Do older people who self‐harm receive the hospital care they need? Available to Purchase

Although self‐harm is most common in younger people in Britain, the risk of suicide subsequent to an initial act of self‐harm is considerably greater in older age groups. Four characteristics have been shown to be associated with increased vulnerability in older people who self‐harm: increased suicidal intent, physical illness, mental illness and social isolation. This paper is part of a broader analysis of all self‐harm presentations to a British hospital accident and emergency department over a five‐year period. It examines the prevalence of these vulnerability indicators in patients aged 65 or over, and considers whether greater vulnerability in older patients is reflected in their clinical management within the hospital and in community support planning on discharge.At the first presentation older patients (n=91) exhibited greater vulnerability than did younger patients (n=2,326). Despite this, we found no evidence that older self‐harm patients were any more likely than younger patients to routinely receive either a psychosocial assessment from a member of staff with specialist mental health training, or community aftercare planning on discharge from the hospital. This study lends weight to recently published national guidelines recommending that all acts of self‐harm in older people be regarded as evidence of serious suicidal intent at the outset.