Improving Care in Self-Harm HIT's successes in 2018-19

Sue Dursley, Nik Munien and Lucy Biddle, Co-Directors of the Improving Care in Self-Harm Health Integration Team (STITCH HIT) give an update on the HIT’s activities in 2018-19.

Salena Willliams stood down as lead director of STITCH this year, while David Gunnell is gradually reducing his involvement with the HIT. The HIT welcomed two new Directors, Nik Munien and Lucy Biddell.

A rolling programme of Emergency Department training at University Hospitals Bristol NHS Foundation Trust (UH Bristol) continues, with very powerful input from people with lived experience of self-harm. An initial training session was held at North Bristol Trust (NBT) and an introduction at Weston General liaison psychiatry team, with a view to cover the entire Bristol, North Somerset and South Gloucestershire patch.

We have trained 60 GPs in self-harm and suicide awareness and ‘top tips’ for supporting suicidal patients have been evaluated. Feedback shows satisfaction and increased knowledge. Our training to individual surgeries continues, one of STITCH’s key activities in 2018/19. We provided information and training to staff plus the development of a support ‘tool’ to help GPs identify self-harm patients and guide them through the care pathway. Evaluation of this work will be completed during 2019/20

Bristol Self Harm Surveillance Register data has been collected for 2018 in the Bristol Royal Infirmary, with data from Southmead Hospital still being collected, with analysis and reporting to follow. The register shows that the rate of psychosocial assessment continues to improve. But, whilst health partners value the register, funding continues to be a frustration.

The efficacy of the HOPE project, which evaluates debt advice and counselling for people for whom financial difficulty was a contributory factor to their self-harm episode, was published in November 2018. Research into self-harm in the context of domestic violence was accepted for publication by the BMJ in July 2018.

Two patient satisfaction surveys were carried out this year: one by Bristol Independent Mental Health Network (BIMHN) service user group and another by NHS England.

We await the results of a comparison with our original evaluation in the early years of STITCH (2013/14) completed by Self Injury Support, which is made up of people with lived experience of self-harm.

The ‘increment prescription’ pilot project continues in the University of Bristol Student Health Clinic. This pilot aims to ensure anti-depressants are subscribed in safe instalments to people who are at risk of suicide, rather than in larger batches that could be used to overdose. In July 2018, STITCH presented to parliament, and we continue correspondence with the suicide prevention minister and the All Party Parliamentary Group with the aim of changing the law on these prescriptions.

Another key work stream developed this year was our schools intervention. Over the year we have presented to the Bristol schools mental health lead forums for both primary and secondary schools. This has been followed up with three hour training sessions presented by HIT Directors alongside a Child and Adolescent Mental Health Services (CAMHS) Consultant Psychiatrist, to help teachers recognise and support young people who self-harm or contemplate suicide. We expect this work to continue in to 2019.

The SHOP Clinic has been very positively evaluated and accepted as a new UH Bristol funded outpatient clinic. We have liaised with Nottingham self-harm team and expect to be part of national research around psychological out-patient interventions for self harm patients to commence this year.

We have gained funding from Public Health England with a bid for £645,000 recurring over three years, £345,000 of which is to fund the HOPE project. This bid was developed in collaboration with Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group (BNSSG CCG).

Bristol City Council Public Health have also assigned a recurring £10,000 towards funding Bristol Self-harm Surveillance Register.