Table 1

Before the psychosocial assessment: themes and exemplar quotations

Psychosocial assessment stageThemesExample quotes
What helped?Empathetic, supportive and humanising care‘I arrived at the emergency department at 2am after a breakdown and had to wait over 5 hours for the mental health team to see me on the day shift. I had self-harmed and told the staff this, and I told them that I was feeling suicidal. I didn’t refer myself to the hospital and I wanted to leave during the 5-hour wait but I was encouraged to wait to see the doctor before I could leave. The nurses on shift were pleasant and one- on-one with me a few times, offered drinks, etc’ (R86, female, age 19–24 years, patient).

‘In the hospital they were amazing!! Very kind and helpful, looked after me extremely well and didn't make me feel like a burden at all’ (R63, female, age 25–29 years, patient).
What did not help?Waiting times/medically cleared‘If we had gone into A&E for self-harm, psychiatric liaison would refuse to see my daughter until she has completed her treatment, be it stitches, stapling or NAC. They would refuse to do an assessment until she was medically fit/cleared; we often had to wait 5, 6, 7 hours for someone to do a mental health assessment’(R20, female, age 55–59 years, carer).
Emergency department environments‘Had to share room with a man who was very intoxicated and who had soiled himself, which was very frightening as a 21-year-old female. Then was moved to corridor for some time, until being moved back to the waiting room once my obs were stable as no more space on the ward. I was not able to see the mental health team until 10am the following day and later found out they had gone home for the night’ (R41, female, age 25–29 years, patient).
Stigmatising attitudes and poor medical care‘In many cases, staff lacked compassion. Such as invalidating my distress, stigmatising responses such as ‘wow you really meant to kill yourself, didn’t you!!’, exclaiming at the severity of my previous scarring and saying I was ‘adding to the collection’, saying that my pain threshold must be high and deciding not to give me any pain relief or medications when stitching or cleaning wounds (almost as if it was to be a punishment for self-harming), saying that I was ‘wasting time’ and other people had ‘real’ injuries’ (R17, female, age 25–29 years, patient).
Coercion and control‘Don’t like it when male security escort me to toilet in case I abscond’(R01, female, age 60–65 years, patient).