Predictors of A&E staff attitudes to self-harm patients who use self-laceration: influence of previous training and experience.

OBJECTIVE: The aim of this study was to investigate the attitudes of accident and emergency (A&E) staff towards patients who self-harm through laceration. METHODS: We developed a questionnaire using focus group methodology. Questionnaires were distributed to 117 A&E staff members. RESULTS: Of the staff, 53.8% responded. The staff believed that self-laceration was an important problem but felt unskilled in managing patients. The staff were unsure of the relationship between self-laceration and both mental illness and risk of suicide. They had previously received little training in managing this condition. In those staff without previous training, a longer period working in A&E was correlated with higher levels of anger towards patients and an inclination not to view patients as mentally ill. A&E staff were keen for further training and wanted a higher proportion of patients to be seen by specialist mental health services. CONCLUSIONS: This study highlights the need for greater staff training in A&E. Despite considerable experience in the field, we found evidence for unhelpful attitudes amongst some staff. This is particularly true for more senior staff without previous DSH training, who, as a group, were less sympathetic to this group of patients. Unfavourable attitudes of health professionals are likely to adversely influence the quality of clinical care delivered to DSH patients who use self-laceration as well as those who use other methods of self-harm.

Self-harm in older people with depression: comparison of social factors, life events and symptoms.

Studying non-fatal self-harm in older adults may provide insight into suicidal behaviour in this age group. The objectives of the study were to determine clinical factors that might help to differentiate those older adults with depression who are most at risk of self-harm and suicide. We examined social factors, life events, hopelessness and other depression symptoms in a group of 48 older people with depression referred following an episode of self-harm compared with 50 similarly aged people with depression who had no history of self-harm. The groups were similar in many respects, although those in the self-harm group were more likely to have a poorly integrated social network and were more hopeless.

Clinical and parenting skills outcomes following joint mother-baby psychiatric admission.

OBJECTIVE: To examine maternal clinical and parenting outcomes as a function of diagnosis following joint mother-baby admission; to identify the associations of poor outcome. METHOD: Demographic and clinical information was collected on 1081 joint mother-baby admissions, including 224 women with schizophrenia, 155 with bipolar disorder and 409 with non-psychotic depression. Information was based on clinical judgements of senior staff in participating units using the Marcé checklist. Predictors of poor maternal clinical outcome, practical problems in baby care, poor emotional responsiveness to infant and perceived risk of harm to baby were identified by logistic regression. RESULTS: Good clinical outcome was reported in 848 (78%) cases. On each parenting outcome, good outcome was reported in at least 80%. The predictors of poor outcome were similar for all four outcomes. These were a diagnosis of schizophrenia, behavioural disturbance, low social class and either psychiatric illness in the woman's partner or a poor relationship with the partner. Of those with poor outcome on all four variables, 66% suffered with schizophrenia. Women with schizophrenia showed more behavioural disturbance, were more likely to experience hallucinations and delusions, and were more likely to be of low social class. They were also less likely to have a partner and more likely to have a partner with a psychiatric illness. CONCLUSIONS: Clinical and parenting outcomes, as reported by clinical staff, are usually good following joint mother-baby admission. Women with schizophrenia may need particular measures to improve their parenting. A marital approach to treatment, directed at the woman's relationship with her partner or the latter's own mental health may improve outcome.