Self-harm in the NHS: time for change

Twenty five years ago my colleague David Owens and I wrote a lament for the state of NHS responses to self-harm – noting little research investment, haphazard service provision and no evidence of central strategy. Revisiting the scene recently in an editorial for the British Journal of Psychiatry , we found little to celebrate in the way of real progress. My friend and colleague Nav Kapur wrote a riposte which was less of a counterblast and more an invitation to peer at glimmers of light at the end of the tunnel.

A recent post on the Recovery in the Bin site puts some flesh on the bones. The author sees an explanation for her experience of poor care in an intimate connection between inadequate service provision and negative attitudes among mental health professionals. This isn’t a self-centred social media rant, but a reasoned account of what it’s like to be on the receiving end as a person whose self-harm requires physical and mental healthcare.

There’s a lot of catching up to do, and three organisations should contribute:-

NHS England should invest in comprehensive outpatient follow up services for self-harm, where therapy is offered regardless of diagnosis. These services could be a part of liaison psychiatry services, since that is where most acute assessment goes on. In a recent straw poll conducted during a webinar for liaison psychiatrists, more than 80% agreed with the idea of liaison psychiatry providing such a service.

The National Institute for Health Research (NIHR) should make a strategic commitment to fund self-harm and suicide intervention research – perhaps as part of one of their themed calls. Ad hoc responses to researcher-led proposals is not driving the necessary improvement in the research evidence needed to support change.

The Royal College of Psychiatrists should campaign assertively in this area, tackling negative attitudes among its own members and lobbying for policy change, intervention research and investment in services. Alliance with the Royal Colleges of Nursing and of General Practice would bring support from the other two clinical practitioners most directly involved.

We need to move beyond words to make action on self-harm a national priority.