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‘Card Before You Leave’ scheme evaluation in Emergency Departments


The Health and Social Care (HSC) Board has carried out an evaluation of the ‘Card Before You Leave’ (CBYL) scheme in Emergency Departments and its findings are now available.

The CBYL scheme was introduced in 2010 to ensure that all patients who attend an Emergency Department with self-harming behaviours or thoughts of suicide have the opportunity to have an assessment by a specialist mental health practitioner.

The evaluation revealed that the majority of patients who attend hospital with self-harm or thoughts of suicide are seen by a specialist mental health practitioner before they leave hospital. The CBYL scheme is aimed at a smaller group of patients where it has been assessed that the patient poses no immediate risk to themselves or others. Under the CBYL scheme these patients are given a next day appointment with a member of the mental health team who will check how they are doing and arrange any on-going care and support that may be required. This provides reassurance to both the patient and their family or carer, at what can be a very distressing time.

Site visits to Health and Social Care Trusts carried out as part of the evaluation reveal that the CBYL scheme has become well established in each Trust since its introduction in 2010. The scheme is working well for patients who take up the offer of a next day appointment. For many patients this provides an important gateway into further services, with 46% receiving a further follow-up appointment with the mental health team. The HSC Board has worked with service users, carers and Trust staff to implement changes, aimed at improving attendance at next day appointments and the report contains recommendations as to how this issue may be further addressed. The evaluation also highlights the need to maximise care and support to those patients who repeatedly attend the Emergency Department with self-harm.

The report makes a number of other recommendations to improve the scheme further and also some wider recommendations about services for people who self-harm.

Aidan Murray, Assistant Director of Mental Health at the Health and Social Care Board said: “I welcome the evaluation findings of the ‘Card Before You Leave’ scheme, which is one important part of the Suicide Prevention Strategy in Northern Ireland. We will continue to make further improvements to the scheme in line with the recommendations of the evaluation.”

For more information on the ‘Card Before You Leave’ scheme visit: