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Self-harm is one of the most common reasons for people to present to EDs.1 Ambulance clinicians are often the first professionals involved in their care. This encounter affects immediate actions and long-term outcomes by influencing future help-seeking behaviour.2 Little is known about prehospital care for people who self-harm,3 although assessing and managing this group represents a unique challenge for ambulance clinicians.4 This study aims to explore the views and experiences of Yorkshire Ambulance Service (YAS) clinicians of prehospital care for self-harm.
This is a cross-sectional questionnaire using an online platform (Online Surveys, www.onlinesurveys.ac.uk; Jisc). The questionnaire was designed by the research team and piloted by four YAS academic paramedics (see online supplemental file 1). It was open from 5 to 30 September 2022 and shared with ambulance clinicians (clinicians working on ambulances) employed by YAS using social media and email bulletins. Multiple-choice answers were analysed using descriptive statistics; free-text responses were analysed independently by two researchers (DR, EG) using thematic analysis.5
Twenty-six clinicians responded to the questionnaire, representing a 0.9%–1.0% response rate. Seventeen (65%) were female and 16 (62%) were paramedics. Seventeen (65%) reported not receiving specific mental health training in their roles. Self-harm was a common presentation in their experience; 19 (73%) indicated that they were called to assess or manage a patient who had self-harmed in the previous 2 weeks. Only nine (35%) felt confident caring for this group, and four (15%) felt that their training and education had adequately prepared them. Table 1 summarises the responses to the multiple-choice questions.
Listed facilitators to good clinical care for people who have self-harmed included previous clinical experience, training in mental health and injury management, availability of mental health services and advice, verbal and non-verbal communication skills, online resources and support from senior colleagues. They were then asked to identify barriers to good clinical care for this group. The following themes emerged: lack of mental health pathways, services and support, lack of mental health education and training and patient factors.
Respondents were asked about their views on the future of emergency care for self-harm. They indicated that confidence and competence in mental healthcare among ambulance clinicians could be improved by mental health training and education, improved availability of mental health and wound care services and better access to senior support and advice. The following themes emerged among suggestions for improvements to the acute care pathway for self-harm: alternatives to EDs, increased availability of mental health support, more staff and resources, mental health training and guidance for the management of patients declining to attend hospital.
All participants responded to all free-text questions. Table 2 summarises the results of the free-text questions, including key themes, supporting quotations and number of respondents belonging to each theme.
This preliminary study was limited by the low response rate but strengthened by the breadth of qualitative data. The findings show that the clinicians who responded do not feel confident or prepared when assessing and managing patients who have self-harmed. Improvements in mental health training for ambulance clinicians and greater availability of mental health services are needed to improve prehospital care for people who self-harm.
We have begun to address the literature gap in paramedic care for self-harm. Respondents support the National Institute for Health and Care Excellence recommendations that alternative services to EDs, such as specialist mental health services and primary care, could improve patient satisfaction and engagement.6 This should be considered by commissioners and policymakers.
Patient consent for publication
This study was approved by University of Leeds (MREC 21-068). Participants were required to agree to an online consent statement before proceeding; completion was also taken to imply consent.
Handling editor Aileen McCabe
Contributors All authors contributed to the focus of this study. DR designed the survey and obtained ethical approval. DR and EG analysed the data. DR drafted the initial manuscript with guidance and feedback from EG and SMM. All authors approved the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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