Date of Award

2011

Degree Type

Thesis

Degree Name

Doctor of Psychology (Clinical)

Faculty

Computing, Health and Science

First Advisor

Professor Alfred Allan

Second Advisor

Ms Kristine Northey

Third Advisor

Dr Maria M Allan

Abstract

Deliberate self-harm is a pervasive issue that is the topic of worldwide clinical and research focus. Among the extensive research findings two salient issues emerge that provide the foundation for this study. The first is that a deliberate self-harm attempt is a significant risk factor for future attempts. The second is that a comprehensive assessment of a person presenting with an incident of deliberate self-harm can reduce further deliberate self-harming behaviour. A limitation of existing research is that no study has clearly identified the nature of assessments that impact on the likelihood of future self-harm attempts. The initial aim of this study was to replicate studies that explored the impact of an assessment after a deliberate self-harm episode, using Western Australian data. It was anticipated that the risk of a re-presentation will be reduced by increasing the likelihood that representation would take longer if an assessment was undertaken. It was also anticipated that some types of assessment would be more beneficial than others. A further aim of this study was to determine what the relevant health professionals believed led to this outcome, in particular, if one type of assessment was more beneficial than the others. In order to achieve these aims the research team examined data of patients who presented to the emergency departments of three teaching hospitals in Perth, Western Australia between 1995 and 2004 and had reported a deliberate self-harm attempt. A total of 8656 files were examined, from a total of 13,500 presentations during this period. Cox proportional hazards regression showed that compared to patients who had no assessment, the time between initial presentation and any further presentation for a self harm episode at one of the participating hospitals was significantly longer for those who received an assessment. Those who received either a social work assessment, or both a social work and mental health assessment, were significantly more likely to take longer to re-present. In an attempt to identify the content of the social work assessment that may have impacted on these findings the researcher interviewed six practitioners who undertook these assessments. These interviewees reported the relationship they established with patients; their exploration of the psychosocial context of the patient; and their conviction that the assessment is in itself an intervention, as the distinguishing factors of these assessments. Based on these findings, it is hypothesized that a psychosocial approach may be influential when conducting assessments of deliberate self harm. These assessments may benefit from a focus on developing a relationship with the client, combined with an attempt to resolve identified needs and should this occur during the assessment it may impact on future self harming behaviours.

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