The clinical assessment of patients admitted to hospital following an episode of self‐harm: a qualitative study

Abstract

Based upon qualitative interviews with clinicians responsible for assessing patients admitted to hospital following an episode of self-harm by overdose, this paper documents interactional factors that shape both how clinicians conduct these assessments and their understanding of what 'causes' someone to harm themselves. The analysis first documents how the patients' overdoses are framed as essentially impulsive acts committed in response to adverse circumstances. This is achieved by clinicians' avoidance of any engagement with, or assessment of, a patient's reasons for taking an overdose. Secondly, the analysis considers why the patients' reasons for taking an overdose do not feature in the clinicians' assessments, and shows, by an examination of two deviant cases, that clinicians avoid engaging with patients' motivations so as to: minimise the risk of generating bedside disagreements; avoid the possibility of being drawn into the emotional life of a patient, and shield themselves from the social and economic inequalities that are a feature of many patients' lives. The paper concludes with a discussion of how bedside assessments that do not engage with patients' reasons for taking an overdose might be experienced by the patients themselves and the deleterious effect this could have upon their clinical management.