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

This study was designed to investigate the clinical and economic aspects of deliberate self-poisoning services in four teaching hospitals in Leeds, Leicester, Manchester and Nottingham. We investigated the management of the current self-harm episode, including direct in-hospital costs, in 456 individuals 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 patients received specialist psychosocial assessment or follow-up. Patients were more likely to receive an assessment if they were already in contact with psychiatric services, had a history of previous overdoses, if they presented during working hours, or if they lived near the hospital. Patients who were 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 care unit accounted for 47% and 8% of the total costs, respectively. This study suggests that general hospital services are disorganised, with evidence of inequitable access to specialist assessment and after-care. This state of affairs cannot be justified on financial or clinical grounds.