Imperative of improving outcomes of hospital-treated self-harm

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Kylie Woolcock
By
Australian Healthcare and Hospitals Association
Kylie Woolcock,
Chief Executive Officer
Issue
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The COVID-19 pandemic has brought issues of access to mental health services to the forefront of Australians’ minds, with a widening gap in Australia’s healthcare system. This increase in public awareness has led to a push by government to address this issue through policy initiatives, such as the National Mental Health and Suicide Prevention Agreement.

Regional, rural and remote Australians experience issues of access to mental health services more acutely, compounded by distance and a lack of regional specialist services. Advocates, peak bodies, and government organisations such as the Productivity Commission, have all identified the need to support Australians living outside of metropolitan areas to lead happier and more fulfilling lives.

Self-harm is associated with mental ill health and is a public health priority. Self-harm alone results in over 30,000 hospital admissions annually and is the strongest independent indicator for a later suicide attempt. The consequences of self-harm fall disproportionately on the shoulders of regional Australians, who are up to twice as likely to die by suicide as their metropolitan counterparts. The likelihood of suicide is known to increase with remoteness and has increased overall in recent years.

The rates of hospital-treated self-harm are highest in very remote areas, at nearly twice the rate of major cities. A policy paper published through the Australian Healthcare and Hospitals Association (AHHA) research arm, the Deeble Institute for Health Policy Research, has now explored how better data can improve care for hospital-treated self-harm, as an important suicide prevention objective.

Routine care for hospital-treated self-harm is variable and can be substandard. Many people report that they experience stigmatising, judgemental and invalidating responses when presenting to health services for help after self-harm or when in suicidal crisis. Available care is failing to meet patients’ needs and linkage to mental health services after discharge is not routine. Despite these known issues, there is no data infrastructure to support hospitals to begin to address them. Instead, monitoring and service improvements are largely localised.

While there has been some progress in the availability of hospital-treated self-harm data, these efforts have not been designed for the purpose of enabling service improvement. For data to be used to improve practice, effort will be needed to improve the accuracy and scope of the data being collected, presentation and outcomes data must be linked, and practice translation supports introduced.

The establishment of a clinical quality registry for hospital-treated self-harm is one mechanism that would provide the necessary data infrastructure to allow linkage of self-harm data to practice, creating quality assurance and helping to ensure that investment in self-harm surveillance improvements translates into better local care.

Such a strategic approach will be critical to assisting the transformation of local leadership into regional quality assurance infrastructure, through resourcing adequately for demand and tailoring services to meet priority population needs.

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