Psychosocial assessment following self-harm: repetition of nonfatal self-harm after assessment by psychiatrists or mental health nurses.

BACKGROUND

Patients admitted to hospital because of self-harm should receive psychosocial assessment before discharge. In practice many of these assessments in the United Kingdom and elsewhere are undertaken by trainee rather than specialist psychiatrists.

AIMS

To compare psychosocial assessments, aftercare, and the pattern of non-fatal repetition for patients admitted to general hospital after self-harm: comparing assessments carried out by trainee psychiatrists, allocated to the task alongside other duties on a roster, or by mental health nurses with a designated role in self-harm services.

METHODS

Arrangements for aftercare and rates of non-fatal repetition of self-harm in 787 consecutive psychosocial assessments in a large UK city were compared, according to whether the assessments were carried out by trainee psychiatrists or mental health nurses.

RESULTS

Compared with nurses, psychiatrists were much more likely to arrange psychiatric admission or outpatient follow-up. Nurses more often pointed people towards voluntary sector help - such as drug, alcohol or relationship counselling. Repetition of self-harm was equally common among those assessed by nurses or psychiatrists (33%; hazard ratio 0.93, 95% confidence interval 0.71 to 1.2).

CONCLUSIONS

Despite making fewer aftercare arrangements that involved statutory mental health care services, psychosocial assessment by mental health nurses showed no sign of detrimental effects on repetition of self-harm.