Perspectives of GPs supporting young people who self-harm: a qualitative study

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

1C.3

Presenter:

Faraz Mughal

Twitter:

@farazhmughal

Co-authors:

Benjamin Saunders, Lisa Dikomitis, Gillian Lancaster, Christopher J Armitage, Ellen Townsend, Carolyn A Chew-Graham

Author institutions:

School of Medicine Keele University, Kent and Medway Medical School University of Kent and Canterbury Christ Church University, Division of Psychology and Mental Health University of Manchester, School of Psychology University of Nottingham.

Problem

Reducing self-harm in young people is an international public health priority; and self-harm is the strongest risk factor for suicide. Emotional distress, mental illness, and relationship difficulties, which have all been exacerbated by COVID-19, are risk factors for self-harm. Rates of self-harm in young people presenting in primary care are increasing, and GPs have a key role in the management of young people who self-harm. Young people have described varied experiences of care for self-harm in general practice, but perspectives of GPs about managing self-harm in this population have not previously been explored. Young people with lived experience of self-harm stated that examining GP views is important, and they co-developed this study’s aim: to explore the perspectives of GPs on the presentation and management of young people who self-harm, and to understand the impact COVID-19 has had on this.

Approach

Semi-structured interviews were conducted remotely with GPs (n=15) across England. Purposive sampling aimed for a maximum variation sample in participant age, gender, years in practice, employment role, and practice list size and index of multiple deprivation. Recruitment was facilitated through Local Clinical Research Networks. Interviews were audio-recorded, transcribed verbatim, and thematic analysis with principles of constant comparison was conducted. A patient and public involvement group informed recruitment techniques, the interview topic guide, and interpretation of data.

Findings

The age of GPs ranged from 32-52 years; seven were male, and eight, female. GPs were from the Northeast, Midlands, East of England, London, and the Southwest; and undertook between two and 10 clinical GP sessions on average each week. GPs understood self-harm to be broad in nature with a spectrum of severity, and perceived COVID-19 to have influenced young people’s access to general practice for self-harm care. GPs described a variety of strategies for managing young people who self-harm: treating underlying mental illness, offering distraction techniques, and signposting. GPs explained how remote consulting (video and teleconsulting) due to COVID-19 reduced the opportunity to identify non-verbal cues and develop relationship-based care: elements of the consultation that can be critical in supporting young people who self-harm.

Consequences

These findings highlight how GPs conceptualise self-harm, and their approaches to the management of self-harm, in young people. COVID-19 appears to have impacted on access to care for young people; and subsequently remote consulting may hinder GPs when managing self-harm. This study will generate primary care practice recommendations for supporting young people who self-harm and will inform the development of a GP-delivered intervention to reduce self-harm in young people.

Submitted by:

Faraz Mughal

Funding acknowledgement:

This study was funded by an NIHR Doctoral Fellowship, FM, NIHR300957. CAC-G is funded through the NIHR Applied Research Collaboration, West Midlands, and CJA through the NIHR Greater Manchester Patient Safety Translational Research Centre. The views expressed are those of the authors and not necessarily those of the NIHR, the NHS, or the Department of Health and Social Care.