Investigating mental health practitioners’ referral decisions to mental health services for people attending the Emergency Department for self-harm: A mixed methods enquiry
More than 200,000 people attend the emergency department (ED) for self-harm. For these people, the ED serves as a crucial point of contact for accessing care after a crisis. Mental health practitioners in the ED conduct comprehensive psychosocial assessment of the person’s needs and risk of harm, decide aftercare, including admission into hospital, referral to mental health services, or discharge without formal mental health service referrals.
However, recommendations of aftercare provided in psychosocial assessments are increasingly influenced by systemic barriers to access mental health support and a ‘culture of exclusion’ has been anecdotally reported. Patients, consequently, describe a gap between the help sought and help recommended.
The research project seeks to understand:
- why these exclusionary practices can occur considering the perspective of practitioners
- how they can be communicated and justified to people seeking help for self-harm
- the impact these practices have on journeys through the mental health system for people who self-harm.
A review of existing evidence and ethnographic observations will be conducted to identify factors that influence referral decisions by mental health practitioners.
Psychosocial assessments in emergency departments across England will be recorded and analysed. Conversation analysis will be used to understand how referral decisions are made between mental health practitioners and patients in psychosocial assessments. This will be triangulated with written justification of the referral decision on the patient’s medical record.
Finally, longitudinal narrative interviews will be conducted with patients to explore the impact of these practices and their experiences of accessing and navigating the mental health system.