PSYCHOSOCIAL ASSESSMENT

Psychosocial Assessment



Psychosocial Assessment

Introduction

Self-harm is a major public health problem (National Collaborating Centre for Mental Health, 2004) and is strongly associated with subsequent suicide (Owens et al., 2002). The association between self-harm and mental illness is more contentious but studies using standardized interviews suggest that over 90% of individuals have evidence of psychiatric disorder at the time of presentation, with affective disorder being the single most common diagnosis (Haw et al., 2001).

Clinicians (Isacsson and Rich, 2001) and clinical guidelines alike ( [Royal College of Psychiatrists, 2004] and [National Collaborating Centre for Mental Health, 2004]) agree that psychosocial assessment-assessment of personal circumstances, social context, mental state, risk, and needs-is central to the clinical management of self-harm. All patients should receive such an assessment. It may improve access to aftercare ( [Kapur et al., 1999] and [Barr et al., 2005]) or may be therapeutic in its own right ( [Whitehead, 2002] and [National Collaborating Centre for Mental Health, 2004]). However, there are wide variations in practice between hospitals in England with many patients not receiving an assessment ( [Kapur et al., 1998] and [Bennewith et al., 2004]). There is also confusion about who should carry out psychosocial assessments. Although non-specialist staff can be trained to perform assessments, in practice most centres rely on mental health staff (Royal College of Psychiatrists, 2004).

Studies that have compared the characteristics of those who receive and do not receive a psychosocial assessment have been carried out in single centres ( [Hickey et al., 2001] and [Barr et al., 2005]) or in multiple centres over short time periods using limited measures ( [Kapur et al., 1999], [Gunnell et al., 2004] and [Bennewith et al., 2005]). There has been little investigation of how assessment influences outcome. Data from two small studies suggest that psychosocial assessments may be protective — they appear to be associated with a reduced risk of self-harm repetition ( [Hickey et al., 2001] and [Kapur et al., 2002]).

The Multi-Centre Monitoring of Self-Harm Project was initiated in response to the National Suicide Prevention Strategy for England (Department of Health, 2002). Its purpose is to provide high quality data from several centres to support suicide prevention and examine national trends in self-harm. The current study reports data from the first phase of the project. Our aim was to investigate the role of specialist psychosocial assessment in the management of patients following self-harm.

Methods

Setting and participants

Despite considerable research, the etiology of schizophrenia remains unclear. Genetic contributions are certain but relatively small. The identified brain changes associated with this disorder are subtle. There is fairly good evidence that neurotransmitters, particularly dopamine and serotonin, are implicated in the expression of psychosis. Many of the medications used to treat schizophrenia modulate these chemicals. However, the negative symptoms, such as emotional flattening and the cognitive deficits of schizophrenia, appear to arise from some other unknown biological mechanism, and consequently medications are less effective in treating these symptoms. It is now believed that schizophrenia involves problems in the development of connections between neurons, and ...