Attitudes towards and satisfaction with services among deliberate self-harm patients: A systematic review of the literature

The Service Delivery and Organisation Programme is part of the National Institute for Health Research The main objective of this study is to systematically review the international literature on patients’ attitudes toward and satisfaction with health services (specifically physical management, in-hospital psychiatric management and post-discharge management) following deliberate self-harm (DSH), to inform the development of improved services. DSH is defined in this study as any intentional self-poisoning or self-injury, regardless of suicidal intent. This research summary outlines the main findings of a review of 31 studies from eight countries analysing attitudes towards and satisfaction with services among deliberate self-harm (DSH) patients. Sixteen of the studies draw on UK service users’ experiences; the remaining 15 reflect patient experiences in Ireland, North America, Australia, New Zealand, Finland, Sweden and the Netherlands. Quantitative data provide evidence about the general experiences of a larger population of DSH patients, while qualitative data are used to deepen our understanding by recounting specific examples and incidents. Findings are discussed in the context of government and professional recommendations regarding the management of DSH patients and recommendations for future research are made. The review was commissioned in 2007 by the NIHR Service Delivery and Organisation Programme (SDO) and carried out by a research team led by Professor Keith Hawton, Director of the Centre for Suicide Research at the University of Oxford, England. Target audiences will include NHS Mental Health Services and Trusts, NHS Primary Care Trusts, Regional Suicide Prevention Leads and members of the National Suicide Prevention Strategy Group, Royal College of Psychiatrists, MIND, SANE, ReThink, The Mental Health Foundation, Self-Harm Network and other services, including relevant websites.

[1]  Jennifer Harris.  Self-Harm: Cutting the Bad out of Me , 2000, Qualitative health research.

[2]  Rachel Jenkins,et al.  On the Prevention of Suicide , 1969, The Australian and New Zealand journal of psychiatry.

[3]  T. McCann,et al.  Accident and emergency nurses' attitudes towards patients who self-harm. , 2006, Accident and emergency nursing.

[4]  L. Appleby,et al.  Attitudes toward suicide prevention in front-line health staff. , 2001, Suicide & life-threatening behavior.

[5]  J. Carrigan.  The psychosocial needs of patients who have attempted suicide by overdose. , 1994, Journal of advanced nursing.

[6]  A. Norberg,et al.  The meaning of suicidal psychiatric in-patients' experiences of being cared for by mental health nurses. , 1999, Journal of advanced nursing.

[7]  C. Hopkins.  'But what about the really ill, poorly people?' (An ethnographic study into what it means to nurses on medical admissions units to have people who have harmed themselves as their patients). , 2002, Journal of psychiatric and mental health nursing.

[8]  P. Friedmann,et al.  Factors associated with older patients' satisfaction with care in an inner-city emergency department. , 2001, Annals of emergency medicine.

[9]  A. House,et al.  Psychosocial and pharmacological treatments for deliberate self harm , 2015 .

[10]  Lena Gunningberg,et al.  Patients' perceptions of quality of care at an emergency department and identification of areas for quality improvement. , 2006, Journal of clinical nursing.

[11]  C. Pitula,et al.  Suicidal inpatients' experience of constant observation. , 1996, Psychiatric services.

[12]  A. House,et al.  Effect of general hospital management on repeat episodes of deliberate self poisoning: cohort study , 2002, BMJ : British Medical Journal.

[13]  G. Currier,et al.  Consumer and Family Experiences in the Emergency Department Following a Suicide Attempt , 2006, Journal of psychiatric practice.

[14]  A. Patel,et al.  Effect of teaching on students' attitudes to self-poisoning. , 1975, British medical journal.

[15]  R. Dunleavey.  An adequate response to a cry for help? Parasuicide patients' perceptions of their nursing care. , 1992, Professional nurse.

[16]  T. Peters,et al.  Variations in the hospital management of self harm in adults in England: observational study , 2004, BMJ : British Medical Journal.

[17]  C. Pope,et al.  Assessing quality in qualitative research , 2000, BMJ : British Medical Journal.

[18]  N. Kreitman,et al.  Distress Behaviour: a Study of Selected Samaritan Clients and Parasuicides (‘Attempted Suicide’ Patients) , 1973, British Journal of Psychiatry.

[19]  J. Piacentini,et al.  Treatment adherence among Latina female adolescent suicide attempters. , 1999, Suicide & life-threatening behavior.

[20]  S. E. Smith.  Perceptions of service provision for clients who self-injure in the absence of expressed suicidal intent. , 2002, Journal of psychiatric and mental health nursing.

[21]  A. Norberg,et al.  The meaning of suicidal psychiatric inpatients' experiences of being treated by physicians. , 2001, Journal of advanced nursing.

[22]  C. Murray,et al.  Who helps? Supporting people who self-harm , 2002 .

[23]  J. Ballenger.  Does a brief training on suicide prevention among general hospital personnel impact their baseline attitudes towards suicidal behavior , 2009 .

[24]  J. Lönnqvist,et al.  Attempted suicide in Europe: rates, trend.S and sociodemographic characteristics of suicide attempters during the period 1989–1992. Results of the WHO/EURO Multicentre Study on Parasuicide , 1996, Acta psychiatrica Scandinavica.

[25]  R. Neimeyer,et al.  Personal and professional factors and suicide intervention skills. , 2001, Suicide & life-threatening behavior.

[26]  J. Lönnqvist,et al.  Patients’ evaluation of their psychiatric consultation after attempted suicide , 2004, Nordic journal of psychiatry.

[27]  K. Hawton,et al.  Deliberate self-harm in Oxford, 1990–2000: a time of change in patient characteristics , 2003, Psychological Medicine.

[28]  D. Wolk-Wasserman.  The intensive care unit and the suicide attempt patient , 1985, Acta psychiatrica Scandinavica.

[29]  E. Simonoff,et al.  Staff knowledge and attitudes towards deliberate self-harm in adolescents. , 2003, Journal of adolescence.

[30]  D. Duffy,et al.  The National Suicide Prevention Strategy for England , 2003 .

[31]  P Vostanis,et al.  Brief report. The overdose process-adolescents' experience of taking an overdose and their contact with services. , 1999, Journal of adolescence.

[32]  M. Åsberg,et al.  Shame reactions after suicide attempt. , 2003, Scandinavian journal of caring sciences.

[33]  C. Chew‐Graham,et al.  Randomised controlled trial of brief psychological intervention after deliberate self poisoning. , 2001, BMJ.

[34]  B. Kelly,et al.  From the emergency department to home. , 2005, Journal of clinical nursing.

[35]  K. Hawton,et al.  Adolescents who take overdoses: outcome in terms of changes in psychopathology and the adolescents' attitudes to care and to their overdose. , 1998, Journal of adolescence.

[36]  C. Pitula,et al.  Suicidal inpatients' perceptions of therapeutic and nontherapeutic aspects of constant observation. , 1999, Psychiatric services.

[37]  J. Williams,et al.  Psychology and suicidal behaviour: elaborating the entrapment model , 2005 .

[38]  S. Aoun,et al.  A consumer's perspective of a suicide intervention programme. , 2001, The Australian and New Zealand journal of mental health nursing.

[39]  A. Beautrais.  A case control study of suicide and attempted suicide in older adults. , 2002, Suicide & life-threatening behavior.

[40]  J. Evans,et al.  A national survey of the hospital services for the management of adult deliberate self-harm , 2001 .

[41]  P R Yarnold,et al.  Effects of actual waiting time, perceived waiting time, information delivery, and expressive quality on patient satisfaction in the emergency department. , 1996, Annals of emergency medicine.

[42]  Jonathan Karro,et al.  Patient perceptions of privacy infringements in an emergency department , 2005, Emergency medicine Australasia : EMA.

[43]  K. Hawton,et al.  Variations in time of hospital presentation for deliberate self-harm and their implications for clinical services. , 2007, Journal of affective disorders.

[44]  W. Hardyman,et al.  Using qualitative research in systematic reviews: Older people’s views of hospital discharge , 2006 .

[45]  A. Kerkhof,et al.  Evaluation of psychiatric consultations with suicide attempters , 1988, Acta psychiatrica Scandinavica.

[46]  Clare Griffiths,et al.  Leading causes of death in England and Wales--how should we group causes? , 2005, Health Statistics Quarterly.

[47]  M. Linehan,et al.  Cognitive-behavioral treatment of chronically parasuicidal borderline patients. , 1991, Archives of general psychiatry.

[48]  G. Carter,et al.  A model for the management of self‐poisoning , 1997, The Medical journal of Australia.

[49]  J. Benger,et al.  Patient satisfaction in emergency medicine , 2004, Emergency Medicine Journal.

[50]  I. Sakinofsky.  Repetition of Suicidal Behaviour , 2008 .

[51]  K. Hawton,et al.  The International Handbook of Suicide and Attempted Suicide , 2002 .

[52]  R. Fish,et al.  `Cutting Doesn't Make You Die' , 2002 .

[53]  J. Sinclair,et al.  Understanding resolution of deliberate self harm: qualitative interview study of patients' experiences , 2005, BMJ : British Medical Journal.

[54]  P. Dans.  The Use of Pejorative Terms to Describe Patients: “Dirtball” Revisited , 2002, Proceedings.

[55]  G. O'Brien,et al.  Deliberate Self-harm and Predictors of Out-patient Attendance , 1987, British Journal of Psychiatry.

[56]  J. Bancroft,et al.  Attitudes towards Self-Poisoning among Physicians and Nurses in a General Hospital , 1975, British Journal of Psychiatry.

[57]  S. Wessely,et al.  Does initial management affect the rate of repetition of deliberate self harm? Cohort study , 1998, BMJ.

[58]  M. Hume,et al.  Appropriate interventions for the prevention and management of self-harm: a qualitative exploration of service-users' views , 2007, BMC public health.

[59]  T. Peters,et al.  General practice based intervention to prevent repeat episodes of deliberate self harm: cluster randomised controlled trial , 2002, BMJ : British Medical Journal.

[60]  A. House,et al.  Involving users in the delivery and evaluation of mental health services: systematic review , 2002, BMJ : British Medical Journal.

[61]  K. Malone,et al.  Adolescents with suicidal behaviour: attendance at A&E and six month follow-up , 2004, Irish Journal of Psychological Medicine.

[62]  A. House,et al.  Self-harm in England: a tale of three cities , 2007, Social Psychiatry and Psychiatric Epidemiology.

[63]  A. Yung,et al.  Managing deliberate self-harm in young people: An evaluation of a training program developed for school welfare staff using a longitudinal research design , 2008, BMC psychiatry.

[64]  J. Piacentini,et al.  Enhancing treatment adherence with a specialized emergency room program for adolescent suicide attempters. , 1996, Journal of the American Academy of Child and Adolescent Psychiatry.

[65]  K. Hawton,et al.  Deliberate self-harm patients who leave the accident and emergency department without a psychiatric assessment: a neglected population at risk of suicide. , 2001, Journal of psychosomatic research.

[66]  S. Nada-Raja,et al.  A Population-Based Study of Help-Seeking for Self-Harm in Young Adults , 2003, The Australian and New Zealand journal of psychiatry.

[67]  N. Kreitman.  Reflections on the Management of Parasuicide , 1979, British Journal of Psychiatry.

[68]  Karen Rodham,et al.  Deliberate self harm in adolescents: self report survey in schools in England , 2002, BMJ : British Medical Journal.

[69]  Keith Hawton,et al.  Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital. , 2003, The British journal of psychiatry : the journal of mental science.

[70]  A. House,et al.  Assessment and management of self‐harm in older adults attending accident and emergency: a comparative cross‐sectional study , 2003, International journal of geriatric psychiatry.

[71]  M. Åsberg,et al.  Treatment of suicidal and deliberate self-harming patients with borderline personality disorder using dialectical behavioral therapy: the patients' and the therapists' perceptions. , 2003, Archives of psychiatric nursing.

[72]  D. Carson,et al.  Suicide prevention: A study of patients' views , 2003, British Journal of Psychiatry.

[73]  C. King,et al.  Suicidal adolescents after hospitalization: parent and family impacts on treatment follow-through. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.

[74]  A. House,et al.  Deliberate self harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition , 1998, BMJ.

[75]  A. House,et al.  Fatal and non-fatal repetition of self-harm , 2002, British Journal of Psychiatry.

[76]  D. Gath,et al.  Management of attempted suicide in Oxford. , 1979, British medical journal.

[77]  A. House,et al.  Management of deliberate self poisoning in adults in four teaching hospitals: descriptive study , 1998, BMJ.