Care gaps among people presenting to the hospital following self-harm: observational study of three emergency departments in England
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 observat...
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| Format: | Article |
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BMJ Publishing Group
2024-10-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/10/e085672.full |
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| author | Sarah Steeg Leah M Quinlivan Navneet Kapur Caroline Clements Jonathan Smith Faraz Mughal Shamini Gnani Elizabeth Monaghan Catherine Robinson Harriet Bickley Steven Barlow Fiona Naylor |
| author_facet | Sarah Steeg Leah M Quinlivan Navneet Kapur Caroline Clements Jonathan Smith Faraz Mughal Shamini Gnani Elizabeth Monaghan Catherine Robinson Harriet Bickley Steven Barlow Fiona Naylor |
| author_sort | Sarah Steeg |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-dee26226e60040afb79cfcb288d6bdfa |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-dee26226e60040afb79cfcb288d6bdfa2025-08-20T02:10:53ZengBMJ Publishing GroupBMJ Open2044-60552024-10-01141010.1136/bmjopen-2024-085672Care gaps among people presenting to the hospital following self-harm: observational study of three emergency departments in EnglandSarah Steeg0Leah M Quinlivan1Navneet Kapur2Caroline Clements3Jonathan Smith4Faraz Mughal5Shamini Gnani6Elizabeth Monaghan7Catherine Robinson8Harriet Bickley9Steven Barlow10Fiona Naylor11Manchester Academic Health Science Centre, University of Manchester, Manchester, UKCentre for Mental Health and Safety, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UKManchester Academic Health Science Centre, University of Manchester, Manchester, UKManchester Academic Health Science Centre, University of Manchester, Manchester, UKNIHR Greater Manchester Patient Safety Research Collaboration, School of Health Sciences, University of Manchester, Manchester, UKNIHR Greater Manchester Patient Safety Research Collaboration, School of Health Sciences, University of Manchester, Manchester, UKDepartment of Primary Care and Public Health, Imperial College London, London, UKNIHR Greater Manchester Patient Safety Research Collaboration, School of Health Sciences, University of Manchester, Manchester, UKSocial Care and Society, School of Health Sciences, University of Manchester, Manchester, UKManchester Academic Health Science Centre, University of Manchester, Manchester, UKNIHR Greater Manchester Patient Safety Research Collaboration, School of Health Sciences, University of Manchester, Manchester, UKNIHR Greater Manchester Patient Safety Research Collaboration, School of Health Sciences, University of Manchester, Manchester, UKObjectives 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.https://bmjopen.bmj.com/content/14/10/e085672.full |
| spellingShingle | Sarah Steeg Leah M Quinlivan Navneet Kapur Caroline Clements Jonathan Smith Faraz Mughal Shamini Gnani Elizabeth Monaghan Catherine Robinson Harriet Bickley Steven Barlow Fiona Naylor Care gaps among people presenting to the hospital following self-harm: observational study of three emergency departments in England BMJ Open |
| title | Care gaps among people presenting to the hospital following self-harm: observational study of three emergency departments in England |
| title_full | Care gaps among people presenting to the hospital following self-harm: observational study of three emergency departments in England |
| title_fullStr | Care gaps among people presenting to the hospital following self-harm: observational study of three emergency departments in England |
| title_full_unstemmed | Care gaps among people presenting to the hospital following self-harm: observational study of three emergency departments in England |
| title_short | Care gaps among people presenting to the hospital following self-harm: observational study of three emergency departments in England |
| title_sort | care gaps among people presenting to the hospital following self harm observational study of three emergency departments in england |
| url | https://bmjopen.bmj.com/content/14/10/e085672.full |
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