Improving Care in Self-Harm HIT review of 2015-16

​Salena Williams, Director of the Improving Care in Self-Harm Health Integration Team (STITCH HIT) gives an update on the HIT's activities in 2015-16.

Salena Williams, Director of the Improving Care in Self-Harm Health Integration Team (STITCH HIT) gives an update on the HIT’s activities in 2015-16.

The Improving Care in Self-Harm (STITCH) 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. Self-harm is a growing problem for the NHS,
with around 200,000 emergency cases reported nationally every year. It is the
highest predictor of suicide, with self-harm patients 35 times more likely to
end their own lives.

The self-harm surveillance register is the backbone of our
data-collection in Bristol. It started at the Bristol Royal Infirmary (BRI) and
we now have five years’ data from the hospital, so we can see the effect of
service changes over time.

Two-thirds of people who self-harm presenting at A&E now receive
a psychosocial assessment, compared to just over half in 2011. This is because
of training staff to recognise self-harm and to offer an assessment, and
extending the Psychiatric Liaison Team’s operating hours. We made these changes
because having an assessment leads to better outcomes for patients, and 80 per
cent of patients attended A&E outside the team’s core hours. The BRI has
created an emergency department staff training package on a rolling six-month
programme. University Hospitals Bristol is now working with other trusts across
the south west to standardise self-harm training for emergency department staff,
and is broadening its own delivery across the Bristol, North Somerset and South
Gloucestershire area.

In 2013, the register was extended to Frenchay Hospital and
Bristol Children’s Hospital. This helps share good practice and create
age-appropriate assessment tools and treatments, particularly for children. There
was some disruption to data collection during the transfer of the emergency
department at Frenchay to Southmead Hospital, but data is again being collected
and analysed.

We have found that average
hospital length of stay for patients admitted to the BRI following self-harm
has reduced from 3.1 days in 2011 to 2.1 days in 2014. People who attend
A&E more than once are offered an enhanced personal support plan. This
means staff have immediate access to the information they need, so they can see
and treat patients more quickly.

Bristol self-harm patients contributed to new research that
shows that consulting the internet, particularly about suicide methods rather
than searches for help, is a strong indicator of the severity of suicidal
intent and the likelihood of subsequent completed suicide. The psychosocial
assessment already includes questions about internet use and these will now be
refined to take account of the motive for these searches. The close working
relationship between researchers and practitioners that our HIT promotes allows
such changes to be quickly evidenced and implemented.