Preventing Suicide and Deliberate Self Harm
Laying the Foundations: Identifying Practice Examples
Project Report
4. Ward 1A, Royal Infirmary of Edinburgh
Target Group
Ward 1A has nine toxicology beds, plus it operates an overspill into the medical assessment wards. The team undertakes all toxicology work - both accidental or drug-related. The ward sees approximately 3000 presentations per year.
Sometimes people are referred to the ward from local psychiatric hospitals, for example, the Royal Edinburgh Hospital - people who have overdosed whilst in hospital there. They would be treated medically and then transferred back.
The ward will take anyone aged 12 upwards. At times it may be felt more appropriate for young or elderly patients to be placed on one of the other wards within medical assessment.
Issues
The ward assesses and treats people who have deliberately harmed themselves - this will be all kinds of self-harm, as well as drug overdoses.
The follow-up service for people who have been on the ward works with people around issues such as abuse, bereavement or relationship difficulties.
Services/approach
The team at Ward 1A are unusual in that they admit people who don't necessarily require medical intervention, for example, if the person has already been sutured at Accident and Emergency. The idea is that it gives the team time to assess the person, and time out for the person as well. It is not always appropriate for someone to be assessed at Accident and Emergency. It also gives the person time in bed and time for relatives and friends to make contact. And if the person is under the influence of alcohol, it gives them an opportunity to sober up.
It is known that they will give people a bed in the ward, so in order to prevent dependency on the system, they keep a Frequent Attender File. Frequent patients would be encouraged to attend for medical treatment but will not be assessed psychiatrically on each occasion. They would be discharged once medically fit. This would be for cases where a comprehensive assessment has already been undertaken on the ward, and contact has already been made with the person's GP. They review individual cases every three or six months.
Accident and Emergency will fast track people to ward 1A instead of letting the person sit around in A&E for hours. This is less stressful for the person, but also better from a clinical point of view, in that if, for example, the person has overdosed on paracetamol, they have to be treated within a certain time frame.
The team have a database of local resources - debt advice, counselling, housing, GPs, emergency contacts, etc, which they use to help people access other services. They also use other databases, such as InTouch and the HEBS database. The Charge Nurse also makes links with other organisations in order to smooth referrals. It is important to know what is available in the community and to give patients a choice and ideas to think about.
The Charge Nurse also offers a follow-up service to people who have been on the ward. She will work with people around issues such as abuse, bereavement or relationship difficulties. She will also work closely with the person's GP - liasing with primary care services is important. The case-load is around 3-12 people who she sees either weekly or fortnightly. The follow-up service gives people more space to talk, and people often use the opportunity to disclose what is going on for them.
The follow-up service is important in that work around reducing self-harm involves finding a window of opportunity for the person to disclose what is going on for them. The service also helps the person look at triggers to self-harm, work out alternative ways of coping and helps people link into self-help groups.
If the self-harm is chronic and it is felt that a person needs a lot of help, they will sometimes refer them on to specialist organisations such as Wounded Wings. If, for example, the person is coping with a specific issues such as having been abused, they would refer on to a specialist organisation such as the Pathway project.
Some people they see at Ward 1A need specific psychological help. The psychiatric staff will refer people onto appropriate services. They will also refer people onto local psychiatric services if necessary.
The DSH team also provides training for workers at community-based projects as well as to hospital-based workers such as staff in Accident and Emergency. The training covers issues such as the difference between a suicide attempt and deliberate self-harm.
Key features
For further information, contact:
Sandra de Munoz, Charge Nurse
Ward 1A
Royal Infirmary of Edinburgh
1 Lauriston Place
Edinburgh, EH3 9YW
Tel 0131 536 1000