General practitioner management of self-harm in young people in England: a qualitative study

Conference:

2021 SAPC North (virtual)

Talk Code:

2B.2

Presenter:

F Mughal

Co-authors:

Mughal F1,2,3, Dikomitis L1, Townsend E4, Armitage CJ3,5, Lancaster G1, Chew-Graham CA1,3,6,7

Author institutions:

1. School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG 2. Unit of Academic Primary Care, Warwick Medical School, University of Warwick 3. National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre 4. Self-Harm Research Group, School of Psychology, University of Nottingham 5. Manchester Centre for Health Psychology, The University of Manchester 6. Midlands Partnership NHS Foundation Trust, Stafford 7. National Institute for Health Research Applied Research Collaboration West Midlands

Background

Self-harm in young people is a national public health priority, and self-harm is the strongest risk factor for suicide. Rates of self-harm in young people presenting in primary care are increasing, and GPs have an important role in the management of young people who have harmed themselves. Young people have described varied experiences of GP care for self-harm, however, the clinical approaches of GPs to young people with self-harm behaviour, and the impact of COVID-19, has not previously been explored. This study aimed to seek the perspectives of GPs on presentation and management of self-harm in young people and how COVID-19 has impacted this.

Approach

Semi-structured remote interviews were conducted with GPs around England. Purposive sampling aimed for a maximum variation sample in participant age, gender, years in practice, employment role, and practice list size. Recruitment has been facilitated through four NIHR Local Clinical Research Networks. Interviews were audio-recorded and transcribed verbatim. Transcripts formed the data and inductive thematic analysis with principles of constant comparison is ongoing. A patient and public involvement group informed this study’s conception, have advised on recruitment techniques and the interview topic guide, and will contribute to interpretation of data and dissemination.

Findings

Nine interviews have so far been conducted. Preliminary findings suggest that GPs use a variety of strategies for managing young people who self-harm in the consultation including treating underlying mental illness and signposting. GPs have found that COVID-19 and remote consulting reduces the opportunity to identify non-verbal cues which can be critical in young people who self-harm.

Implications

The understanding of how GPs conceptualise and manage self-harm in young people and how COVID-19 has influenced this will inform clinical practice recommendations on the primary care management of young people with self-harm behaviour.

Funding acknowledgement:

This research is funded through FM’s NIHR Doctoral Fellowship (NIHR300957). CCG is part funded by the NIHR Applied Research Collaboration West Midlands. CJA is supported by the NIHR Greater Manchester Patient Safety Translational Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, NIHR, or the Department of Health and Social Care.