Clinician knowledge, attitudes, and behaviours across studies
| Across studies | Clinician knowledge | Clinician attitudes | Clinician behaviours |
|---|---|---|---|
| Similarities | Less self-harm training provided in comparison with general mental health, evidenced by only 39% of GPs receiving suicidal behaviour training in the previous 5 years26,30 | Self-harm a ‘cry for help’ and a ‘help-seeking behaviour’22, 28, 31 GPs want patients who self-harm to access mental health assessment27,29 Want to help patients who self-harm and see themselves as a frontline service for young people who self-harm25,26 Lack confidence assessing and talking to patients who self-harm, including young people22,25, 33 Feel self-harm is on a ‘spectrum of risk’ for suicide22,25 Use ‘gut feeling’ and instinct to manage risk with self-harm in adults and young people22,28 | Most refer patients who self-harm to hospital setting (mental health, A&E, ABC)23,24,27 Patients who self-harm are also managed in primary care22,23,25,27 |
| Differences | In young people there is uncertainty in establishing the severity of self-harm and future risk of self-harm28 GPs are aware risk of suicide greater in those who self-harm22 | Self-harm in young people as a coping strategy25 Few self-harm primary care services30 Feel hospital admission reinforces self-harm behaviour32 Self-harm common in older adolescents, linked to social problems, should not be ignored, and should be acknowledged for both young person and parent/carer25 Concerns over conflict with parents of young people and in alienating young person25 Difficult assessing suicide risk in patients who had self-harmed and in establishing suicidal intent according to patient demographic22 | Do not always intervene, and share responsibility for patient safety with patient22 Exhibit uncertainty when managing young people28 Ask direct questions with young people in lay terms while wanting to build rapport. Concerns over maturity of young people, signpost to services, and offer GP follow-up25 Lack of coding self-harm on electronic records29 Prescribe medication and undertake psychosocial intervention after self-harm23 More likely to intervene if documented suicidal ideation/behaviour23 In rural settings, referral influenced by service provision32 |
A&E = accident and emergency. ABC = ambulatory care.