GPs do not feel equipped to manage people who self-harm according to a new joint study between University College Cork and Keele University, which has significant implications for the training of GPs in Ireland.
Self-harm is a serious risk factor for suicide, and more than half of young people who die by suicide have a history of self-harm.
There are increasing self-harm rates reported among male patients in midlife, and people aged over 65 who self-harm are at an increased risk of suicide by 145 times.
The research, published this week in the British Journal of General Practice, is a systematic review which analysed 12 studies published between 1997-2016 on 789 GPs and family medicine physicians from Europe, America and Australia.
Barriers
The study identified barriers and facilitators which impacted GP management of patients who self-harm. The current limited consultation time in general practice with people who self-harm, and existing shortages of alternative self-harm and support services were found to be barriers to the provision of good care.
The development of self-harm clinical guidelines with people who self-harm and GPs was identified as facilitating effective GP care.
“Evidence indicates that most self-harm presentations will occur in community settings,” Dr Isabela Troya of University College Cork and the National Suicide Research Foundation said.
“This is extremely relevant to Ireland as there are over 2,500 registered General Practitioners in Ireland who are the first point of contact to patients seeking medical support.
“Our review shows that GPs recognise self-harm as a serious risk for suicide, but many report feeling unprepared to manage self-harm. This has implications for GP training in Ireland and worldwide.
“In Ireland, previous research conducted by the National Office for Suicide Prevention with over 469 GPs has highlighted GPs reported limited suicide prevention training,” she said.
Mental health
Dr Troya, who was second author on the research paper, said GPs and primary care are ideally positioned to address mental health issues.
“The role of the GP is multidimensional and includes assessment, treatment and referral to specialist care when necessary.
“Primary care is well placed to promote mental health, and identify people at risk of self-harm and suicide at an early stage,” she said.
The research was led by Dr Faraz Mughal, a GP and National Institute for Health Research (NIHR) In-Practice Fellow at Keele University.
“This is the first study to review the global literature on GPs and self-harm, and bring it all together, to outline the role a GP could play in helping people who self-harm,” Dr Mughal said.
“This provides the foundation for important further research to understand and test how GPs can better support people who self-harm. We know it is increasingly common for people to see their GP for self-harm.
“I aim to study how GPs can improve their provision of self-harm care, and how they can help people struggling with self-harm,” he said.
