DSH Liaison Nurse Service Louth/Meath Mental Health Services

Philosophy of Service National 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 basis To offer relatives and friends the opportunity to speak to the dedicated professional To ensure the completion of a comprehensive risk assessment and liaison and referral on to appropriate agencies To co-ordinate follow-up and after care plans Aim 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 POINT Patients want conversation and not Q & A session Not a problem saturated assessment but a conversation that is in itself useful i.e. Normalise, safety plans, exception questions, generate possibilities, use existing support Diverse nature of group – drop out common Collaboration is key Work with Drs and MSE and use MDTM mtg Use recognised assessment tools Incorporate 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.

Male45Laceration13 Female60Drugs9 Times Seen291Asphyxiation2 Hx DSH45Other35 Psych Hx35Louth97 Unemployed30Monaghan8 Overdose70Pts Seen in LCH80 Alcohol41DNA’S55 DSH Liaison Nurse Service Statistics 2002 Totals

What Have We Learned? Diverse client group – live chaotic lives Difficult to engage with high drop-out from services Able to see people at the heart of their crisis – not useful to have appointments in 2-3 weeks time Vital for recognising signs that could prevent future crisis Suicide is often a means towards an end rather than an end itself Overwhelming sense of embarrassment leads to added vulnerability Staff in LCH positive about role

Recommendations 18 months on: Assessed 174 people. Further Follow-up plans agreed with over 80% Engagement better if seen in LCH Most common presenting difficulties include: alcohol abuse;Situational crisis; Inter-personal difficulties Comments 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 support Need for audit/research to facilitate a better understanding of DSH Development of protocols and policies Share information and experiences of this pilot project

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