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Self-Harm – A Primary Care Perspective

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Abstract

The incidence of self-harm is increasing in the UK. It is the single best predictor of completed suicide and is associated with poor outcomes in terms of emotional wellbeing and educational attainment. The majority of patients do not present to medical services after an episode of self-harm and so GPs play an important role in identifying the problem, reducing stigma and providing support.

 

Self-harm is associated with a broad range of risk factors related to emotional distress rather than severe mental illness. It is commonly associated with misuse of alcohol and other substances. Other important risk factors are adverse life events such as unemployment and relationship difficulties, as well as a history of current or past abuse or institutional care. In young people precipitating factors can include arguments with parents and stressors at school such as exam pressures, bullying or cyber bullying.

 

Self-harm is stigmatised by the general public and medical professionals, so there is a need to approach the subject with sensitivity, respect and acceptance. Self-harm is a behaviour, rather than a diagnosis in itself. It can be seen as a symptom of an underlying mental or personal difficulty, or serve a function for the patient; exploring these reasons can guide management, which focuses on the underlying difficulties. Actively involve the patient in the management plan, asking about their preferences and previous experiences of treatment. High risk patients with a severe mental illness or active suicidal thoughts should be urgently referred on to mental health services for further assessment. Patients at low risk may be supported in primary care, and those in between can be referred to non-urgent mental health or social services, or a 3rd party organisation.

Additional Info

  • Authors: E Diggins, D Cottrell & A House
  • Keywords: Self harm, suicide, mental illness, management, primary care
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Read 1449 times Last modified on Friday, 08 July 2016 10:57

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