Deliberate Self-harm and Predictors of Out-patient Attendance

Abstract

Kreitman (1979) reported that up to one-half of patients given out-patient appointments one week after an episode of deliberate self-harm (DSH) fail to attend, and gave a number of possible explanations for this. Firstly, parasuicide is often the result of a crisis which may have resolved (albeit temporarily) by the end of a further week. Secondly, someone in a state of heightened tension may find one week too long to wait, and may resort to other strategies to deal with his problems. Thirdly, many parasuicides may find a psychiatric label unacceptable in the context of their problems, and fourthly, an appoint ment made for a fixed day and a fixed hour may not fit the need for immediate action which the subjects subculture had inculcated in him as a habit pattern. Morgan et al (1976) reported that up to 40% of their DSH patients either did not attend any appointment or failed to complete their treatment. Two possible explanations for this were that they either felt that they did not need psychiatric treatment, or else believed that psychiatric treatment was not an answer to their problems. Kessel and Lee (1962), probably in line with much psychiatric practice, did not give a follow-up appointment to 40% of their self-poisoners; this was for two reasons. Firstly, these patients did not have a problem for which psychiatric treatment was appropriate and secondly, many of these patients had an entrenched personality disorder, which made it unlikely that psychiatric intervention would be beneficial.