KEY POINTS:
Two-thirds of the people admitted to hospitals with a drug overdose or some other kind of self-harm are walking out without effective mental health treatment - and one in 10 will be dead within five years.
A study by Auckland University psychiatrist Simon Hatcher has found that hospitals
are failing to intervene before it is too late for many.
He told a World Suicide Prevention Day seminar in Auckland yesterday that multi-disciplinary teams were needed to fill the gap, including social workers, Work and Income, Accident Compensation Corporation (ACC), drug and alcohol counsellors and physical health professionals, as well as mental health specialists.
New Zealand hospitals see between 5000 and 6000 cases of self-harm every year - 1.35 per cent of the population, a higher rate than for diabetes.
More than three-quarters of the cases are drug overdoses, almost three-quarters are female and their average age is 30.
Although only 1 per cent actually commit suicide in the following year, Dr Hatcher quoted five studies which found that between 5 per cent and 15 per cent die within five years, mostly from less obviously suicidal causes such as heart disease, respiratory disease and accidents.
One study found that alcohol was mentioned on 36 per cent of their death certificates. Dr Hatcher said 95 per cent of people admitted to hospitals for self-harm were given a psychiatric assessment, and most were referred to a mental health crisis team or a mental health centre.
But in study of 187 people admitted for self-harm in the Waitemata District Health Board, where he works, he found that in the subsequent six months:
* Only 69 per cent actually had any contact with either a crisis team or mental health centre
* Only 57 per cent had even a phone call from a crisis team
* Only 30 per cent actually saw a crisis team member face to face
* Only 20 per cent had contact with a community mental health centre.
"A phone call is probably not an effective intervention, especially with a group that has such a high mortality rate," Dr Hatcher said.
"It's not necessarily the fault of the crisis team.
"It's a difficult area to chase people up aggressively.
"Some would be referred to the crisis team but don't make contact and can't be contacted because they have moved house, changed phones and so on."
But he said the teams needed more resources to track people down, and the health services needed to provide a wider range of options for people who deliberately harmed themselves.
"The ideal way to do it is to have a dedicated self-harm team in the same way as dedicated stroke teams. "They need to be multi-disciplinary, including mental health and physical health and non-health staff from non-government organisations, Work and Income, ACC and social workers, because people who present with self-harm often have multi-faceted problems.
"Drug and alcohol agencies are involved a bit.
"They would need to be in any multidisciplinary team."
He said the Waitemata board had just appointed three psychiatric nurses to assess every patient presenting with mental health issues such as self-harm at North Shore Hospital's emergency department.
"The nurses will be doing the assessment and trying to ensure that people do get adequate follow-up. So Waitemata is already beginning to address the problem," he said.
"But it's not a specific self-harm team."
He hopes that the Ministry of Health will earmark money for specific self-harm teams in its national suicide prevention action plan, due to be published shortly.
SELF-HARM
* Hospitals see between 5000 and 6000 cases of self-harm a year.
* 95 per cent get psychiatric assessments.
* Only 30 per cent get more than a follow-up phone call from a mental health crisis team within six months.
* Between 5 and 15 per cent are dead within five years.
