Deliberate self-harm: the St Andrew’s experience

Abstract

Deliberate Self-Harm (DSH) resulting in multiple cuts to the forearms and wrists is an increasingly common problem in the UK, providing a regular source of referrals for hand trauma services in the UK. It requires the input of both the mental health services and appropriate surgical services and frequently long-distance transfers to regional hand trauma centres. In providing for a minimum standard of care, as stipulated by the UK Department of Health in 1984 (Department of Health and Social Security 1984), for this often behaviourally challenging subset of patients, recommendations were made that all DSH patients have a mental health assessment prior to discharge. The care of such patients is frequently labour intensive in its demands on nursing staff demanding skills and expertise that may be better provided for by psychiatric staff (Royal College of Psychiatrists 1994), but little advice is available for the specific context in which plastic surgeons should manage this subset of patients. Retrospective data was gathered between 1996 and 2005 to ascertain the demographic profile of patients, previous self-harm and mental health history, and the patterns of injury and; to assess by long-term follow-up residual disabilities incurred by the injuries. In total, there were 228 individual patients presenting on 270 occasions with a male to female ratio of 3:2. The average duration as an inpatient was for 2–3 days. Being a large regional hand trauma unit, the catchment area within which such referrals are made, makes coordinating the safe discharge and appropriate follow-up of these patients particularly difficult. Despite the benefits of a large mental health unit on site, local versus regional funding issues have historically made patient care difficult. Multi-specialty cooperation and appropriate funding has significantly improved the level of patient supervision and quality of discharge for these patients in the last 10 years, but this has occurred with varying levels of success at a predominantly local level.