Hospital care for self-harm patients linked to higher risk of death, says Man Uni study

Hospital care for self-harm patients has been linked to a higher risk of death, in particular admission to a psychiatric bed, in a University of Manchester study.

For the first time ever, an investigation into the connection between the treatments self-harm patients receive in hospital and their subsequent risk of death has been carried out by the university.

Cases involving adults, who had self-harmed and attended five hospital emergency departments in Manchester, Oxford and Derby between 2000 and 2010, were researched.

It was found that within 12 months, 261 had died by suicide and a further 832 had died from other causes.

Professor Nav Kapur from The University of Manchester and Manchester Mental Health and Social Care Trust led the study.

He said: “Clearly we need to do more to find out what works following self-harm and how it works.

“Attendance at hospital represents an opportunity for services to address underlying issues such as mental health problems, difficult life circumstances, and alcohol use which contribute to self-harm.”

Once admitted to hospital there are a number of treatments self-harm patients receive, including assessment by a mental health specialist, admission to medical or psychiatric beds and referral to a specialist community team.

The findings showed that most types of management were associated with higher risk of death and the highest risks were associated with admission to a psychiatric bed.

Mr Kapur said: “Hospitals have a number of strategies to use when people attend with self-harm, but no one has looked at the association of these with mortality risk on a large scale before.

“We need to be clear that these findings indicating higher risk of death do not mean these treatments are harmful – instead it looks like health services are reserving the most intensive treatments for the patients at greatest need.”

Different characteristics of people receiving different forms of treatment, and possible effects of the treatments, were also looked at during the university’s research.

They found that particular interventions might have greater effects in particular groups of patients.

For example, psychiatric admission may have had a greater effect on reducing deaths among men, those aged 65 and over, and those who had self-harmed previously.

Mr Kapur added: “Our research suggests routine aspects of care can be really helpful – doing the simple things well could improve services for patients and may ultimately reduce the number of deaths.”

The research was carried out as part of the Multicentre Study of Self-harm in England which is a collaborative study between the Universities of Oxford, Manchester and Nottingham, and Derbyshire Healthcare NHS Foundation Trust. 

The work was funded by the UK Department of Health.

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