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Objectives: This study aimed to examine the impact of community mental health (CMH) care following index hospital-treated intentional self-harm (ISH) on all-cause mortality. A secondary aim was to describe patterns of CMH care surrounding index hospital-treated ISH., Design: A longitudinal whole-of-population record linkage study was conducted (2014-2019), with index ISH hospitalization (Emergency Department and/or hospital admissions) linked to all available hospital, deaths/cause of death, and CMH data., Setting: Australia's most populous state, New South Wales (NSW) comprised approximately 7.7 million people during the study period. CMH services are provided statewide, to assess and treat non-admitted patients, including post-discharge review., Participants: Individuals with an index hospital presentation in NSW of ISH during the study period, aged 45 years or older., Intervention: CMH care within 14 days from index, versus not., Measurements: Cox-proportionate hazards regression analysis evaluated all-cause mortality risk, adjusted for relevant covariates., Results: Totally, 24,544 persons aged 45 years or older experienced a nonfatal hospital-treated ISH diagnosis between 2014 and 2019. CMH care was received by 56% within 14 days from index. Survival analysis demonstrated this was associated with 34% lower risk of death, adjusted for age, sex, marital status, index diagnosis, and 14-day hospital readmission (HR 0.66, 95% CI 0.58, 0.74, p < 0.001). Older males and chronic injury conveyed significantly greater risk of death overall., Conclusions: CMH care within 14 days of index presentation for self-harm may reduce the risk of all-cause mortality. Greater effort is needed to engage older males presenting for self-harm in ongoing community mental health care.

Objective: Psychosocial interventions demonstrate benefits during care for self-harm patients, however their adoption in hospital care remain largely unknown. This study aimed to evaluate the variation in and factors associated with psychosocial intervention use when treating self-harm patients at New South Wales (NSW) public hospitals., Method: We used the all-inclusive NSW Admitted Patient Data from July 2001 to June 2014. The primary outcome was receipt of hospital based psychosocial intervention. Mixed effect logistic models were used to quantify the between-hospital variation and patient and hospital-level characteristics in relation to outcome., Results: It was noted that over the 13-year study period, the use of psychosocial intervention increased over time by 4% per annum. Substantial variation in use was observed between hospitals, and receipt of psychosocial interventions were also associated with patient characteristics such as increasing age and an increasing number of comorbid mental disorders., Conclusion: Despite the increasing trend in use of psychosocial intervention, it was not commonly adopted in many hospitals when treating self-harm patients, even cases with greater needs, suggesting substantial potential to improve uptake and targeting., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Repetition of hospital-treated self-poisoning and admission to psychiatric hospital are both common in individuals who self-poison., Aims: To evaluate efficacy of postcard intervention after 5 years., Method: A randomised controlled trial of individuals who have self-poisoned: postcard intervention (eight in 12 months) plus treatment as usual v. treatment as usual. Our primary outcomes were self-poisoning admissions and psychiatric admissions (proportions and event rates)., Results: There was no difference between groups for any repeat-episode self-poisoning admission (intervention group: 24.9%, 95% CI 20.6-29.5; control group: 27.2%, 95% CI 22.8-31.8) but there was a significant reduction in event rates (incidence risk ratio (IRR) = 0.54, 95% CI 0.37-0.81), saving 306 bed days. There was no difference for any psychiatric admission (intervention group: 38.1%, 95% CI 33.1-43.2; control group: 35.5%, 95% CI 30.8-40.5) but there was a significant reduction in event rates (IRR = 0.66, 95% CI 0.47-0.91), saving 2565 bed days., Conclusions: A postcard intervention halved self-poisoning events and reduced psychiatric admissions by a third after 5 years. Substantial savings occurred in general hospital and psychiatric hospital bed days.

This case study reviews 11 sessions of art psychotherapy with a consumer diagnosed with having borderline personality disorder. A consumer who reported difficulty in communicating her lived trauma verbally and engaged in self-harming behaviour was offered individual art therapy sessions following a consultation between an art therapy student and clinical nurse consultant in an attempt to understand her experiences and to collaboratively engage her. Notes were taken after each session by the art therapy student, reflecting conversations with this consumer while they were engaged in art making, which were subsequently explored within formal clinical supervision sessions with a mental health nurse consultant. An art portfolio is reproduced. It illustrates the expressive power of image creation. The key features of the images were that of lived trauma, the externalization of thoughts and feelings, and intense emotional expression. The results of this chronological art portfolio case study indicated therapeutic benefits from the intervention for this consumer. Further investigations of this type of intervention are warranted within the mental health setting.

Objective: To examine Australian trends in deliberate self-harm in order to explore aetiological factors and improve clinical practice., Method: A database recording 5 years of activity of a consultation-liaison service from a large tertiary referral hospital in Sydney was analysed to discover trends in types of self-harm, sex, age, marital status, repetition rates, diagnoses and follow up., Results: 1295 patients with deliberate self-harm were referred to the Service over the 5 years. Of these patients, women exceeded men (ratio of 1.48:1). Self-poisoning constituted 79.5% of the referrals. Rates of self-harm referrals increased from 1999 to 2001, but appeared to plateau in 2002 and 2003. Eighty-eight per cent of referrals were first presentations of self-harm. Most referrals received the diagnosis of adjustment disorder with depressed mood, but a significant proportion was diagnosed with major depressive disorder and schizophrenia, particularly in those that violently self-harmed. There was a significant decline in the rate of admission to hospital over the study period., Conclusions: While patient characteristics did not change significantly, there was a decline in admission rates to hospital. Many patients had serious mental illnesses, highlighting the importance of a thorough psychiatric assessment of people who self-harm.

Background: Stabbing and firearm trauma causing severe injuries (injury severity score (ISS) >15) and death is uncommon in Australia. The present study describes the experience with stabbings and firearm trauma causing severe injuries at a major Australian urban trauma centre., Methods: Data from a prospectively generated trauma registry regarding all patients presenting to Royal Prince Alfred Hospital (RPAH), Sydney, Australia with penetrating trauma causing severe injuries from July 1991 to June 2001 was retrospectively analysed., Results: Of all patients presenting to RPAH with stabbing and firearms wounds over the 11 year study period, 28% received an ISS >15. One hundred and forty patients were identified. 94% were male. The mean age was 34 years (15-82 years). The number of cases/year has not shown an increasing trend. Thirty per cent of patients sustained firearm related injuries, with the remainder mainly caused by knives or machetes. Fifteen per cent of injuries were self inflicted. The most common location of injury was on a public street. Fifty-two per cent of patients were injured in more than one anatomical region, with the abdomen being the most common site of injury (53%). On hundred and seventy-four operations were performed - laparotomies (43%), thoracotomies (26%), craniotomies (5%) and orthopaedic, vascular, wound explorations and other procedures (26%). Twenty-eight per cent of patients suffered at least one complication during their admission, with coagulopathy being the most common complication (20%). Mean length of stay was 10.4 days (1-107 days). The total mortality rate for the severely injured patients was 21%, with gun-related injuries having a higher mortality rate than stabbing injury (36%vs 15%). Sixty per cent of deaths were related to exsanguination., Conclusions: Stabbings and firearm trauma are associated with significant morbidity, mortality and utilization of hospital resources in metropolitan Sydney. Overall mortality rates are similar to institutions with higher volumes of penetrating trauma.

Repeat Deliberate Self Harm is a recognised risk factor for completed suicide and therefore reduction by effective health service response represents a valid contribution to suicide prevention. However, only a small fraction of people with deliberate self harm presentations to general health settings actually reach specialist mental health follow-up appointments. Therefore, even if responses at that point are known to be effective they do not make a significant contribution to reducing repeat self-harm overall. We describe health system organisational change strategies to improve health service engagement for the target group, and present data demonstrating the effectiveness of these strategies.