Self-harm and accident and emergency (A & E)

Abstract

Background: Self-harm is a major worldwide concern and research has demonstrated that 20-25% of individuals who die by suicide have engaged in an act of self-harm within the 12 months before their death. A & E proves to be a crucial entry point for the engagement with services for those who self-harm. However, experiences of care have been described in a negative light with Service Users reporting staff attitudes and behaviours to sometimes be ‘ignorant’ and ‘punitive’. Objective: This review aimed to synthesise the findings from qualitative and quantitative studies in order to understand how adults who self-harm experience care in A & E. In doing so, this review asks the following questions ‘What is unhelpful about the care they received?’ and ‘What is helpful about the care they received?’ Method: A systematic literature search, in line with PRISMA guidelines, was carried out across five databases. 11 out of 1630 studies were included the final review, when inclusion criteria were applied. Findings from these studies were analysed using thematic synthesis. Results: Four themes were identified which captured the experience of care; negative staff attitudes, an unsuitable physical environment, inner turmoil/ experience, and what is perceived as helpful. Conclusions: It is evident that Service Users are dissatisfied with certain aspects of the physical environment and some staff attitudes. However, more research is necessary to explore alternative delivery systems and to assess feasibility.