ABSTRACT
The stated target reduction in annual suicide-rates was 15% by the year 2000, (Health of the Nation White Paper 1992). It was noted that this could be achieved if the number of people completing suicide within a year of presenting to A&E with Deliberate Self-Harm (DSH), were to be halved (Royal College of Psychiatrists 1994). The latest government White Paper (Our Healthier Nation, 1998) sets a target reduction in annual suicide-rates of one-sixth by 2010. The close links between suicide and DSH (Williams & Morgan 1994), emphasise the importance of effective psychosocial assessment for all people presenting to A&E with DSH. Yet fifteen years after the DHSS circular (LASSL(84)5), first criticised the high levels of discharge without psychosocial assessment, of people presenting to A&E with DSH, concerns are still being raised. To assist hospitals, The Royal College of Psychiatrists published a consensus statement on standards of service for the general hospital management of adult DSH (CR32 1994), but to date, there is no definitive approach to service provision. This paper reviews the literature and details two West Midland hospitals, which currently adopt different approaches to the care of the individual who deliberately self-harms. The paper concludes by reviewing some of the problems and questions which remain unanswered, in this highly emotive area.
