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Care gaps among people presenting to the hospital following self-harm: observational study of three emergency departments in England

Steeg, Sarah; Bickley, Harriet; Clements, Caroline; Quinlivan, Leah M; Barlow, Steven; Monaghan, Elizabeth; Naylor, Fiona; Smith, Jonathan; Mughal, Faraz; Robinson, Catherine; Gnani, Shamini; Kapur, Navneet

Authors

Sarah Steeg

Harriet Bickley

Caroline Clements

Leah M Quinlivan

Steven Barlow

Elizabeth Monaghan

Fiona Naylor

Jonathan Smith

Catherine Robinson

Shamini Gnani

Navneet Kapur



Abstract

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.

Citation

Steeg, S., Bickley, H., Clements, C., Quinlivan, L. M., Barlow, S., Monaghan, E., …Kapur, N. (2024). Care gaps among people presenting to the hospital following self-harm: observational study of three emergency departments in England. BMJ Open, 14(10), https://doi.org/10.1136/bmjopen-2024-085672

Journal Article Type Article
Acceptance Date Aug 30, 2024
Online Publication Date Oct 22, 2024
Publication Date Oct 22, 2024
Deposit Date Nov 11, 2024
Publicly Available Date Nov 11, 2024
Journal BMJ Open
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 14
Issue 10
DOI https://doi.org/10.1136/bmjopen-2024-085672
Keywords Psychosocial Intervention, MENTAL HEALTH, Suicide & self-harm, Emergency Departments, Patients, PUBLIC HEALTH
Public URL https://keele-repository.worktribe.com/output/974298
Publisher URL https://bmjopen.bmj.com/content/14/10/e085672

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Licence
https://creativecommons.org/licenses/by/4.0/

Publisher Licence URL
https://creativecommons.org/licenses/by/4.0/

Copyright Statement
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.






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