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Improving Care in Self-Harm HIT review of 2015-16

12 May 2016

Salena Williams, Director of the Improving Care in Self-Harm Health Integration Team (STITCH HIT) gives an update on the HIT's activities in 2015-16.

The Improving Care in Self-Harm (STITCH) HIT is working to reduce the number of suicides in the Bristol area, by transforming understanding of self-harm across the health service and improving treatment and support for self-harm patients. Self-harm is a growing problem for the NHS, with around 200,000 emergency cases reported nationally every year. It is the highest predictor of suicide, with self-harm patients 35 times more likely to end their own lives.

The self-harm surveillance register is the backbone of our data-collection in Bristol. It started at the Bristol Royal Infirmary (BRI) and we now have five years’ data from the hospital, so we can see the effect of service changes over time.

Two-thirds of people who self-harm presenting at A&E now receive a psychosocial assessment, compared to just over half in 2011. This is because of training staff to recognise self-harm and to offer an assessment, and extending the Psychiatric Liaison Team’s operating hours. We made these changes because having an assessment leads to better outcomes for patients, and 80 per cent of patients attended A&E outside the team’s core hours. The BRI has created an emergency department staff training package on a rolling six-month programme. University Hospitals Bristol is now working with other trusts across the south west to standardise self-harm training for emergency department staff, and is broadening its own delivery across the Bristol, North Somerset and South Gloucestershire area.

In 2013, the register was extended to Frenchay Hospital and Bristol Children’s Hospital. This helps share good practice and create age-appropriate assessment tools and treatments, particularly for children. There was some disruption to data collection during the transfer of the emergency department at Frenchay to Southmead Hospital, but data is again being collected and analysed.

We have found that average hospital length of stay for patients admitted to the BRI following self-harm has reduced from 3.1 days in 2011 to 2.1 days in 2014. People who attend A&E more than once are offered an enhanced personal support plan. This means staff have immediate access to the information they need, so they can see and treat patients more quickly.

Bristol self-harm patients contributed to new research that shows that consulting the internet, particularly about suicide methods rather than searches for help, is a strong indicator of the severity of suicidal intent and the likelihood of subsequent completed suicide. The psychosocial assessment already includes questions about internet use and these will now be refined to take account of the motive for these searches. The close working relationship between researchers and practitioners that our HIT promotes allows such changes to be quickly evidenced and implemented.

Improving Care in Self-Harm HIT review of 2015-16
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