Skip Page Header

Home > National clinical programme for the assessment and management of patients presenting to Emergency Departments following self-harm.

Health Service Executive; College of Psychiatrists. (2016) National clinical programme for the assessment and management of patients presenting to Emergency Departments following self-harm. Dublin: The National Clinical Programme for Mental Health Clinical Programme, HSE Clinical Strategy and Programmes Division.

PDF (Assessment and management of patients presenting to Emergency Departments following self-harm.) - Published Version

In 2014, more than 11,000 people came to Irish general hospital Emergency Departments following self-harm. From the National Self-Harm Registry Ireland, we know that up to 15% of patients who present following self-harm will leave the Emergency Department (ED) without a bio-psycho-social (BPS) assessment of risk and need, and that 17% of patients will repeat their self-harm act within 3 months (Griffin et al, 2015).

Self-harm is the single biggest risk factor for completed suicide, increasing the risk of suicide 40-fold, as compared to the general population (Owen et al, 2002; Carroll et al, 2014). Suicide is now the commonest cause of death for young men (aged 15-24 years) and middle aged men (45-54 years). Alcohol consumption is implicated in more than 37% of cases of self-harm (Griffin et al, 2015) and half of those who die by suicide have had a history of alcohol abuse in the final year of their lives (Arensman et al, 2013).

Diversity with regard to assessment procedures and management in health settings, as well as feedback from families bereaved by suicide, have led to repeated calls for the development and resourcing of an effective response for people who present to health services having engaged in self-harm.

The aim of this National Clinical Care Programme (NCP) for the Assessment and Management of Patients Presenting to Emergency Departments Following Self-harm is to develop a standardised and effective process for the assessment and management of individuals of all age ranges, including children, adolescents, adults and older adults, who present with self-harm to ED.

It refers to the mental health/bio-psycho-social assessment and initial management of both risk and need following self-harm, in the acute hospital Emergency Department, from time of presentation to discharge.

This NCP requires that all patients presenting to ED with self-harm (including suicidal ideation and intent) will receive standardised triage, bio-psycho-social assessment and assertive follow up by skilled clinicians.

Family/carers will be included in the assessment and follow up process. The quality of the programme will be monitored through a set of key metrics.

Training offered by this programme will ensure that patients and their families have access to clinicians with sufficient expertise to provide high-quality, evidence-based care and treatment. Critical to the success of this clinical programme will be the consolidation and further development of (and, in some areas, formation of) close working relationships between the ED clinical team, mental health liaison staff and community mental health teams (CMHTs) and General Practitioner (GP) services.

The objectives of this programme are to:

 Improve the assessment and management of all individuals who present to ED with self-harm

 Reduce rates of repeated self-harm

 Improve access to appropriate interventions at times of personal crisis

 Ensure rapid and timely linkage to appropriate follow-up care

 Optimise the experience of families and carers in trying to support those who present with self-harm.

Repository Staff Only: item control page