Table 2

During the psychosocial assessment: themes and exemplar quotations

ThemesExample quotes
During the assessment: What helped?Collaborative assessments and engaged communication‘In any situation, what works well is when I feel listened to and like I had some input and agreement into the decision and follow up and most importantly that I understood the situation and why it was happening’ (R34, female, age 30–34 years, patient).
Space and time to talk‘I was given a very quick psychiatric assessment in A&E. I was appreciative of being given some attention at the time as it was the first time I'd spoken about my mental health and self-harm/suicidal ideation. … Ideally it would be beneficial to be given some time/space to explore issues rather than feeling that they want you processed and out of the department as soon as possible’(R04, male, age 40–44 years, patient).
Recognition and reassurance’The last two occasions I have had an assessment with a psychiatric-liaison practitioner, they have been really positive. I was made to feel as a human and felt as though how I was feeling was validated… Initially, I was nervous. I find talking openly very difficult and tend to fabricate answers due to being scared of the repercussions. The nurses I saw could sense my apprehensions but were encouraging with me to speak. Afterwards, I felt like I wanted them to be a constant part of my mental health recovery, knowing that the reason why I saw them was due to nearly losing my life. They temporarily restored my faith in the MH system’ (R59, female, age 20–24 years, patient).
Help‘I got taken into a separate room to discuss my situation and options available - the staff member listened well and took all my intentions seriously. I felt heard. I was sent home afterwards with a detailed “crisis plan of action” that I could read and share whenever things were getting difficult. This was helpful’ (R113, female, age 35–39 years, patient).
During the assessment:
What did not help?
Generic tick-box assessments‘What didn't work well was being told I would be okay, the nature of a checklist-like set of questions to evaluate someone’s mental health, left no room for me to really talk about how I was actually feeling’(R09, non-binary, age 18–24 years, patient).
Intense and invasive questions‘These assessments were often quite intense and invasive, in so much as a professional with whom I would never again have contact sought to dredge up my entire life history, only to send me home feeling more unsettled than when I'd arrived …’ (R101, female, age 30–34 years, patient).
Unnecessarily repeating details‘Sometimes there is little point in repeating the reasons or trying to explain why I have self-harmed. People often don't understand it as it is linked to OCD. I get frustrated when people don't understand and it then makes it difficult to work with professionals’(R95, female, age 25–29 years, patient).
During the assessment:
What did not help?
Stigmatising attitudes during the assessment‘What doesn't work is being told I am doing it for attention, and that they know better than me what is helpful, so they won't change the plan. The most unhelpful things are to be told that I didn't really want to kill myself because I'm not dead and that it is up to me if I kill myself’ (R116, female, age 35–39 years, patient).

‘When I have presented with a diagnosis of emotionally unstable personality disorder, triage was still quick, but staff have been cold and lacking in empathy and compassion. Assessments were treated, almost with boredom, and I've been discharged despite being a current risk of suicide or further self-harm’.(R47, female, age 25–29 years, patient).