Local Self-injury Service receives NICE recognition

An innovative approach to caring for people who self-harm within north Bradford has received national recognition after being shortlisted for last year's NICE shared learning award. Established two years ago, the Self-injury Service within NHS Bradford and Airedale provides medical treatment, psychosocial assessment and information to people in the area aged 16 and over who self-harm.

Dr Gillian Proctor, a clinical psychologist helped set up the Self-injury Service. Here she talks to Gregory Jones, press officer at NICE about the benefits the service has brought to individuals in Bradford and how the NICE clinical guideline on self-harm (published in 2004) has helped her team establish the new service.

“We set up the Self-injury Service to improve the medical treatment offered to patients over the age of 16 who self harm within the north Bradford area. Usually if someone self-harms, their first port of call is to go to the accident and emergency department (A&E) at their local hospital. However, some people who present to A&E after self harming do not feel their experience is a positive one - for example, they encounter negative attitudes from staff. This may prevent them from returning for vitally important treatment for infected wounds. As A&E units are very busy, this environment can be unsuitable for patients who self-harm, who are often vulnerable, may still be distressed when they seek treatment and may already have a degraded sense of self-worth. In line with NICE's clinical guideline on self-harm, we wanted to set up a service that offered users increased satisfaction compared with A&E. We wanted to bring about increased attendance for medical treatment following self-harm, to reduce the risk of illness and death from infected wounds, and to reduce the risk of future suicide attempts. We also wanted to ensure nursing staff were trained to understand patients who self-harm and to treat clients in a respectful and helpful way.

To set up the service, we recruited volunteers from practice nurses, district nurses, a GP from the local GP practices and an out-of-hours district nursing team. Few of the staff volunteering had previous experience of working with people with mental health problems. I, together with a service user who has personal experience of self-harm, devised a day's training package which was delivered to all staff involved in the service, and staff were offered ongoing supervision and support.

The self-injury service we set up is unique. If a patient is registered with a GP and over the age of 16, they can have their wounds dressed by a nurse or doctor at a local surgery, 24 hours a day, 7 days a week and they will not have to go straight to A&E. This is good news as it means they will be treated by a sympathetic, non-judgemental member of staff who has been specially trained in understanding self-harm. They only have to go to hospital if their injury is serious and where this is necessary, they will have a timed appointment arranged and will not need to wait several hours in A&E.

Two years on, the feedback we have received from patients using the service has been outstanding and we have received additional funding to expand the service across Bradford. Local A&E departments have also recorded a 30% drop in the number of people presenting after self-harming. This service has also been independently evaluated, comparing patient experiences of this service with A&E. All respondents who have attended the new service said staff understood or wanted to understand why they had self-harmed, and 90% felt staff were respectful and caring and sensitive to their needs and concerns.

We were extremely pleased to be shortlisted for the clinical category in the recent NICE shared learning awards. The NICE clinical guideline has really helped to give our work credibility amongst local managers and healthcare professionals. We have been able to reassure them that what we are doing fits in with the NICE guideline on self-harm, as the advice is based upon the best available evidence. The Self-injury Service provided by NHS Bradford and Airedale is now known throughout England and I hope that others will follow our example by making a real difference through successfully implementing NICE guidance.”

For your chance to enter this year's NICE Shared Learning Awards further information can be found on the NICE website by clicking on the following link: www.nice.org.uk/sharedlearningawards