DSH Liaison Nurse Service

Louth/Meath Mental Health Services

Philosophy of ServiceNational task force on suicide (1998) “every case of

parasuicide be examined by the liaison psychiatric team and that each team nominate a health care professional to oversee the future management of these individuals”…Suicide in Ireland (2001) “specific attention to be paid to those who deliberately self harm (DSH)”…To provide psycho-social assessment to individuals who have been been admitted to the Louth County Hospital with DSH. To achieve anti-discriminatory practice while working actively to contribute to a better understanding of DSH and to provide a service which conveys respect for the dignity and worth of each individual assessed and their families.Of known risk factors DSH has strongest association with suicide

Goals and Objectives

To offer a priority response to requests for assessment to clients admitted to the Louth county hospital following DSH on a Monday to Friday basisTo offer relatives and friends the opportunity to speak to the dedicated professionalTo ensure the completion of a comprehensive risk assessment and liaison and referral on to appropriate agenciesTo co-ordinate follow-up and after care plansAim to form link for future help, screen for psychiatric disorders; Assess safety/risk; Use scaling questions; Offer an opportunity to have story validated and focus on strengths, past coping and clarify future options and vision

Today’s Situation

Critical point in someone's life – can be used as a TURNING POINTPatients want conversation and not Q & A sessionNot a problem saturated assessment but a conversation that is in itself useful i.e. Normalise, safety plans, exception questions, generate possibilities, use existing supportDiverse nature of group – drop out commonCollaboration is keyWork with Drs and MSE and use MDTM mtgUse recognised assessment toolsIncorporate psychiatric nursing skills in one- to- one and family work

Initial Assessment Meeting. Set Appointment for fixed time. Offer relatives and friends time Contract for 4- 6 sessions initially Client to set agenda Set Safety plan in place Focus on existing strengths and abilities Liaison with the community mental health

team E.g. Psychiatrist, Affective disorder team,

CPN, Alcohol Counsellor and the clients GP.

Male 45 Laceration 13

Female 60 Drugs 9

Times Seen

291 Asphyxiation 2

Hx DSH 45 Other 35

Psych Hx 35 Louth 97

Unemployed

30 Monaghan 8

Overdose 70 Pts Seen in LCH

80

Alcohol 41 DNA’S 55

DSH Liaison Nurse Service Statistics 2002

Totals

What Have We Learned?

Diverse client group – live chaotic livesDifficult to engage with high drop-out from servicesAble to see people at the heart of their crisis – not useful to have appointments in 2-3 weeks timeVital for recognising signs that could prevent future crisisSuicide is often a means towards an end rather than an end itselfOverwhelming sense of embarrassment leads to added vulnerabilityStaff in LCH positive about role

Recommendations18 months on:Assessed 174 people. Further 20 people @ 28.02.03Follow-up plans agreed with over 80%Engagement better if seen in LCHMost common presenting difficulties include: alcohol abuse;Situational crisis; Inter-personal difficultiesComments include: want time to be heard;Choices re: follow-up, opportunity for family to be involved; Not blanket clinic attendance; Possibility for future access and supportNeed for audit/research to facilitate a better understanding of DSHDevelopment of protocols and policiesShare information and experiences of this pilot project

THANK

YOU