Summary
Self harm rates in the UK are amongst the highest in Europe, resulting annually in 220,000 emergency presentations to hospital presentations in England (Hawton et al. 2007), and 6,000 in Wales (NPHS 2008). The hospital costs of self-harm in the UK have been estimated to be £56m. However despite such high presentations the majority of incidences of self-harm do not present to hospital and are managed through primary care (Dennis et al 1990) or do not come to attention of health services (Guthrie et al 2001).
Self harm is a key predictor of suicide (Owens et al 2002). There is an elevated risk of repeat suicide attempts in the months following a suicide attempt (Ho 2003). The distribution of suicide is not geographically even and differences exist within and between countries (Rehkopf and Buka 2006). Suicide rates in Wales are high and male suicide rates in Wales are above the UK average and at the highest level since 1981.
Self harm has been found to be associated with negative life events and a range of psychosocial problems (Kielty et al 2014), including family problems, relationship breakdowns, unemployment, isolation and financial problems (Hawton et al 2003, Guthrie et al 2001). Poor social integration increases suicide risk and increased social interaction can buffer against risk (Duberstein et al 2004). An intervention which includes social interaction can offer a vital source of support for isolated individuals. Follow up contacts for individuals can provide reassurance and sense of connectedness (Carter et al 2005).
This study adapts an Australian study which delivered a brief intervention to patients who presented to hospital with self harm. They report the intervention which reduced depression symptoms and increased quality of life (Petrakis and Joubert 2013). SWISH is a non-clinical service working with patients in hospital and primary care settings across Carmarthenshire to offer a brief contact intervention to support patients at a vulnerable time and link them into existing community services to encourage their sense of social connectedness. For those who are referred on to other health care services SWISH works as a ‘bridging service’ to keep patients engaged and supported whilst they wait for appointments.
The authors thank the SWISH team (Professor Peter Huxley, Dr. Ann John, Mihaela Barbu, Saiful Islam, Professor Ian Russell, Lily Bidmead, Penny Llewelyn, Angie Darlington and Dr. Phil Jones) and Professor Lynette Joubert at Melbourne University.
Funded by NISCHR / Welsh Government
Contact Details
Trial Manager / Lead Contact: Dr Nilufar Ahmed
Email: n.ahmed@swansea.ac.uk