Focus on the Improving Care in Self-Harm (STITCH) HIT

Self-harm is a growing problem for the NHS in Bristol and across the rest of the UK, with around 200,000 hospital emergency department cases reported nationally every year. The number of people who self-harm in Bristol alone is estimated at around 25,000. The condition is the highest predictor of suicide, with self-harm patients 35 times more likely to end their own lives. With the newly-released Department of Health Priorities paper, outlining the need for adequate self-harm care in Emergency Departments, and the University of Bristol starting a study into the impact of the internet on suicide, the work of this HIT is more relevant than ever.

The Improving Care in Self-Harm Health Integration Team (HIT) is working to reduce the number of suicides in the Bristol area, by transforming understanding of self-harm across the health service and improving treatment and support for self-harm patients. They aim to ensure self-harm treatment and care is equitable, fully evidence based and non-stigmatising for all people who self-harm, and to reduce suicides in Bristol.

What they’ve achieved so far

The Improving Care in Self-Harm HIT aims to research and audit current activity and care pathways for self-harm patients. They have created a panel of experts and service user groups and are working to produce standardised patient and carer information and develop evidence-based staff training to ensure self-harm care of the highest standard is delivered consistently across Bristol.

The team is tackling the problem in several ways. In its first year, the HIT worked closely with GPs in a series of study days. The team has trained more than 100 GPs. These sessions were run by both clinical professionals, and people who self-harm. This training will help GPs recognise and interact more effectively with people who self-harm and help them create management plans for self-harm patients.

The team has also set up a Bristol-wide self-harm surveillance database to collate numerical activity and outcome data across three hospital sites: Bristol Royal Hospital for Children, Bristol Royal Infirmary and Frenchay Hospital. They have also collated all national evidence and literature relating to good self-harm care, and introduced standardised, research-based documentation for psychiatry staff to use across Bristol’s two acute NHS trusts.

To find out more about STITCH’s achievements in its first year, download the STITCH annual review.

Upcoming projects and activities

The HIT is also using the NHS experience based design research model to carry out a qualitative study of hospital emergency department staff and patients about their experiences of self-harm care and plans to use this research to develop a comprehensive staff training package. Funding will allow the team to carry out follow-up research that assesses care before and after the introduction of the training package. Another key project is to increase the number of self-harm patients who receive psychiatric assessments on admission to hospital emergency departments and evaluate the effect of this on patient outcomes.

The next stage for the team is to get self-harm flagged in GPs’ IT systems, so patients who present at A&E are flagged with their GP. The team is running a pilot with 10 GPs to find out what they want and how this integration can be achieved.

Salena Williams, HIT Director and Senior Liaison Psychiatry Nurse at the Bristol Royal Infirmary, says: “We have had overwhelmingly positive feedback from patients who self-harm for the changes we have already made to the Emergency Department at the BRI. We will build on this success, and will continue to develop services through involving patients at every stage of the process. I sincerely hope that the steps we’re taking through the work of the HIT will save lives in the future.”