DSH Liaison Nurse Service

1. DSH Liaison Nurse Service Louth/Meath Mental Health Services

2. Philosophy of Service National task force on suicide (1998) “every case of parasuicide be examined by the liaison psychiatric team and that each team nominate a health care professional to oversee the future management of these individuals”… Suicide in Ireland (2001) “specific attention to be paid to those who deliberately self harm (DSH)”… To provide psycho-social assessment to individuals who have been been admitted to the Louth County Hospital with DSH. To achieve anti-discriminatory practice while working actively to contribute to a better understanding of DSH and to provide a service which conveys respect for the dignity and worth of each individual assessed and their families. Of known risk factors DSH has strongest association with suicide

3. Goals and Objectives • To offer a priority response to requests for assessment to clients admitted to the Louth county hospital following DSH on a Monday to Friday basis • To offer relatives and friends the opportunity to speak to the dedicated professional • To ensure the completion of a comprehensive risk assessment and liaison and referral on to appropriate agencies • To co-ordinate follow-up and after care plans • Aim to form link for future help, screen for psychiatric disorders; Assess safety/risk; Use scaling questions; Offer an opportunity to have story validated and focus on strengths, past coping and clarify future options and vision

4. Today’s Situation • Critical point in someone's life – can be used as a TURNING POINT • Patients want conversation and not Q & A session • Not a problem saturated assessment but a conversation that is in itself useful i.e. Normalise, safety plans, exception questions, generate possibilities, use existing support • Diverse nature of group – drop out common • Collaboration is key • Work with Drs and MSE and use MDTM mtg • Use recognised assessment tools • Incorporate psychiatric nursing skills in one- to- one and family work

5. Initial Assessment Meeting. • Set Appointment for fixed time. • Offer relatives and friends time • Contract for 4- 6 sessions initially • Client to set agenda • Set Safety plan in place • Focus on existing strengths and abilities • Liaison with the community mental health team • E.g. Psychiatrist, Affective disorder team, CPN, Alcohol Counsellor and the clients GP.

6. DSH Liaison Nurse Service Statistics 2002 Totals

7. What Have We Learned? • Diverse client group – live chaotic lives • Difficult to engage with high drop-out from services • Able to see people at the heart of their crisis – not useful to have appointments in 2-3 weeks time • Vital for recognising signs that could prevent future crisis • Suicide is often a means towards an end rather than an end itself • Overwhelming sense of embarrassment leads to added vulnerability • Staff in LCH positive about role

8. Recommendations • 18 months on: • Assessed 174 people. Further 20 people @ 28.02.03 • Follow-up plans agreed with over 80% • Engagement better if seen in LCH • Most common presenting difficulties include: alcohol abuse;Situational crisis; Inter-personal difficulties • Comments include: want time to be heard;Choices re: follow-up, opportunity for family to be involved; Not blanket clinic attendance; Possibility for future access and support • Need for audit/research to facilitate a better understanding of DSH • Development of protocols and policies • Share information and experiences of this pilot project

9. THANK YOU