Conference: Psychosocial assessment following self-harm
Important new guidance for assessing patients following self-harm was launched in a special conference in Oxford last week.
Funded by the 2019 NHS England Trailblazer initiative and organised by Oxford Health NHS Foundation Trust along with University of Oxford’s Centre for Suicide Research, the conference brought together more than 100 clinicians, researchers and experts by experience to discuss various aspects of psychosocial assessment of people who present to services having self-harmed.
Psychosocial assessment at that point is important because it can provide a crucial opportunity for an individual in a crisis to share their problems with a mental health professional and be offered aftercare. Research, however, shows a great variation across the UK in whether such an assessment is offered and how it is conducted.
The newly launched resource Psychosocial assessment following self-harm: A clinician’s guide aims to help clinicians conduct full and effective psychosocial assessments that can help individuals who have self-harmed – and in some cases to save lives.
The guide has been co-authored by nurse consultant Karen Lascelles, psychiatric liaison, research nurse Fiona Brand and Professor Keith Hawton, Director of the Oxford Centre for Suicide Research. You can access the guide here.
It is a fitting milestone in the pioneering work that Karen, Prof Hawton and others have been doing in suicide prevention, and Prof Hawton acknowledged as much in his opening address to the conference.
“Congratulations to Karen for her great work and also to the designer Steve Messer. There will soon be an online version of the guide which will include videos of people role-playing certain components of the psychosocial assessment. This will be an excellent training tool for both new and experienced staff and anyone involved in assessing people following self-harm,” he said.
“It is quite appropriate that this guide has been produced in Oxford where a large part of our research has been helped by clinicians. They have made a major contribution to our knowledge over many decades.”
The one-day conference at Unipart had a comprehensive programme that looked at:
- Psychosocial assessment in the Emergency Department – recent research and experiences from a patient and a carer
- The new NICE guidelines for self-harm – available here
- Brief Interventions following self-harm
- Where do patients source paracetamol for overdose?
- Self-Harm by nurses and midwives
- Suicide risk assessment – in light recent research and lived experience
- The impact of the death of a patient by suicide on staff
In the morning session the delegates heard from Dr Leah Quinlivan about her research which looked at provision and experiences of psychosocial assessment, and Professor Nav Kapur who presented the new NICE Guidance and emphasised the importance of the therapeutic and collaborative relationship.
Insights from patients and carers
Peer support worker Linda Thomson and Andy Watson from Bucks Carers Group shared their experiences of attending the A&E following self-harm. The message they gave loud and clear, and which is supported by research, is: what people most value, whether a patient or a carer, is having the time to talk and be listened to with dignity, compassion and empathy by a skilled and non-judgemental clinician.
Linda Thomson said:
“I’ve had many bad experiences which made me feel worthless. I was asked ‘can you not just sort yourself out?’ or I wasn’t taken seriously, or I was asked the same questions over and over again by someone who had not read my notes.
“It all changed when one nurse said: “I do care.” I didn’t believe her and said you are here just for your wages. But she said: I care about you. I wouldn’t be in this job if I didn’t care.” That was the human contact I needed. And I am still here, and I don’t self-harm anymore.”
Andy Watson gave a poignant testimony of a carer’s perspective, in particular how alone the carer can feel in the crisis situation.
“I remember being past the breaking point and called the team: Help! And the chap in the crisis team said: ‘You are not the patient.’ And you just want someone to hold your hand and see how you are.”
The contribution from people with lived experience continued in the afternoon, with Julie Cooper, Oxford Health experience and involvement facilitator, sharing a powerful and creative film describing her experiences of suicidal crises, and Philip Pirie, suicide prevention campaigner, drawing on the devastating loss of his son to suicide.
Each of the day’s sessions were followed by lively panel discussions. In the picture on the top from left: Andy Watson, Linda Thomson, Keith Hawton and Karen Lascelles.
Babita Khunkhun, service lead in the liaison team at Berkshire Healthcare, commented on the conference:
“I wish I could bring my whole team here! They do a really good job, but even so I would like them to hear what it is like for patients and carers.”
Nurse consultant Karen Lascelles said:
“Today is about giving clinicians guidance and important messages to help them carry out meaningful psychosocial assessments with people following self-harm, be that in the emergency department or other settings. Hearing from individuals with lived experience is instrumental to conveying these messages and we are very fortunate to have had such rich experiential involvement at this conference.
“Of course, we need to attend to clinicians’ lived experience as well and we were able to share some of our research on how the tragic death of a patient by suicide can affect staff, both professionally and personally. We gave all delegates a copy of a resource we developed for psychiatrists, which can be accessed here. An adapted version for all mental health professionals will be launched shortly.”
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Published: 8 November 2022