The role of the General Practitioner in the management of patients with self-harm behaviour in primary care: a systematic review

Problem

Around 220,000 people present with self-harm (SH) annually to emergency departments across England. SH is the strongest risk factor for suicide. A key area of the National Suicide Prevention Strategy (2017) is: ‘reducing rates of SH as a key indicator for suicide risk’. Two-thirds of people present to their General Practitioner (GP) in the month preceding a SH episode and within the month following SH. GPs are thus well placed to intervene to prevent SH, repeat SH, and suicide.

The aim of this systematic review is to explore the role of the GP in the management of people with SH behaviour in primary care and to contribute to the development of a primary care intervention which could reduce SH rates.

Approach

This systematic review is conducted and reported in accordance with PRISMA guidelines. A systematic search of published literature on the role of the GP in the management of SH was conducted in six electronic databases: MEDLINE, PsychINFO, EMBASE, CINAHL, AMED, and Web of Science. Titles, abstracts, and full texts of articles were independently screened by two reviewers against pre-defined eligibility criteria, with discrepancies resolved by discussion or a third reviewer. The quality of included studies was appraised using the Mixed Methods Appraisal Tool. Data extraction included: study design; knowledge, attitudes and behaviours of GPs and facilitators and barriers to GP SH management. A narrative synthesis (Popay, 2006) is being conducted.

Findings

The search found 6,976 unique citations. After screening 12 studies are being synthesised. The studies were conducted in Europe, Australia, and America, with a GP age range of 25-63 years. Most studies are of good methodological quality. GPs describe SH as both a ‘cry for help’ and a coping mechanism. GPs see themselves as frontline support for patients but refer most patients who SH to specialist care settings. The co-production of general practice SH clinical guidelines and the development of SH-specific primary care services were seen as important facilitators for the management of people who SH in primary care. A lack of time and heavy GP workload were seen as key barriers in the adequate assessment of SH risk in the consultation.

Consequences

Preliminary findings highlight a need for GP training in brief psychosocial interventions, better relationships with specialist services, and the crucial need of SH services in primary care and the community. This review is important for the development of brief primary care SH interventions, that are acceptable for people who SH and feasible for GP use, which in turn can reduce referral to specialist services and ease burden on secondary care.