Doctor lauds treatment for self harm

Admitting people when they are well rather than sick has been key to reducing admissions at Dunedin Hospital's acute mental health ward for those who harm themselves, clinical psychologist and primary investigator Dr Kumari Fernando says.

Dr Fernando said while it might not sound logical, the "green card" system for those prone to self harming resulted in a dramatic drop in admissions in the pilot group.

The system gave those with a propensity to harm themselves control and autonomy.

In conjunction with mental health staff, people planned their own short stay at the ward.

Admitting people when they were not harming themselves reinforced positive, rather than negative, behaviour.

Dr Fernando emphasised that people were still helped when they did harm themselves, and that each patient's "green card" sat alongside other therapy or treatments rather than replacing them.

Versions of the scheme operated in other district health boards, but Dr Fernando believed Dunedin was the first to formally collate data to show the benefits.

From July 2009 to October 2010, based on a cohort of 10, average length of stay dropped from a month to 6.6 days. Dr Fernando "strongly believed" the number of admissions per patient also dropped. However, more research was needed to determine the drop.

Reducing time in hospital meant patients could get on with their lives, she said.

It also freed up beds for other patients. At about $500 a bed night, there was a cost saving for the DHB.

The scheme's success has been recognised with clinical practice and research awards from the Dunedin School of Medicine and the Southern District Health Board.

Working with nurse and researcher Sarah Harland, Dr Fernando hoped to increase the cohort to 30 by the end of the year.

Findings would be written up for an academic journal, she said.

She thanked former clinical nurse specialist Trudy Dent, now the co-ordinator of the Dunedin-based Southern Support Eating Disorders Service, who helped set up the scheme, as well as all staff in the acute ward.

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