LANARKSHIRE SELF-HARM HEALTH NEEDS ASSESSMENT
Briefing Paper
Background1
What is self-harm? It is defined as “Self-poisoning or self-injury, irrespective of the apparent
purpose of the act” – NICE. It focuses on those acts where the person sets out to injure
themselves. It also includes self-harming that is reported to occur seemingly out of the
person’s control or awareness – during ‘trance-like’ or dissociative states.
How common is self-harm? A national interview survey suggests a lifetime occurrence of 4.66.6%, with a school survey reporting up to 13% amongst 15-16 year olds having self-harmed
at some time - 7% percent had done so in the previous year. Commoner in women compared
to men. Adolescents are at greater risk.
Factors associated with self-harm: socio-economic disadvantage – single/divorced/living
alone/single parents or severe lack of social support; adverse life events - numbers and type;
physical ill-health; mental disorder – phobic & psychotic disorders, schizophrenia & certain
psychological characteristics/interpersonal difficulties; alcohol & drugs; child abuse & domestic
violence
Consequences of self-harm: repetition & suicide – 50-100% fold increased risk of suicide after
self-harming; physical ill-health – acute liver failure following paracetamol poisoning, scarring,
tendon & nerve damage, permanent disability & hospitalisation; economic cost – In, England
& Wales, 150-170,000 cases attend A&E per year, up to 69,000 hospital admissions in
2001/02, and anti-depressants overdose in UK costing about £5.1million
Aim
Undertake an assessment of needs to identify opportunities to reduce morbidity and mortality
associated with self-harm in the Lanarkshire area
Methodology
Describe the epidemiology; compare current service against defined standards; and appraise
evidence for current health improvement interventions.
Processes to include: review of published literature; analysis of routine & ad hoc data;
stakeholder (participatory) seminar; interviews; discussions; questionnaires, data collection
forms; surveys/cross-section sampling; critical appraisal/evidence-based methods
Sources of information: Epidemiological – published, grey and peer-reviewed literature;
analyses of routine (e.g. PTI, SMR) data; Service - NICE guidance on DSH, service
framework for LA and NHS, key informants and service users; Health Improvement - MH
Legislation 2003; current MH and Wellbeing promotion strategy documents
Network of contacts: SIREN, Choose Life – local and national; Scottish Development Centre
for Mental Health; Health Scotland – Mental Health programme; NHSL (and other NHS
boards) - Mental Health service; (academic) - Prof Steve Platt – University of Edinburgh,
Robert Young – MRC Social & Public Health Science unit
Current service
Framework: Primary care; Inpatient care; Ambulance; Community services; Accident &
Emergency
Appraisal parameters: Efficacy, safety, effectiveness, appropriateness, cost, efficiency, equity,
access, ownership, relevance, responsiveness, etc
1
Excerpts from National Collaborating Centre for Mental Health. Self-harm: The short-term physical and psychological
management and secondary prevention of self-harm in primary and secondary care. NICE National Clinical Practice Guideline
Number 16
femi.oshin@nhs.net
533572697
02/03/2016
Key Project milestones for the Lanarkshire Self-Harm Health Needs Assessment
Milestone
Comments
Time
1st week June 2008
1. Scoping
2. Stakeholder Consultation
Meeting
Mid-July 2008
3. Lanarkshire Self-Harm
Service Map
Draft
End July 2008
4. Lanarkshire Self-Harm
Service Map
Final
End September 2008
5. Health Needs
Assessment Report
Draft for consultation
2nd week September 2008
6. Health Needs
Assessment Report
Final report
4th week September 2008
femi.oshin@nhs.net
533572697
02/03/2016