the consultant role might become more generic in nature, with the potential that this might compromise job satis- faction, as Pajak et al (2003) have shown that general adult psychiatrists demonstrate significantly lower levels of job satisfaction. Declaration of interest This project was funded by the Department of Health. References CALNAN, S.,WAINWRIGHT, D., FORSYTHE, M., et al (2001) Mental health and stress in the workplace: the case of general practice in the UK. Social Science and Medicine, 52, 499-507. DEPARTMENT OF HEALTH (1996) Health Survey for England 1994. Department of Health. DEPARTMENT OF HEALTH (2005) New Ways of Working for Psychiatrists: Enhancing Effective, Person-Centred ServicesThrough New Ways of Working in Multidisciplinary and Multiagency Contexts. Department of Health. EDWARDS, D., BURNARD, P., HANNIGAN, B., et al (2000) Stressors, moderators and stress outcomes for community mental health nurses: findings from the All Wales Community Mental Health Nursing Study. Journal of Psychiatric Bulletin (2007), 31, 255^258. doi:10.1192/pb.bp.106.014415 LEAH HUGHES AND NICK KOSKY Meeting NICE self-harm standards in an accident and emergency department AIMS AND METHOD An audit in a general hospital acci- dent and emergency (A&E) depart- ment and the subsequent development of a triage process for people presenting with self-harm is described. A random sample of 103 people attending with self-harm were selected and their treatment audited against standards derived from NICE guidelines. RESULTS The service provided by the A&E department was sub-standard. Of particular concern was the lack of processes addressing risk assessment and safe discharge. A pro forma was designed with the aim of improving assessment of self-harm. A repeat audit 3 months after introduction of the pro forma showed an improve- ment in the recording of relevant information underpinning risk assessment. CLINICAL IMPLICATIONS Procedures for those presenting to A&E departments with self-harm may not meet recommended guidelines. The use of a pro forma with staff training can improve risk assessment. Dorset County Hospital is part of the West Dorset General Hospitals NHS Trust and is a modern hospital with 500 beds. The mean attendance rate of patients presenting with self-harm to the accident and emergency (A&E) department is 46 patients a month. Psychiatric services are provided in partnership with a neighbouring trust. Self-harm is an umbrella term for causing harm to oneself. Allen (1995) explores the difficulty with defini- tion of this term, and describes a very wide range of methods that people use to hurt themselves, including scratching, cutting, stabbing, scalding, burning them- selves or overdose of prescribed medication. The self- harm may or may not have suicidal intent. Dealing with self-harm has been a national priority for some time (Department of Health, 1992, 2002). Those who harm themselves remain at a substantially increased level of completed suicide for some time after the episode of self-harm (Eastwick & Grant, 2004). Self-harm accounts for 150 000 attendances at general hospitals each year, and is one of the top five causes of acute medical admissions in the UK (Royal College of Psychiatrists, 2006; http://www.rcpsych.ac.uk/crtu/ centreforqualityimprovement/self-harmproject.aspx). The National Service Framework for Mental Health (Department of Health, 1999) emphasised the need for a specialist psychosocial assessment following self-harm. The Royal College of Psychiatrists’ view (2004) is that this can be done by trained A&E personnel and doctors working in the A&E department, although this has been debated by other authors (Hughes & Owens,1996; Cook, 1998). original papers Mears et al Consultant psychiatrists’ working patterns Psychiatric and Mental Health Nursing, 7 , 529-539. GOLDBERG, D. (1992) General Health Questionnaire (GHQ- 12). nferNelson. KARASEK, R., BRISSON, C., KAWAKAMI, N., et al (1998) The Job Content Questionnaire (JCQ): an instrument for internationally comparative assessments of psychological job characteristics. Journal of Occupational Health Psychology, 3, 322-355. MASLACH, C. & JACKSON, S. E. (1993) Manual of the Maslach Burnout Inventory (2nd edn). Consulting Psychologists Press. MEARS, A., PAJAK, S., KENDALL,T., et al (2004) Consultant psychiatrists’ working patterns: is a progressive approach the key to staff retention? Psychiatric Bulletin, 28, 251 -253. PAJAK, S., MEARS, A., KENDALL,T., et al (2003) Workload and Working Patterns in Consultant Psychiatrists. Department of Health. ROYAL COLLEGE OF PSYCHIATRISTS (2004) 12th Annual Census of Psychiatric Staffing 2004. Royal College of Psychiatrists. http:// www.rcpsych.ac.uk/pdf/ census1.pdf. *Alex Mears Research Fellow, Royal College of Psychiatrists Research and Training Unit, Standon House, 21Mansell Street, London E1 8AA, email: alex.mears@virgin.net, Sarah Pajak ResearchWorker , Tim Kendall Deputy Director, Royal College of Psychiatrists Research andTrainingUnit, Cornelius Katona Dean (1998-2003), Royal College of Psychiatrists, Jibby Medina Research Assistant, Royal College of Psychiatrists Research and Training Unit, Peter Huxley Professor of Social Work, Sherrill Evans Research Coordinator, Claire Gately ResearchWorker, Institute of Psychiatry, London 255