Abstract
The review by Burns et al. of the ‘management of deliberate self-harm in young people’ [1] focused on the need for evidence-based approaches, with the inevitable selection of randomized controlled trials. However, such an approach misses useful research, particularly reviews of what should be standard practices in an accident and emergency department, the usual site of initial management of suicidal behaviours. Indeed, it is pertinent to reflect on two studies that have examined the impact of such initial assessments.
Hickey et al. [2] reported that deliberate self-harm patients who left an accident and emergency department in Oxford without a psychiatric assessment not only had a greater past history of self-harm, but they were more likely to self-harm again in the subsequent year than a matched comparison group who had been assessed. Similarly, Kapur et al. [3] in a study of six hospitals in North West England reported that patients who had deliberate self-poisoning and who had not received psychosocial assessment were more likely to poison themselves again. Furthermore, they calculated that only 12 patients needed to receive a psychosocial assessment to prevent one repetition of self-poisoning, and they concluded that ‘if we assume that 50% of patients are assessed currently, we might prevent 7000 repeat episodes of self-poisoning by complying with existing guidelines and ensuring that all patients are properly assessed’.
One cannot necessarily assume that only 50% of people who engage in suicidal behaviour and who present to Australian accident and emergency departments are assessed in a psychosocial manner. However, if that were to be the case, and if one extrapolated on a population basis from the UK to Australia, approximately 2300 repeat episodes of suicidal behaviour in Australia could be prevented each year.
Such studies do not fulfil the criteria for randomized controlled trials, but they are real-world studies with evidence which is worthy of consideration.