Hospital staff at most psychiatric clinics in Stockholm experience that patients who self-harm have too long hospital stays, with ensuing detrimental effects

Abstract

Background

Previous research on patients who self-harm has indicated potential negative effects from long hospital stays. Yet, such care has been reported to occur regularly. We conducted this questionnaire study to investigate how hospital staff, who treat self-harming patients, experience the relation between lengths of stay and self-harm behaviour, and the motives for non-beneficial hospital stays.

Methods

The respondents of the questionnaire were nurses and mental health workers employed at public inpatient wards in Stockholm, treating patients who self-harm. The questionnaire contained questions with fixed answers and room for comments. A total of 304 questionnaires were distributed to 13 wards at five clinics, and the response rate was 63%. The data were analysed with descriptive statistics and qualitative descriptive content analysis.

Results

The results show that most staff experienced that more than a week’s stay either increased (57%) or had no effect (33%) on self-harm behaviour. Most respondents at most clinics considered the stays to be too long at their wards, and that the stays could be reduced. The respondents recognized several reasons for non-beneficial hospital stays, like fear of suicidal behaviour and doctors’ fear of complaints. Patients appearing as demanding or fragile were thought to be given more care than others. The respondents’ comments confirmed the majority’s experience of detrimental effects from longer hospital stays.

Conclusions

A majority of the health care staff experienced that patients who self-harm often receive too long hospital stays, with detrimental effects, and they had experienced several non-medical reasons for such care.

Keywords:

• Self-harm
• borderline personality disorder
• medical ethics
• inpatient care
• suicide prevention

Acknowledgements

The authors acknowledge the psychiatric leadership board of the county of Stockholm, which prompted this work in order to improve the psychiatric inpatient care in Stockholm. The authors acknowledge all healthcare staff who accepted to participate in the study. Finally, the authors thank all the unit managers at the wards, who accepted their wards to participate in the study and helped with handing out and collecting the anonymous questionnaires.

Ethics approval and consent to participate

According to 3–6 §§ and 13 § of the Swedish Ethical Review Act concerning research on human subjects [42], an ethics approval and an informed consent is needed if the research concerns sensitive personal data, personal data concerning delinquency, physical interventions on research subjects, is performed with potentially harmful methods, concerns biological material from humans or physical interventions on deceased humans. Since this study concerned the healthcare staff’s experiences regarding compulsory treatment of BPD patients, including no sensitive personal data, and no patients were involved, the project was not of sensitive nature and did not need to be ethically reviewed according to the Swedish Ethical Review Act [42]. All participants in this study were informed in the cover letter that their participation was anonymous and voluntary (see Appendix I). We confirm that all methods were carried out in accordance with relevant guidelines and regulations.

Disclosure statement

The authors declare that they have no competing interests.

Data availability statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Additional information

Notes on contributors

Antoinette Lundahl

Antoinette Lundahl, M.D., works at Norra Stockholms Psykiatri, S:t Görans hospital, as a senior consultant in psychiatry at a ward for patients with anxiety- and personality disorders. She is also a PhD student at Stockholm Centre for Healthcare Ethics at Karolinska Institutet.

Gert Helgesson

Gert Helgesson is a professor in medical ethics at the Department of Learning, Informatics, Management and Ethics (LIME) at Karolinska Institutet, Stockholm.

Niklas Juth

Niklas Juth is an associate professor at LIME, Karolinska Institutet. Helgesson and Juth have prior experience of the methods used in this study.