GPs do not feel equipped to manage people who self-harm, study finds

GPs do not feel equipped to manage people who self-harm, with limited consultation times being a barrier to delivering good care, a new study has found.

The joint research study, conducted by University College Cork and Keele University in Newcastle, England, has significant implications for the training of GPs in Ireland, the researchers added.

Self-harm is a serious risk factor for suicide, and more than half of young people who die by suicide have a history of self-harm.

There are increasing self-harm rates reported among male patients in mid-life, and people aged over 65 who self-harm are at an increased risk of suicide.

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The research, published in the British Journal of General Practice this week, identified barriers and facilitators which had an impact on GP management of patients who self-harm.

It found that the current limited consultation times in general practice with people who self-harm, and existing shortages of alternative and support services for people who self-harm are barriers to the provision of good care.

The development of clinical guidelines to establish how best to treat those who self-harm was identified as a method to facilitate effective GP care.

Denis McCauley, chairman of the GP sub-committee for the Irish Medical Organisation (IMO), acknowledged that capacity issues can make care difficult.

“GPs are good problem solvers, good assessors. But our job is to plan a pathway of care,” he said.

“People who are self-harming due to suicidal ideation, there is a clear pathway there but people who are self-harming down to low self-esteem, for example, they need a multi-disciplinary team to treat them.”

He added that some of these services have “severe deficiencies”, resulting in patients being put on waiting lists.

“So there is help available, but it’s not always available quickly,” he added.

Training

The research was conducted through a systematic review, which analysed 12 studies published between 1997 and 2016, on 789 GPs and family medicine physicians, from Europe, America and Australia.

Dr Isabela Troya, from University College Cork and the National Suicide Research Foundation, said generally people who self-harm first present themselves in community settings, such as GP care.

“This is extremely relevant to Ireland as there are over 2,500 registered general practitioners in Ireland who are the first point of contact to patients seeking medical support,” she said.

“Our review shows that GPs recognise self-harm as a serious risk for suicide, but many report feeling unprepared to manage self-harm.”

She added: “This has implications for GP training in Ireland and worldwide. In Ireland, previous research conducted by the National Office for Suicide Prevention with over 469 GPs has highlighted GPs reported limited suicide prevention training.”

Dr Troya, one of the authors of the research paper, said GPs and primary care are ideally positioned to address mental health issues and this research can be the foundation to establish how GPs can improve the care individuals who self-harm receive.

[ jo@samaritans.ie ]