Predictors of A&E staff attitudes to self-harm patients who use self-laceration: influence of previous training and experience.

OBJECTIVE: The aim of this study was to investigate the attitudes of accident and emergency (A&E) staff towards patients who self-harm through laceration.
METHODS: We developed a questionnaire using focus group methodology. Questionnaires were distributed to 117 A&E staff members.
RESULTS: Of the staff, 53.8% responded. The staff believed that self-laceration was an important problem but felt unskilled in managing patients. The staff were unsure of the relationship between self-laceration and both mental illness and risk of suicide. They had previously received little training in managing this condition. In those staff without previous training, a longer period working in A&E was correlated with higher levels of anger towards patients and an inclination not to view patients as mentally ill. A&E staff were keen for further training and wanted a higher proportion of patients to be seen by specialist mental health services.
CONCLUSIONS: This study highlights the need for greater staff training in A&E. Despite considerable experience in the field, we found evidence for unhelpful attitudes amongst some staff. This is particularly true for more senior staff without previous DSH training, who, as a group, were less sympathetic to this group of patients. Unfavourable attitudes of health professionals are likely to adversely influence the quality of clinical care delivered to DSH patients who use self-laceration as well as those who use other methods of self-harm.