Hospital management of self harm in adults in England

Editor—Mitchell states that our paper is unusual because we have not reported in more detail on our data, but the editorial decision on our original manuscript was to restrict us to a short report focusing on the wide variation in the management of self harm and the lack of compliance with national guidelines. More detailed analysis of factors influencing management and outcome after self harm will form the basis of future publications.

Mitchell seems to assume that in our analyses assessments by a senior house officer in psychiatry were not included in the proportion of attendances leading to a psychosocial assessment. As assessments by a senior house officer in psychiatry are a subset of this group the two processes cannot be compared as though they are mutually exclusive. Furthermore, in analysing factors associated with medical admission, such as levels of psychosocial assessment, our data cannot be used to distinguish cause from effect.

We did not comment on good or bad practice as there is no research evidence to indicate what this might be, although there is some indication that people who have had a psychosocial assessment are at lower risk of repeating harm to themselves.¹