether.
A/Prof. Witt said that integrated, community-based care was vital to improve sustained, evidence-based support beyond acute self-harm crises.
“As rates of self-harm and suicide continue to rise, we need to find new ways to intervene earlier – and ensure people get the appropriate support for their particular situation,” A/Prof. Witt said.
“This might mean co-locating services within community healthcare settings, or ensuring those at high risk are referred to specialist mental health care providers – and, importantly, are proactively followed-up in the weeks and months after their visit to the ED.
“Introducing cross-sector care coordinators could also help address fragmentation across health care sectors, providing people with a central point of contact and potentially supporting better engagement across different services and, ultimately, better rates of recovery.”