Article Text

Does the assessment of young people attending hospital with self harm meet national standards?
  1. V Rippon1,
  2. S Gough1,
  3. L Kilbey1,
  4. H Saddredini1,
  5. D Wood1,
  6. R Sands2
  1. 1Paediatrics, Nottingham University Hospitals NHS Trust, Nottingham, UK
  2. 2Paediatrics, Sherwood Forest Hospitals NHS Trust, Mansfield, UK


Aims To determine whether young people who self harm are being assessed according to national guidance.

Methods A multi-centre retrospective case note audit was undertaken of a random sample of young people (12-18 years) presenting during a six-month period (1st Jan 2010-July 31st 2010) with any form of self harm to a District General and tertiary Children's Hospital. Standards were derived from NICE guidance CG16: Self Harm and included a comprehensive risk and needs assessments, admission rates and waiting times for mental health assessment.

Results 167 episodes (in 160 young people) of self harm were audited - 57% resulted in admission and most patients were female (79%). Mean age was 15.3 years (12-18) with 79 episodes in patients under 16 years.

Self poisoning (77%) was the most common method, with cutting seen less often (14%) and both methods were documented in <1%. Presentation was delayed in 13% and 10% required medical treatment. Nearly half had self harmed previously and 15% had known mental health problems, whilst 11% had a forensic history.

Information about substance use, smoking and education status was rarely recorded and 35% did not have a past medical or social history recorded. Evidence of planning and future intent to self harm was not documented in 12% and 17% of patient episodes respectively. Four young people were assessed as presenting a significant risk to themselves or others. Of those not admitted, 7 were under 16 years with only two being offered admission.

69% of those admitted were seen within 24 hours by mental health services, compared with 61% of those discharged. Waiting times were not clear in 14%, and 16% of patients were not referred for a full mental health assessment.

Conclusions The audit shows the assessment of young people with self harm is not meeting national standards. Documentation of adolescent psychosocial factors was often incomplete and not all young people under 16 years were offered admission. Assessment by mental health services was often delayed beyond recommended timescales, and in a small but significant number no referral was made.

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