Perspectives of GPs supporting young people who self-harm in England: a qualitative study

Faraz Mughal, Lisa Dikomitis, Gillian Lancaster, Christopher J Armitage, Ellen Townsend, Carolyn A Chew-Graham

Keywords: Self-harm; young people; GPs; qualitative research

Self-harm in young people is an international public health priority, and self-harm is the strongest risk factor for suicide. Rates of self-harm in young people presenting in primary care are increasing, and general practitioners (GPs) have a key role in the management of young people who self-harm. Young people have described varied experiences of care for self-harm, but perspectives of GPs about young people have not previously been explored.

Research questions:
What are the perspectives of GPs on presentation and management of young people who self-harm, including the impact of COVID-19?

Semi-structured interviews were conducted remotely with GPs around England. Purposive sampling aimed for a maximum variation sample in participant age, gender, years in practice, employment role, and practice list size. Recruitment was facilitated through Clinical Research Networks. Interviews were audio-recorded, transcribed verbatim, and thematic analysis with principles of constant comparison was conducted. A patient and public involvement group informed recruitment techniques, the interview topic guide, and interpretation of data.

Fifteen interviews were conducted. GPs understood self-harm to be broad in nature with a spectrum of severity. GPs described a variety of strategies for managing young people who self-harm: treating underlying mental illness, offering distraction techniques, and signposting. GPs stated that remote consulting due to COVID-19 reduced the opportunity to identify non-verbal cues and develop relationship-based care that can be critical in supporting young people who self-harm.

These findings will inform clinical practice recommendations for primary care and the development of a GP-led intervention to reduce self-harm in young people.

Points for discussion:
How this study informs the COPING study

The management of self-harm by GPs outside of England

Implications for health policy