Recommendations for hospital-treated self-harm

Self-harm accounts for over 30,000 hospital admissions a year in Australia, usually occurring in the context of psychological distress. It is frequently directly associated with suicidal intent, psychosocial stressors and for many, mental ill health.

In a new Issues Brief, ‘Hospital-treated self-harm: Improving care through improved data’, the Deeble Institute for Health Policy Research — a research arm of the Australian Healthcare and Hospitals Association (AHHA) — recommends establishing a clinical quality registry for hospital-treated self-harm as a recognised mechanism for linking data to improved care.

Authored by 2022 Deeble Summer Scholar Dr Katie McGill, the Issues Brief highlights how routine care for hospital-treated self-harm is variable and can be substandard with care not meeting many patients’ needs, and linkage to mental health services after discharge not part of routine practice.

“For people presenting to hospital for self-harm treatment, connecting with community and out-patient services can be a vital part of recovery, but routine care is not always in line with best practice and can fall short of meeting people’s needs and expectations,’ said AHHA Chief Executive Kylie Woolcock.

“Reports of people experiencing stigmatising, judgemental and invalidating responses when presenting to health services for help after self-harm or with thoughts of suicide is a significant concern.

“By improving data quality and collection practices in relation to hospital-treated self-harm, we can form a better picture of this vitally important national health issue. Self-harm usually occurs alongside psychological distress and is often associated with suicidal intent, psychosocial stressors and poor mental health.

“Currently, self-harm surveillance data relies on clinical records from hospital admissions, and while there have been improvements in data accessibility, this data infrastructure is not designed for the purpose of improving care at a service level, or delivering improvements in patient-reported outcomes.

“Many areas of the health system are recognising that we need to shift towards measuring patient reported outcomes and experiences and mental health care is no different. By continuing to incorporate these metrics into how we plan and deliver care, it can create potentially life-changing results.”

The Issues Brief makes crucial recommendations including establishment of a clinical quality registry.

“A clinical quality registry for hospital-treated self-harm would create the link between data and improved care. By building on existing data collection frameworks with emerging self-harm clinical register capability, we can implement monitoring and service improvements at a national level and improve the outcomes that matter to patients,” Woolcock said. Below are the key recommendations:

• Self-harm surveillance data is critical for service planning and design, and accuracy and scope must be improved to ensure services can resource adequately for demand and tailor services to meet priority population needs.
• Improvements in care and outcomes for self-harm require reform for value-based health care that includes the routine collection and monitoring of PREMs and PROMs, and linking self-harm presentation surveillance data with outcomes data.
• Data infrastructure must be coupled with practice translation so that capability for learning health systems can be established. This will require audit and feedback loops at the hospital level to support service improvement efforts and government support to establish collaborative learning networks.
• Governments should commit to a strategic approach that transforms local leadership into sector-wide quality assurance infrastructure, by building clinical quality registry capability for hospital-treated self-harm. This activity should be effectively resourced and occur in a coordinated fashion in parallel with ongoing improvements in self-harm surveillance.
   

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