The Improving Care in Self-Harm Health Integration Team (HIT) is working to reduce the number of suicides in the Bristol area, by transforming understanding of self-harm across the health service and improving treatment and support for self-harm patients. They aim to ensure self-harm treatment and care is equitable, fully evidence based and non-stigmatising for all people who self-harm, and to reduce suicides in Bristol.
Self-harm is a growing problem for the NHS in Bristol and across the rest of the UK, with around 200,000 hospital emergency department cases reported nationally every year. The number of people who self-harm in Bristol alone is estimated at around 25,000. The condition is the highest predictor of suicide, with self-harm patients 35 times more likely to end their own lives.
Aims and objectives
Suicide prevention is a national priority. Self-harm is the highest risk predictor of future completed suicide. People who self-harm and their care and treatment spans across Bristol health and social care, both statutory and voluntary sectors. STITCH aims to examine the care pathway, ask staff and patients what helps them and utilise Bristol Health Partners knowledge, expertise and resources to enable us to achieve the highest quality evidence based patient focussed care and treatment.
The work of the HIT could have far-reaching benefits. The team wants to reduce the incidence of repeat self-harm in Bristol by 10 per cent and cut by 20 per cent the number of self-harm patients who commit suicide. This will benefit the NHS as well as patients by reducing hospital self-harm hospital bed admissions by half and reducing intensive care bed admissions by 20 per cent.
The HIT aims to:
- Ensure 80 per cent of patients who have self-harmed receive psychiatric assessment
- Train more than 80 per cent of emergency staff in self-harm
- Reduce the incidence of repeat self-harm in Bristol by 10 per cent
- Reduce prescriptions of drugs with high lethality when taken in overdose
- Reduce admission to a hospital bed for self-harm by 50 per cent
- Reduce admission to intensive care of self-harm patients by 20 per cent
- Reduce the length of stay in hospital for self-harm patients by 10 per cent
- Reduce suicides in Bristol by those who self-harm by 20 per cent
- Additional quality objectives include: reducing duplication, CQC/NICE compliance, patient satisfaction
The leading experts in self-harm and suicide in Bristol are involved in the team. The HIT is co-directed by Sue Dursley, Psychiatric Liaison Nurse, and Salena Williams, Senior Nurse, at the Bristol Royal Infirmary. The research lead is David Gunnell, Professor of Epidemiology at University of Bristol and Hon Consultant in Public Health at North Bristol Trust.
STITCH is also supported by Jonathon Benger, Professor at UWE and a Medical Consultant in the emergency department at Bristol Royal Infirmary. The team has close links with public health at Bristol City Council via the Suicide Prevention Group which is chaired by Leonie Roberts. The Avon and Wiltshire Mental Health Partnership NHS Trust provide support through their Consultant Psychiatrist Amy Green, based at Southmead Hospital.
Find out more about who’s involved in STITCH HIT.
How patients and the public are involved
The team is committed to patient experience based service design. This has formed the core of much of their work. The team works closely with the Self Injury Self Help (SISH) group, involving them in many of their projects. The SISH group works with many patients, gaining their views and recording their ideas for change. They have independently evaluated the patient experience of attending an emergench department following self-harm. They also train A&E staff in recognising and treating self-harm.
A SISH representative also presented at the 2016 National Suicide Prevention Conference in London, alongside HIT team members. They have also consulted with relatives of people who self-harm to develop projects, and self-harm patients have been actively involved in running the training sessions for GPs.
Projects and activities
Funding will allow the Improving Care in Self-Harm HIT to research and audit current activity and care pathways for self-harm patients; create a panel of experts and service user groups; produce standardised patient and carer information and develop evidence-based staff training to ensure self-harm care of the highest standard is delivered consistently across Bristol.
The team is tackling the problem in several ways. In its first year, the HIT worked closely with GPs in a series of study days. The team has trained more than 100 GPs. These sessions were run by both clinical professionals, and people who self-harm. This training will help GPs recognise and interact more effectively with people who self-harm and help them create management plans for self-harm patients.
The team has also set up a Bristol-wide self-harm surveillance database to collate numerical activity and outcome data across three hospital sites: Bristol Royal Hospital for Children, Bristol Royal Infirmary and Southmead Hospital. This is already yielding important data, such as that paracetamol accounts for 40 per cent of cases of self-poisoning. They have also collated all national evidence and literature relating to good self-harm care, and introduced standardised, research-based documentation for psychiatry staff to use across Bristol’s two acute NHS trusts.
The HIT is has used the NHS experience based design research model to carry out a qualitative study of hospital emergency department staff and patients about their experiences of self-harm care and plans to use this research to develop a comprehensive staff training package. Funding will allow the team to carry out follow-up research that assesses care before and after the introduction of the training package. Another key project is to increase the number of self-harm patients who receive psychiatric assessments on admission to hospital emergency departments and evaluate the effect of this on patient outcomes.
The next stage for the team is to actively promote the pathway from hospital to GP. The teain visit GP practices regularly to enhance how patients move from one service to another. The team continues to run a pilot with 10 GPs to help improve care for self-harm, for example by reducing the prescription of medications that are potentially dangerous in overdose.
Find out more about STITCH’s achievements its annual report:
- STITCH annual report 2013-14 (PDF)
- STITCH annual report 2014-15 (PDF)
- STITCH annual report 2015-16 (PDF)
- STITCH annual report 2016-17 (PDF)
Other collaborations and networks
The team works closely with the Bristol Self Injury Self Help (SISH) group, as well as the Self Injury Network Group (SING). SING is a collaboration for those who work with young people who self-harm, including counsellors, teachers and others who offer support services to young people. The team also works closely with the Suicide Prevention Audit Group (SPAG), which includes representatives from Public Health, railways and the Clifton Suspension Bridge.
To find out more, please contact:
- Salena Williams, Liaison Psychiatry, UHBristol: firstname.lastname@example.org or 0117 342 9214
- Sue Dursley, Liaison Pyschiatry, UHBristol: email@example.com or 0117 342 9214
STITCH at the HIT conference
The STITCH HIT presented this poster (PDF) at the 2018 Bristol Health Partners Health Integration Team conference.