General hospital services for deliberate self-poisoning: an expensive roadto nowhere?

This study was designed to investigate the clinical and economic aapects of deliberate self-poisoning services in four teaching hospitals in Leeds, Le icester, Manchester and Nottingham. We investigated the management of the c urrent self-harm episode, including direct in-hospital costs, in 456 indivi duals who presented to hospital on a total of 477 occasions with deliberate self-poisoning during a 4-week period in 1996. Fewer than half of the pati ents received specialist psychosocial assessment or follow-up. Patients wer e more likely to receive an assessment if they were already in contact with psychiatric services, had a history of previous overdoses, if they present ed during working hours, or if they lived near the hospital. Patients who w ere admitted were nearly twice as Likely to, receive specialist assessment, and those who received a specialist assessment were nearly three times as likely to be offered follow-up. in-patient days and days on the intensive c are unit accounted for 47% and 8% of the total costs, respectively. This st udy suggests that general hospital services are disorganised, with evidence of inequitable access to specialist assessment and aftercare. This state o f affairs cannot be justified on financial or clinical grounds.