RT Journal Article
SR Electronic
T1 Care gaps among people presenting to the hospital following self-harm: observational study of three emergency departments in England
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e085672
DO 10.1136/bmjopen-2024-085672
VO 14
IS 10
A1 Steeg, Sarah
A1 Bickley, Harriet
A1 Clements, Caroline
A1 Quinlivan, Leah M
A1 Barlow, Steven
A1 Monaghan, Elizabeth
A1 Naylor, Fiona
A1 Smith, Jonathan
A1 Mughal, Faraz
A1 Robinson, Catherine
A1 Gnani, Shamini
A1 Kapur, Navneet
YR 2024
UL http://bmjopen.bmj.com/content/14/10/e085672.abstract
AB Objectives This study aims to examine the proportions of patients referred to mental health, social and voluntary, community and social enterprise (VCSE) services and general practice and to assess care gaps among people presenting to the hospital following self-harm.Design Population-based observational study. Data were extracted from hospital records.Setting Three emergency departments (EDs) in Manchester, UK.Participants 26 090 patients aged 15+ years who presented to participating EDs following self-harm and who received a psychosocial assessment by a mental health specialist.Primary and secondary outcome measures Primary outcome measures are as follows: care gaps, estimated from the proportion of patients with evidence of social and mental health needs with no new or active referral to mental health, social and VCSE services. Secondary outcome measures are as follows: proportions of referrals by groups of patients, estimated mental health and social needs of patients. Indicators of mental health and social need were developed with academic clinicians (psychiatrist, general practitioner and social worker) and expert lived experience contributors.Results 96.2% (25 893/26 909) of individuals were estimated as having mental health needs. Among this group, 29.9% (6503/21 719) had no new or active referral to mental health services (indicating a care gap). Mental healthcare gaps were greater in men and those who were aged under 35 years, from a black, South Asian or Chinese ethnic group, living in the most deprived areas and had no mental health diagnosis, or alcohol, substance misuse, anxiety or trauma-related disorder. 52.8% (14 219/26 909) had social needs, with care gaps greater for men, individuals aged 45–64 and those who were unemployed or had a diagnosed mental disorder.Conclusions Care gaps were higher among hospital-presenting groups known to have increased risks of suicide: men, those in middle age, unemployed individuals and those misusing substances. Improved access to mental health, social and VCSE services and general practice care is vital to reduce inequities in access to self-harm aftercare.No data are available. The code used to analyse data are available from the lead study author on request.