Consultation-liaison psychiatric services among patients presenting to the hospital with deliberate self-harm: A retrospective record-based study

Abstract

Background: Screening patients with deliberate self-harm (DSH) attempts for psychiatric morbidity is crucial to tackling the growing silent epidemic. Despite the benefits of consultation-liaison psychiatry (CLP), referral rates for DSH from healthcare professionals are abysmally low. We aimed to assess the utilization of CLP services among patients presenting with DSH to the emergency department (ED) of a tertiary healthcare center, and psychiatric morbidity among referred DSH cases. Materials and Methods: We conducted a retrospective, record-based study of all DSH cases entered in the medico-legal case register maintained at the ED and verified with the DSH referral register maintained in the department of psychiatry from January 2022 to December 2023. Clinical details of psychiatric and personality morbidity assessed as a standard of care using the World Health Organization’s Composite International Diagnostic Interview, International Personality Disorder Examination, Beck’s suicide intent scale, and DSH inventory were collected among referred DSH cases. Results: Of 1083 registered DSH cases, 999 (92.24%) cases were analyzed. CL gap was noted in 542 (54.25%) cases, despite referral rate of 85.4%. Of 853 referred cases, 457 (53.58%) cases underwent psychiatric consultation. Of which, 359 (78.56%) cases had attempted an impulsive DSH act and 98 (21.44%) cases had diagnosable psychiatric disorder, with the most common being depression (41.84%), psychosis (24.49%), and alcohol use disorder (23.47). Of 542 (54.25%) patients who did not have psychiatric consultation, 306 (56.45%) cases opted for discharge against medical advice (DAMA), 146 (26.94%) cases were not considered for psychiatric opinion by the treating physician, and 90 (16.61%) cases dissented for psychiatric consultation. Conclusion: A large CL gap despite a high referral rate possibly reflects reduced mental health awareness, stigma, and presumed fear of legal proceedings in DSH patients and their caregivers, thereby exercising DAMA or dissent for psychiatric evaluation.