Healthwatch Bucks has found that the treatment at Stoke Mandeville A&E for people who have self-harmed is not in line with NICE guidelines. The treatment of physical injuries is good. But the emotional support needs improving.

Why did we do this project?

Mental Health and Wellbeing is a priority area for Healthwatch Bucks. A Bucks resident talked to us about their concerns with their treatment in A&E after a self-harm injury. We wanted to find out more.

What did we do?

We created an interview designed to check whether people’s experiences of treatments for self-harm were in line with the NICE (National Institute for Health and Care Excellence) guidelines. We enlisted the help of Buckinghamshire Mind who interviewed eight people. They told people who to contact if they needed help after the interview and provided emotional support at the time of interviewing.

What did we find?

Many of the people interviewed said the treatment of their injuries was good, and all said they received enough pain relief. Some people said the staff were “lovely” and “really nice”. But others felt they were being judged. One person even said she was called “attention-seeking” by a member of staff.

Only one person found the advice on reducing self-harm from PIRLS helpful. PIRLS is the mental-health team that assess people who have self-harmed to work out what needs to happen next. Most people found it hard to see the value in the PIRLS assessment. Some said that they felt it was only a risk assessment or just “face value stuff” that had to be done before discharge. One person was especially distressed as she said that the PIRLS team talked to her about her self-harming behaviour in a waiting room instead of a private area.

Our Recommendations

We recommend that:

  • Buckinghamshire Healthcare NHS Trust, Oxford Health NHS Foundation Trust (PIRLs) and the Buckinghamshire Urgent Care Alliance (Urgent Treatment Centre) make sure that private areas are available to discuss sensitive matters. These need to be clearly signposted.

Buckinghamshire Healthcare NHS Trust should:

  • make sure that their clinical staff are given guidance in providing caring treatment and warned of the risk of appearing judgmental.
  • ensure that all people who have self-harmed are identified and are consistently offered a safe and supportive place to wait, and the choice of someone to wait with them.
  • review their current processes for ensuring that patients give consent to treatment and are informed about confidentiality. The process should ensure that this does happen and that patients are aware it has happened.
  • look at whether these recommendations apply to anyone who is in mental distress and implement them accordingly.

Oxford Health NHS Foundation Trust should:

  • ensure that PIRLS works with service users to help them understand what it is there to do for them. This should take into account the views of those who self-harm on a regular basis.
  • confirm that they are providing service users with as much information as possible about target and actual waiting times.


You can read the full report and list of recommendations by clicking below.

Dignity and Harm Report

Published on 8 Nov, 2018 (updated 15 Jan, 2019)

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