Life Matters: Management of Deliberate Self Harm in Young People
Report No 11 - November 2001
Background
Youth suicide has been on the
increase worldwide since the early 1950s. In most countries suicide is
one of the three major causes of death in the 15-24 year age group. In
Australia the number of deaths by suicide is approaching the number of
deaths from motor vehicle accidents.
Deliberate self-harm, which includes
attempted suicide, is a predictor of death by suicide with the greatest
risk being in the initial weeks after discharge from hospital.
Growing community concern over
the increasing incidence of suicide and deliberate self-harm in young
people prompted State and Federal Governments to implement a variety of
suicide prevention initiatives.
As part of these initiatives,
Guidelines were issued in June 2000 by the Australasian College for Emergency
Medicine and the Royal Australian and New Zealand College of Psychiatrists
to provide a framework for the management of deliberate self-harm within
Emergency Departments and for linkages to on-going care in the community
and focusing on care and treatment of patients.
What the examination found...
- Only 3 out of every 4 of the reviewed files indicated an adequate
level of service provided to deliberate self-harming young people in
Emergency Departments.
- Deliberate self-harm patients are not always treated with the appropriate
level of urgency, wait longer for treatment than other patients with
similar levels of medical need, and do not always receive an appropriate
psychiatric assessment.
- Opportunities for patients to 'slip through the gaps' occur at a number
of points throughout the patient's care, particularly during the waiting
periods and transition between services.
- The Guidelines have not been uniformly distributed and implemented
across the health system.
- Duty of care for the patient during the period between leaving the
hospital and accessing support and treatment in the community is unclear.
- Waiting times for accessing community-based services by deliberate
self-harm patients can be excessive.
- Community-based mental health services have limited capacity to assertively
maintain engagement with at-risk clients.
- Little or no summary information is collated and used by community-based
mental health services to assist in identifying and addressing specific
issues in relation to the management of deliberate self-harm in young
people.
- The Department of Health is not systematically monitoring or evaluating
the achievement of strategies outlined in the Mental Health Plan for
Western Australia.
- No clear responsibilities for outcomes in relation to youth suicide
prevention have been assigned, no priorities articulated and no review
process set in place.
- The Ministerial Council for Suicide Prevention (MCSP) is an advisory
committee that is effective in facilitating inter-agency co-ordination.
What the examination recommended...
Major recommendations made in the report are that:
- The Department of Health should endorse the Guidelines for the Management
of Deliberate Self-Harm in Young People and ensure their implementation
across the Western Australian health system.
- The Department of Health should, in consultation with community mental
health clinics, develop and implement minimum service specifications,
for example, in relation to after-care planning, timely follow-up treatment
and assertive follow-up where a client does not attend an appointment.
- Hospitals should develop and implement local strategies for providing
effective care for managing deliberate self-harm patients in accordance
with the Guidelines. These local strategies should be set out in a detailed
action plan
- Hospitals and community mental health services should develop local
protocols for timely referral of patients to care in the community,
timely transmission of relevant details and effective collaboration
and coordination between hospitals, community based services and other
relevant local groups.
- Community mental health services should ensure that adequate management
information is available and utilised to improve service delivery.
- State strategies for suicide prevention need to be regularly reviewed
and evaluated and progress on achievements publicised via a regular
reporting mechanism.
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