Assessment Rates and Compliance With Assertive Follow-up After Self-Harm: Cohort Study

Abstract

The objectives of this study were to identify 1) the proportion of self-harm episodes that resulted in assessment by a specialist self-harm team and offers, attendance, and completion of brief therapy and 2) the factors associated with these treatment options. A prospective cohort study of 717 hospital presentations of self-harm was conducted. Rates of assessment, offers and completion of therapy ranged from 50% to 60%. Of those offered therapy, 73% attended one or more sessions. Attendance was associated with depressive psychopathology and existing treatment in primary care. These results may reflect some of the challenges of engaging this patient group. We found that receipt of treatment was determined by patient factors. Future studies might also examine the role of service-related or clinician factors.

Keywords:

• assertive follow-up
• assessment
• compliance
• self-harm

The Department of Health funds the monitoring of self-harm in Manchester. The views and opinions in this paper do not necessarily reflect those of the Department of Health or the NHS.

The authors thank the staff from the MaSH Project for data collection and the staff from the SAFE Team for their cooperation with the project.

Notes

^a All variables are at least 99% complete.

^a All variables are at least 90% complete with the exception of diagnosis (56% complete) and current GP treatment (85% complete).

^b Psychodynamic Interpersonal Therapy.

^a All variables are at least 87% complete, with the exception of diagnosis which is 57% complete.

^b Although the full range of variables (as shown in Table 2) were tested for an association with the offer of therapy, only factors that were significantly associated with the offer of therapy are shown for ease of presentation.

^c All variables were also analyzed as predictors of completion of four sessions of therapy. The only predictor that reached significance was gender, with 53% of 111 women completing therapy compared to 35% of 57 men (RR: 1.5, 95% CI: 1.0 to 2.2, p = 0.03).