Healthcare and social services resource use and costs of self-harm patients
Patients who have self-harmed have increased morbidity across a wide range of health outcomes, but there is no evidence on their pattern of health and social service use, and its relationship with repetition of self-harm. Previous studies have shown that resource use and costs in the short-term hospital management of self-harm is associated with certain patient and service characteristics but their impact in the longer term has not been demonstrated. The aim of this study is to test the association between changing levels of costs of health and social care with further episodes of self-harm and to identify the clinical and social factors associated with this.
This was a cost-analysis incidence study of a sample of patients from a cohort of self-harm patients who remained within one region over the course of their follow-up. Resource use was retrospectively observed from their first episode of self-harm (dating back on some occasions to the 1970’s), and costs applied. Panel data analyses were used to identify factors associated with observed costs over time.
Patients with five or more episodes of self-harm had the highest levels of resource costs. Health and social care costs reduced with time from last episode of self-harm. In the year following the first episode of self-harm, psychiatric care accounted for 69% and psychotropic drug prescriptions 1% of the mean resource costs.
The management of self-harm occurs within a complex system of health and social care. Major self-harm repeaters place the greatest cost burden on the system. Better understanding of the impact of risk assessment models and consequent service provision on clinical outcome may help in the design of effective services for this patient group.
KeywordsCost-analysis Self-harm Resource use Cohort Morbidity
The authors wish to acknowledge the help of Richard Chatwin for his design of the ACCESS data collection database, and all the medical records, primary care and NHS informatics staff who facilitated this research. Julia Sinclair was funded by the Medical Research Council as part of a Health Services Research Training Fellowship. Alastair Gray and Oliver Rivero-Arias were funded by HEFCE and Keith Hawton and Kate Saunders by Oxfordshire and Buckinghamshire Mental Health NHS Foundation Trust.
Conflict of interest statement
- 5.Sinclair JMA, Hawton K, Gray A (2009) Six year follow-up of a clinical sample of self-harm patients. J Affect Disord [e-pub ahead of print]Google Scholar
- 6.Tyrer P, Alexander J, Ferguson B (1988) Personality assessment schedule (PAS). In: Tyrer P (ed) Personality disorder: diagnosis, management and course. Butterworth/Wright, London, pp 140–167Google Scholar
- 7.Beck A, Schuyler D, Herman J (1974) Development of suicidal intent scales. In: Beck A, Resnik H, Lettieri DJ (eds) The prediction of suicide. Charles Press, MarylandGoogle Scholar
- 9.Netten A, Curtis L (2005) Unit costs of health and social care. Personal Social Services Research Unit, University of Kent, CanterburyGoogle Scholar
- 10.National Health Service (2005) Annual financial returns of NHS trusts, 2003–2004. National Health Service, LeedsGoogle Scholar
- 11.Department of Health (2005) NHS reference costs 2004. Online accessGoogle Scholar
- 12.British National Formulary 50 (2006) http://www.bnf.org/bnf/
- 13.StataCorp (2003) Stata Statistical Software: Release 9.0. Stata Corporation, College Station, TXGoogle Scholar
- 20.Hawton K, Townsend E, Arensman E, Gunnell D, Hazell P, Van Heeringen K, et al (2000) Psychosocial and pharmacological treatments for deliberate self-harm. Cochrane Rev, Library Issue 3, OxfordGoogle Scholar
- 27.Glick HA, Polsky DP, Schulman KA (2001) Trial based economic evaluations: an overview of design and analysis. In: Drummond MF, McGuire A (eds) Economic evaluation in health care: merging theory with practice. Oxford University Press, Oxford, pp 113–140Google Scholar
- 31.National Institute for Clinical Excellence (2004) The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. Report No. 16. National Institute for Clinical Excellence, LondonGoogle Scholar
- 32.Royal College of Psychiatrists (2004) Assessment following self-harm in adults. Report No. CR122. Royal College of Psychiatrists, LondonGoogle Scholar