How GPs can help young people avoid future self-harm: a qualitative study

Faraz Mughal; Carolyn A Chew-Graham; Ellen Townsend; Christopher J Armitage; Martyn Lewis; Benjamin Saunders

doi:10.3399/BJGP.2024.0209

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No effective interventions to reduce repeat self-harm behaviour?
Marion Brown

Published on: 29 December 2024

Published on: (29 December 2024)
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No effective interventions to reduce repeat self-harm behaviour?
Marion Brown, Retired, none
This article states that “GPs are usually the first point of healthcare contact for young people aged 16–25 years, after self-harm”,¹ and refers to the NICE Guidance NG2252 on the topic.

This article¹clearly states the following:
“The risk of suicide rises 50 times in the year after a self-harm episode compared with the people with no coded self-harm episode in their general practice record.”
“Young people aged 16–24 years commonly present to a GP after self-harm, thus GPs have an important role in self-harm care.”
“At present, there are no effective interventions that GPs can use with young people to reduce repeat self-harm behaviour.” (?)

The most urgent information that any primary care physician (or other healthcare practitioner) needs to ascertain is ‘has there been any recent new, or change of, prescribed medication which might have resulted in an adverse drug reaction (ADR) which may have prompted the self-harm and/or increased suicide risk?’.
Medication-induced akathisia is under-recognised and can lead to self-harm and suicide. When recognised for what it is, appropriate action can be taken swiftly. Akathisia is a known ADR of medications commonly prescribed for young people, including antidepressants and medications for asthma, acne, nausea and others. An informative free co...
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This article states that “GPs are usually the first point of healthcare contact for young people aged 16–25 years, after self-harm”,¹ and refers to the NICE Guidance NG2252 on the topic.

This article¹clearly states the following:
“The risk of suicide rises 50 times in the year after a self-harm episode compared with the people with no coded self-harm episode in their general practice record.”
“Young people aged 16–24 years commonly present to a GP after self-harm, thus GPs have an important role in self-harm care.”
“At present, there are no effective interventions that GPs can use with young people to reduce repeat self-harm behaviour.” (?)

The most urgent information that any primary care physician (or other healthcare practitioner) needs to ascertain is ‘has there been any recent new, or change of, prescribed medication which might have resulted in an adverse drug reaction (ADR) which may have prompted the self-harm and/or increased suicide risk?’.
Medication-induced akathisia is under-recognised and can lead to self-harm and suicide. When recognised for what it is, appropriate action can be taken swiftly. Akathisia is a known ADR of medications commonly prescribed for young people, including antidepressants and medications for asthma, acne, nausea and others. An informative free course on the topic is available online at MISSD.co.³

The well-known suicide risks when antidepressants (and other drugs) are initiated, or the dose increased/decreased, etc. – and during switching or withdrawal - must surely be recognised and prescribers suitably educated. There is a ‘duty to warn’⁴, and any sort of ‘safety planning’ has to include possible adverse medication effects – which, if they occur, need to be brought to the prescriber’s attention urgently.

As described by Dr Timothy Moss, “Akathisia is vulnerable to misdiagnosis, not only of the original condition. The writhing restlessness, disorientation, intensity of suffering, and inability to describe what is happening may lead to misdiagnosis… ”⁵ Most importantly, if a person is experiencing akathisia, they will be viscerally unable to engage in any form of recommended psychological intervention (per NICE self-harm guidance)² or CBT/DBT psychological approaches as mentioned in the article.¹

References
1. Mughal F, Chew-Graham CA, Townsend E, Armitage CJ, Lewis M, Saunders B. How GPs can help young people avoid future self-harm: a qualitative study. Br J Gen Pract. 2024;74(749): e832-e838.
2. NICE. Self-harm: assessment, management and preventing recurrence. 2022. NG225. Available at: www.nice.org.uk/guidance/NG225.
3. MISSD. www.missd.co.
4. Spielmans GI, Spence-Sing T, Parry P. Duty to Warn: Antidepressant Black Box Suicidality Warning Is Empirically Justified. Front Psychiatry 2020; 11:18. doi:10.3389/fpsyt.2020.00018.
5. Moss TR. Withdrawing from antidepressants. eLetter. Br J Gen Pract 2023. Available at: https://bjgp.org/content/73/728/138/tab-e-letters?_gl=1*f3gwj1*_gcl_au*NzE5ODU5NjgyLjE3MzE1NzQ1NTkuMTYxODY0Mjc4NS4xNzM1NTUzNTU5LjE3MzU1NTM1NTk.#withdrawing-from-ssri-antidepressants-advice-for-primary-care.

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Competing Interests: None declared.