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Improving Services & Outcomes for People who Self Harm

News and presentations from todays conference chaired by Sarah Hughes Chief Executive The Centre for Mental Health

Using digital technology to support people who self-harm or feel suicidal: Lessons from developing the ‘distrACT’ mobile app
Dr Knut Schroeder ,Founder & Director Expert Self Care Ltd, General Practitioner, Bristol, Honorary Senior Clinical Lecturer, Centre for Academic Primary Care, University of Bristol
Pre-event abstract
Using digital technology to support people who self-harm and may feel suicidal – lessons from developing the distrACT mobile app
Nationally there are around 200,000 hospital emergency department cases of self-harm reported every year. The number of people who self-harm in Bristol alone is around 25,000. It is the highest predictor of suicide, with self-harm patients 35 times more likely to end their own lives.
A new app to help people who are considering self-harm or having suicidal thoughts was launched in Bristol in November 2017. As an alternative to printed information materials, the distrACT app is designed to give easy, quick and discreet access to general health information and advice about self-harm. Through distrACT, people will find reliable answers to their questions about self-harm in plain language – anywhere, anytime, in private.
The distrACT app has been created by doctors together with young adults and experts in self-harm and suicide prevention, including Bristol Health Partners and the Improving Care in Self-Harm Health Integration Team (STITCH HIT), University of Bristol and University Hospitals Bristol NHS Foundation Trust, as well as other local and national organisations. Charities Self-Injury Support and Self-Injury Self Help helped by involving young people with experience of self-harm in the design.
Designed to work for primarily young adults in the UK who struggle with self-harm or want to support others, the app's aims include:
•    Suicide prevention: Help reduce the risk of suicides in people who self-harm
•    Crisis support: Advice on how to access help in an emergency, lists of useful emergency numbers and support sites, and tips for safety planning
•    Signposting: Guide people who self-harm to further sources of support
•    Self-care: Encourage self-monitoring strategies and self-management of symptoms
•    Health literacy: Increase knowledge and understanding of self-harm and related issues
•    Practical support: Give practical tips and provide ideas for safer alternatives to self-harm
•    Stigma: Reduce stigma and dispel myths about self-harm
•    Resilience: Help people develop skills to build resilience and increase well-being
•    Accessing health services: Support decisions around accessing health services and other means of support.

The presentation focused on the following: 
1.    Case study: the ‘distrACT’ self-harm support and suicide prevention app
2.    What lessons did we learn from creating the distrACT app?
3.    How to develop a mobile app from scratch – top tips for the uninitiated

Improving the response to self harm in emergency departments
Salena Williams, Senior Nurse Liaison Psychiatry, University Hospital Bristol NHS Trust
Pre-event abstract
Improving the response to self harm in Emergency Departments
Self-harm is a common reason for admission to general hospitals, accounting for more than 200 000 admissions in the UK annually. To discover who these patients were, why they were attending and what was their care pathway, we set up a Bristol self-harm surveillance register (BSHSR), which now collects data across two general hospitals and a children’s hospital. I describe the method of setting up the surveillance register, and show what is collected and how it can be used to understand self-harm presentations to the general hospital and how it can be used to improve care.
STITCH was set up to use the information collected across Bristol and we are now part of the national suicide prevention Dept. of Health Guidance: 
Key findings were that paracetamol (followed by tramadol and co-codamol) was the most common medication used in overdose, and that 80% of patients had previously self-harmed. One of the important findings was that only 59% of patients were receiving a mental health assessment in the emergency department, despite the risk of repeat self-harm and rate of completed suicide being far higher than the general population. This information led to funding for a seven-day psychiatric service. This has significantly improved the number of patients who receive NICE recommended psychosocial assessment. We held an ‘experience based design’ evaluation of acute hospitals and care for patients who self harm. We provide a 6 week rolling programme of mental health training to ED staff, with people with lived experience. The register monitors method of overdose and has allowed provision training to GPs on prescribing to patients who self harm, leading to reduced admission to ITU following overdose. We are improving the care pathway between the hospital and surgeries by targeting areas of deprivation and we have produced SASHA – a self harm aide memoire for GPs. Repeat attendance of self harm is high, leading to the creation of a ‘self harm out patients clinic: the SHOP’. Using the surveillance register we are able to find out more about those who died by suicide following self harm. 57 people have ended their lives since the commencement of the BSHSR. The information gathered is of value in risk assessment of those who are suicidal.

Powerpoint presentation

Harmless – A personal journey to improved self harm prevention services
Sarah Kessling, Training Team Leader, Harmless & The Tomorrow Project
Pre-event abstract
Harmless was established at the beginning of October 2007 to respond to the needs of people who do, or are at risk of, self harm. It is a national voluntary organisation for people who self harm, their friends, families, and professionals. As a user-led specialist self harm service, they offer flexible support to best meet the needs of any individual. 
Harmless contributes to national research on self harm and suicide prevention, along with being involved with several self harm strategy boards across the UK, including the All Parliamentary Group on self harm. Their work has been shown as best practice by Public Health England. Sarah Kessling is the Training Team Leader, and Specialist Trainer, for Harmless’ Let’s Talk Training team. She will be presenting to delegates Harmless’ model of best practice, clinical outcomes and personal testimonies from clients. Self harm does not discriminate, and can affect anyone, anywhere, at any time in their life. In addition to providing clinical and practical support, Harmless delivers specialist training nation-wide to enable professionals to improve their working knowledge, skills and confidence in responding to self harm. 

Powerpoint presentation

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