An Audit of Risk Assessments and Management for Self-Harm and Suicide in Patients with Depressive Symptoms at the Reedyford Healthcare Group

Talk Code: 
Win Let Oo
Author institutions: 
University of Central Lancashire

The Problem

Over 5 million adults in England are living with depression, with the highest prevalence rates recorded in the North West and North East of England, 12.88% and 11.53%, respectively (NHS Digital, 2019). Depression is also associated with the highest rates of self-harm and suicide (SH&S) (Singhal, Ross, Seminog, Hawton, & Goldarce, 2014). The impact of SH&S on a family ranges from shock and horror to, blame, secrecy and shame. Survivors may also be negatively judged or self-stigmatise (Cerel, Jordan, & Duberstein, 2008). Managing self-harm episodes has a significant financial implication for the NHS (Tsiachristas, et al., 2017). If high-risk individuals are identified and intervened early, it would not only save lives but also potentially reduce financial strains.

My Approach

A retrospective audit of 62 patients presenting with depressive symptoms over 3 months was performed at The Reedyford Healthcare Group, a practice of 11,000 patients in Nelson, Lancashire. The audit was to evaluate the performance of risk assessment and management of SH&S against the National Institute for Health and Care Excellence guidelines for adults with depression. Two criteria were included with associated standards of 100%:

  1. All patients with depression should be assessed for suicidal ideation and intent by asking direct questions.
  2. A patient presenting with significant risk to self/others should be referred to specialist mental health services the same day, as soon as possible.

The Learning

42 patients were asked direct questions about SH&S. 2 patients presenting with immediate risk were urgently referred to specialist services. The results indicated that the practice could improve, and a quality improvement approach has been planned.

Why It Matters

The assessment of risk in patients presenting with depression is vital. This audit shows that it is not always done in practice. The author has not found other published audits on this topic and suggests that this may be appropriate for national audit. This is particularly prudent with the current concern regarding mental health in the COVID-19 pandemic.


Presenter: Ms Win Let Oo, 4th year medical student, University of Central Lancashire




Cerel, J., Jordan, J. R., & Duberstein, P. R. (2008). The Impact of Suicide on the Family. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 29(1), 38-44.

NHS Digital. (2019, October 24). NHS Digital. Retrieved from NHS Digital:

Singhal, A., Ross, J., Seminog, O., Hawton, K., & Goldarce, M. J. (2014, May). Risk of self-harm and suicide in people with specific psychiatric and physical disorders: comparisons between disorders using English national record linkage. Journal of the Royal Society of Medicine, 107(5), 194-204.

Tsiachristas, A., McDaid, D., Case, D., Brand, F., Leal, J., Park, A.-L., . . . Hawton, K. (2017). General hospital costs in England of medical and psychiatric care for patients who selfharm: a retrospective analysis. The Lancet Psychiatry, 759-767.