Jordan Ellis
Self-harm is a common response to emotional distress, and it can take many forms, including cutting, burning, or injuring oneself. While self-harm is not routinely grounds for hospital admission, it can be necessary in certain situations. Hospital admission rates due to self-harm are higher among individuals aged 15-19 and females, especially those aged 16-24. Those with a history of psychiatric treatment and diagnoses of psychosis, mood, or personality disorders are more likely to be admitted. While hospitalization can help stabilize individuals during a crisis, it is not always necessary, and voluntary admission is an option for those seeking treatment.
| Characteristics | Values |
|---|---|
| Hospitalization for self-harm prevention | Not routinely recommended |
| Hospitalization for management of medical consequences of self-harm | May be necessary with close monitoring of the individual's behaviour |
| Hospitalization when there is a risk of serious self-harm | Urgent referral to a mental health service should be considered |
| Self-harm definition | Intentionally damaging or injuring one's body as a response to overwhelming emotional distress |
| Hospital admission rates as a measure | Indicator of how well mental health crises are being prevented |
| Age group with highest admission rates | 15-19 years old |
| Gender with higher admission rates | Females |
| Possible reasons for changes in admission rates | Changes in reporting methodology, such as reclassification of Same Day Emergency Care (SDEC) cases |
| Psychiatric admissions after self-harm | Follow-up psychiatric care is crucial, especially for patients with a history of psychiatric treatment and diagnosed disorders |
| Voluntary admission to mental health hospital | Recommended for individuals experiencing suicidal thoughts, self-harm urges, or inability to take care of basic needs |
| Factors influencing hospitalization | Severity of agitation, intention to harm others, and risk of serious injury |
| Anxiety-related hospitalization | Necessary if anxiety interferes with self-care or poses a risk of self-harm or harm to others |
| Admission process | Speaking with a healthcare team to determine suitability and available treatment options |
| Legal considerations for patient refusal of treatment | Common law doctrine of 'necessity', Mental Health Act 1983, and statutory safeguards |
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What You'll Learn
Voluntary admission to a mental health hospital
Voluntary admission to a psychiatric hospital or other mental health facility is when an individual chooses to admit themselves for treatment. This is different from involuntary commitment, where a person is hospitalized against their will and cannot leave the hospital without permission. In the UK, people who are voluntarily admitted are referred to as voluntary or informal patients.
Voluntary admission can be an option for individuals who are experiencing a mental health crisis and feel they need urgent support. It offers a supportive and stabilizing environment for individuals to heal and improve their functioning. A typical voluntary stay can last from 10 days to two weeks, although individuals are generally free to leave at any time. However, there may be a requirement to provide a period of notice, and if mental health workers believe the person is still at risk, they can initiate an involuntary hold to provide ongoing care.
In some cases, individuals may be admitted voluntarily to avoid involuntary commitment. People with mental illness can write psychiatric advance directives, allowing them to consent in advance to voluntary admission if needed. This can be particularly relevant for individuals who meet the criteria for involuntary psychiatric care but agree to voluntary admission. Minors over a certain age may also be able to agree to voluntary mental health treatment, although parental or guardian approval is usually required.
After stabilization through voluntary admission, individuals may step down to outpatient treatment or partial hospitalization programs. These allow individuals to return home while continuing mental health treatment a few days a week. Transitional housing may also be an option, providing transportation to therapy sessions, medical appointments, and support groups.
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Self-harm as a response to emotional distress
Self-harm is when someone intentionally damages or injures their body, and it is a common way of responding to or expressing overwhelming emotional distress. It can include cutting, burning, or injuring oneself. Many people who self-harm do not want to die; instead, they resort to self-harming as a way to cope with their emotional pain.
Hospital admission rates due to self-harm are a useful measure of the prevalence of intentional self-harm and an indicator of how well we are preventing these mental health crises from occurring. Between 2012/13 and 2021/22, hospital admission rates for self-harm in individuals aged 10-24 increased by 40% for females and decreased by 22% for males. However, in 2022/23, there was a significant drop in hospital admissions due to self-harm for all age groups, which may be attributed to changes in reporting methodologies.
While self-harm can be a sign of underlying mental health issues, hospitalization in non-specialized general hospitals to prevent acts of self-harm is not routinely recommended. Instead, admission to a general hospital may be necessary to manage the medical consequences of self-harm and closely monitor the individual's behavior to prevent subsequent self-harm. In cases where there is an imminent risk of serious self-harm, urgent referral to a mental health service or close monitoring by family, friends, or other available resources is crucial.
For young adults who present to hospitals due to deliberate self-harm, follow-up psychiatric care is essential. Admissions to psychiatric inpatient treatment after general hospital treatment are more common for patients with a history of psychiatric treatment and diagnosed psychosis, mood, or personality disorders.
If you or someone you know is experiencing self-harm urges, suicidal thoughts, or difficulty taking care of basic needs, seeking help from a healthcare team is vital. Voluntary admission to a mental health hospital can provide stabilization during a crisis and help develop a plan for ongoing treatment through therapy, medication management, and other specialized programs.
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Gender differences in self-harm hospitalisation rates
Self-harm is a common way of responding to or expressing overwhelming emotional distress. Hospital admission rates are a useful measure of intentional self-harm and an indicator of how well we are preventing these mental health crises from occurring.
Between 2012/13 and 2021/22, the rate of hospital admissions for females aged 10–24 rose from 508 admissions per 100,000 population to 711 per 100,000 population – an increase of 40%. In 2022/23, this number decreased sharply to 531 per 100,000. For males in the same age group, the rate of admissions decreased by 22% from 193 per 100,000 population to 154 per 100,000 population during the same period. This decreasing trend continued in 2022/23, reaching 116 per 100,000 population – the lowest rate recorded to date.
The data suggests that young women aged 16–24 are more likely to report having self-harmed than young men. However, it is important to note that the true prevalence of self-harm could be much higher as these figures do not take A&E attendances into account. Additionally, the significant drop in hospital admissions due to self-harm across genders in 2022/23 may be attributed to a change in NHS England's reporting methodology, which reclassified Same Day Emergency Care (SDEC) cases, resulting in fewer admissions being recorded.
A study in Beijing, China, surveyed 32,362 students in grades 7 to 12 to evaluate the prevalence of self-harm and its association with drinking behaviours by gender. The results indicated that girls have consistently higher rates of self-harm than boys, with intense social media use and a lack of confiding in family members being associated with a greater likelihood of self-harm in girls.
Overall, these findings highlight the need for early identification, accurate diagnosis, and effective treatment of mental health conditions to prevent self-harm and suicide in children and young people, with a particular focus on addressing gender-specific risk factors.
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Psychiatric inpatient treatment after self-harm
Self-harm is defined as intentionally damaging or injuring one's body, and it is often a way to express or cope with overwhelming emotional distress. While hospitalization is not routinely recommended for self-harm, admission to a general hospital may be necessary to address the medical consequences of self-harm and prevent subsequent self-harm incidents. In such cases, close monitoring of the individual's behavior is crucial. If there is an imminent risk of serious self-harm, urgent referral to a mental health service is advised.
Psychiatric inpatient treatment for self-harm aims to address the underlying causes and provide therapeutic interventions to reduce self-harm behaviors. The National Institute for Health and Care Excellence (NIHCE) recommends exploring other options before considering inpatient admission. However, if self-harm is associated with treatable mental illnesses such as bipolar disorder, depression, or schizophrenia, short-term admission for medical treatment may be justified as the risk of self-harm decreases with proper treatment.
Various therapeutic, social, and environmental interventions have been implemented on psychiatric wards to reduce self-harm. Dialectical Behavior Therapy (DBT) has been the most frequently used and effective intervention, showing significant reductions in self-harm behaviors, especially in adolescent patients. Cognitive Behavioral Therapy (CBT) has also been effective in reducing overall self-harm cases in the community, but it may be more suitable for out-patients.
Other interventions, such as Skills to Enhance Positivity (STEP) and Systems Training for Emotional Predictability and Problem Solving (STEPPS), have also shown promising results in reducing hospital admissions for self-harm. These interventions focus on improving patient-staff communication and enhancing patients' ability to cope with emotions and solve problems. Additionally, early identification, accurate diagnosis, and effective treatment of mental health conditions can play a crucial role in preventing self-harm and promoting recovery.
Breaking the cycle of self-harm can be challenging, but it is achievable. Understanding triggers, replacing harmful behaviors with healthy alternatives, such as exercise or art, and seeking professional help are essential steps in the recovery process. Crisis support services, such as text-based counseling, can provide individuals who self-harm with immediate assistance and strategies to manage their emotions effectively.
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Legality of treating self-harm patients who refuse treatment
Treating self-harm patients who refuse treatment is a complex issue that requires careful consideration of the patient's capacity to consent and the applicable laws, such as the Mental Health Act. In the UK, the Mental Health Act 1983 (or the Mental Health (Scotland) Act 1984) provides a framework for managing such situations.
The law recognises the importance of respecting a patient's autonomy and their right to make decisions about their own body. In the case of competent adults, there is a presumption of competence to refuse medical advice and treatment, even in emergency situations. This presumption can be rebutted if there is evidence that the patient lacks capacity to make decisions. The burden of proving lack of capacity falls on those who wish to treat the patient against their will.
The Mental Health Act comes into play when an overdose or act of self-harm is considered a consequence of a mental disorder. In such cases, the patient may be detained and treated under the Act, even if they have refused treatment. However, this is a complex area of law, and the Mental Health Act Commission has expressed concern that misinterpretations of the Act may lead to further confusion and potentially unlawful detentions.
To ensure legal and ethical practice, doctors must be well-versed in the law on assessing capacity and the application of the Mental Health Act. In the case of R v Collins and Others ex p S, the Court of Appeal found that detaining a patient who refused treatment was unlawful because there was no intention to assess or treat her mental disorder. This highlights the importance of ensuring that any detention or treatment is carried out with the proper purpose of addressing a patient's mental health needs.
Additionally, the House of Lords has ruled that doctors should provide competent patients with adequate information to enable them to make informed decisions about their treatment. This includes understanding the potentially lethal consequences of their actions and the importance of immediate treatment. If a patient is competent and their refusal is respected, they cannot later sue for negligence or negligent advice. However, if a patient lacks capacity and is not treated, there could be a claim of negligent failure to treat.
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Frequently asked questions
Hospitalization is often necessary if the individual is violent, extremely agitated, uncommunicative, or at risk of harming themselves or others. Hospital admission may also be required if the individual has a history of psychiatric treatment and a diagnosis of psychosis, mood, or personality disorders.
Early identification, accurate diagnosis, and effective treatment of mental health conditions can prevent self-harm and suicide. Many people with mental health issues can benefit from outpatient treatment, but some may require a temporary stay in a mental health hospital.
Between 2012/13 and 2021/22, hospital admission rates for self-harm in females aged 10-24 increased by 40%, followed by a sharp decrease to 531 per 100,000 in 2022/23. During the same period, admission rates for males decreased by 22%, continuing to fall to 116 per 100,000 in 2022/23. The overall decrease in admissions across all age groups in 2022/23 may be due to changes in reporting methodologies.
Yes, individuals can voluntarily admit themselves to a mental health hospital to help stabilize during a crisis and develop a plan for future treatment. However, if the individual refuses treatment, managing their care becomes complex, and the legality of providing treatment without consent is questionable.
