News Archive

A project ensuring that patients who present to emergency departments with deliberate self-harm receive rapid follow-up care was launched last month.

The system links the post-discharge care of the patients to the resources of the GP-based Perth Primary Care Network (PPCN), which will offer follow-up and ongoing support to all patients, with contact occurring within three days of discharge.

The service follows the consumer from hospital to GP and enhances communication and shared care. The project is an initiative of the North Metropolitan Area Mental Health Services’ new Clinical Applications Unit (CAU), based at the Faculty’s Centre for Clinical Research in Neuropsychiatry.

It was prompted by the fact that deliberate self-harm is a significant problem which would benefit from additional care pathways. Between 1970 and 1996, there were 33,321 hospital admissions in WA for a self-inflicted injury. This translates to more than 1,000 admissions every year, on average.

There are also about 11 hospitalisations for deliberate self-harm for every death by suicide. Effective follow-up can reduce the number of deaths and re-presentations and ensure that people who deliberately self-harm receive the help they need to recover.

CAU director Dr Daniel Rock said the project was not about re-inventing the wheel.

“Patients can be best managed by the most appropriate existing services, with various feedback mechanisms built into the clinical pathway to minimise the number of individuals lost to follow-up,” he said.

Other hospitals using a similar approach have demonstrated its cost-effectiveness. A pilot program for the integrated management of self-poisoning in the Hunter region of NSW reduced average length of stay by about one day to about 3.5 days, saving 1470 bed-days each year.

Ms Gayle Corbould, Senior Project Officer at CAU, said knowing there would be community-based follow-up could reduce the feeling of frustration and impotence experienced by many general hospital staff when dealing with deliberate self-harm presentations.

“Care coordination for deliberate self-harm is a more efficient use of existing resources,” she said. “It can reduce admissions to inpatient care from the emergency department and prevent readmissions and re-presentations.

“It will also provide more consumers with better access to the most appropriate services after discharge.”

CAU decided to tackle the problem head-on by first undertaking an audit of the pathways of care offered to people who deliberately self-harmed and who were subsequently discharged from the ED at Sir Charles Gairdner Hospital.

Ms Corbould met representatives from the Ministerial Council on Suicide Prevention and the Coroner’s Office and held discussions with the hospital GP liaison officer and members of the ED mental health team, which highlighted gaps in care for people who deliberately self-harm.

She said talks with people who use mental health services at the public Consumer Mental Health Forum held in November last year also offered valuable insights.

Ms Corbould, who has worked as a social worker in SCGH’s ED, helped with the first hospital audits on deliberate self-harm and suicide attempts presenting at the ED.

The audits enabled the hospital to develop a service specifically targeting young people presenting with deliberate self-harm. Later, this expanded to include all deliberate self-harm presentations and indicated a need to develop risk-assessment and problem-solving interventions.

In collaboration with the Royal Perth Hospital ED mental health team, CAU trialled a system to record all mental health presentations to the ED. The plan now is that RPH and SCGH EDs will uniformly record data that will capture the characteristics of this group of patients, especially those who re-present.