Specialist care needed for older people who self-harm
By Charlotte Fantelli
The May issue of the British Journal of Psychiatry clearly outlines the need for quality assessment and care for over 60's who self-harm.
The study carried out by the University of Manchester, highlights the important issues facing those treating older people with self-harm related injuries, and the added risks they pose, for example, those over 60 who have self-harmed are three times more likely to go on to complete suicide than younger adults who self-harm. This reinforces a need for specialist care and help for people in this age group who self-harm.
Researchers studied 1,177 people over the age of 60, who had been admitted to hospital after self-harming, and found that 1.5% of these people completed suicide within 12 months. Compare this to the risk of suicide in the general population in this age group and it is 67 times higher, a risk that simply cannot be ignored.
Other findings of interest include:
The suicide rate was highest among men aged 75 years and above.
Other important risk factors included previous self-harm or contact with mental health services.
Those who repeated self-harm were more likely to be single or live alone.
Elizabeth Murphy, lead researcher at the Centre for Mental Health and Risk at the University of Manchester, said: “Our study shows that older adults who are admitted to hospital with self-harm are a high-risk group for subsequent suicide."
What this study highlights is the need for proper care as soon as self-harm is identified. "Emergency departments may therefore be a key setting in terms of their potential for suicide prevention. All older adults who present to hospital with self-harm should be considered as being at elevated risk of suicide, unless a detailed assessment shows otherwise. In particular, men over 75 years old need to be carefully monitored and assessed, as the risk of suicide is particularly increased in this group" Murphy continues.
Guidelines are in place to protect vulnerable patients like these, however, this study reiterates the need for them to be adhered to. Psychiatrists Professor Michael Dennis Professor and Honorary Consultant in Old Age Liaison Psychiatry at Swansea University, advises: "Adherence to guidelines should be monitored and audited by healthcare providers, particularly where there is pressure on beds.
"Older people should not be discharged home from the emergency department before an appropriate assessment has been undertaken by a mental health specialist trained to assess the risks and needs in this age group. Mental health services and primary care also need to be ready to deal with the longer-term management of vulnerable older people with depression and a history of self harm."
Murphy E, Kapur N, Purandare N, Hawton K, Bergen H, Waters K and Cooper J. Risk factors for repetition and suicide following self-harm in older adults: multicentre cohort study. British Journal of Psychiatry 2012; 200: 399-404
Dennis MS and Owens DW. Self-harm in older people: a clear need for specialist assessment and care. British Journal of Psychiatry 2012; 200; 356-358