By Faraz Mughal.
We all know how serious self-harm is, and self-harm in young people is no different. Recent findings using electronic general practice patient records showed an increase in self-harm recorded in general practice in young people, particularly in girls aged 13-16.[1] In terms of healthcare utilisation: in the National Health Service young people most commonly seek help through general practitioners (GPs).[2] General practice is often the frontline of developed health systems and thus understanding and capturing the experiences of young people who access general practice for self-harm care is crucial in improving the care young people receive. Below, I focus on key findings from our recently published research in the British Journal of General Practice (BJGP). [3]
What we did
With funding from the Royal College of GPs Scientific Foundation Board and support from the National Institute for Health Research (NIHR) I led an interview study with 13 young people aged 19-25 around England to explore their experiences of general practice care and attain insights to inform clinical practice. Interviews were done (pre-Covid) either in person or on the telephone and analysed using reflexive thematic analysis. The research team had expertise in social sciences, medical anthropology, and general practice. A patient and public involvement and engagement group at Keele University informed recruitment techniques and interpretation of findings.
What did we find?
Three main themes were generated: help-seeking avenues, barriers to seeking help from general practice, and facilitators to accessing general practice care. I want to draw attention to some of the barriers and facilitators identified to highlight what needs to change for excellent care of young people who self-harm in general practice.
Young people described how preconceived views of GP care informed by personal experience and from hearing stories of others hindered them seeking help sooner. They also shared fears of being admitted to hospital and losing confidentiality which acted as a further barrier for seeking help for self-harm. Young people reflected on the importance of GP interactions when discussing self-harm and how these may affect future help-seeking: highlighting the importance of good experiences for self-harm care. Young people felt GPs who were active listeners, involved them in decision making, and established relationship-based care (continuity of care with one GP) enabled them to continue to seek care for self-harm.
What can GPs do?
We suggested recommendations for GPs managing self-harm in young people in the figure below–taken from the BJGP paper.
What can general practice do?
General practice is under substantial pressure, but young people who have harmed themselves are vulnerable, and at high risk of suicide, and thus need to be a priority for general practice. Practice teams need to be flexible with young people when making appointments and supporting continuity of GP care. There also needs to a concerted effort for public health messaging on self-harm in young people which highlights the importance of accessing GP care for young people struggling with self-harm.
References
- Morgan, C., Webb, RT., Carr, MJ., et al. (2017). Incidence, clinical management, and mortality risk following self-harm among children and adolescents: cohort study in primary care. BMJ, 359:j4351. https://www.bmj.com/content/359/bmj.j4351.long
- Marchant, A., Turner, S., Balbuena, L., et al. (2020). Self-harm presentation across healthcare settings by sex in young people: an e-cohort study using routinely collected linked healthcare data in Wales, UK. Arch Dis Child, 105(4):347-354. https://adc.bmj.com/content/105/4/347.long
- Mughal, F., Dikomitis, L., Babatunde, OO., et al. (2021). Experiences of general practice care for self-harm: a qualitative study of young people’s perspectives. Br J Gen Pract, BJGP.2021.0091. https://bjgp.org/content/early/2021/07/27/BJGP.2021.0091.long
Faraz Mughal (@farazhmughal), general practitioner, and NIHR doctoral fellow, School of Medicine, Keele University, England. Affiliate, NIHR Greater Manchester Patient Safety Translational Research Centre. Honorary clinical research fellow, Unit of Academic Primary Care, University of Warwick. Email: F.mughal@keele.ac.uk.
Declaration: FM sits on the National Institute for Health and Care Excellence self-harm clinical guideline development committee.
This study was funded by an RCGP Scientific Foundation Board Practitioner Allowance Grant (SFB 2018-29). FM is funded by a NIHR doctoral fellowship (NIHR300957). The views in this blog are that of the author, and not necessarily those of the NHS, NICE, NIHR, or the Department of Health and Social Care.
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