What precipitates deliberate self-harm? A cognitive behavioural formulation of attempted suicide presentations at an inner city hospital.

OBJECTIVE To develop a working model that provides an understanding of the process of deliberate self-harm and a framework for psychological intervention in an emergency department setting. METHOD A retrospective clinical audit of a consecutive series of 51 deliberate self-harm patients referred to the liaison psychiatry service by the emergency department of an inner city hospital. RESULTS Patient characteristics were diverse. The age range was 17-92 years, with 79% between 15 and 35 years. Most were single and unemployed and the majority had a psychiatric disorder. Characteristically, there was at least one immediate stressor and intoxication immediately before the attempt. CONCLUSIONS The diversity of deliberate self-harm patients requires strategic intervention in a setting such as the emergency department. The working model for intervention presented here may be transferable to other settings such as general practice or community mental health centres using an educational and skills development approach with ongoing supervision.