Paul Corcoran, Deputy Director - National Suicide Research Foundation

1. Hospital-treated deliberate self harm in Ireland Paul Corcoran National Suicide Research Foundation 14 September 2011 National Mental Healthcare Conference, Dublin

2. Acknowledgements Data Registration Officers Other Registry and NSRF colleagues Health Service Executive Department of Health and Children

3. Introduction Deliberate self harm is the single most important risk factor for suicide and a significant public health problem in its own right Reliable national level data on deliberate self harm are lacking internationally The incidence of hospital treated self harm is an important population level indicator of mental health and wellbeing For the individual patient self harm may be associated with multiple difficulties and may cause significant morbidity

5. National Registry of Deliberate Self Harm Coverage HSE Dublin/ Mid-Leinster HSE Dublin/ North East HSE South HSE West All 38 hospital emergency departments

7. Number of deliberate self harm presentations and patients +3% 9,493 +2% 11,966 2009 - 8,421 - 10,537 2002 Year Presentations % diff Persons % diff 2003 11,204 +6% 8,805 +5% 2004 11,092 -1% 8,610 -2% 2005 10,789 -3% 8,594 - 2006 10,688 -1% 8,218 -4% 2007 11,084 +4% 8,598 +5% 2008 11,700 +6% 9,218 +7% 2010 11,966 - 9,630 +1%

8. Trend in deliberate self harm rate

9. Trend in deliberate self harm rate among 20-24 year-olds

10. Incidence rate by age and gender

11. Incidence rate by single year of age and gender for 10-24 year-olds

12. Time of deliberate self harm presentation to hospital

13. Self harm presentations by day in January

14. Self harm presentations by day in March

15. Method of self harm by sex and age Men Women Alcohol was involved in 44% of male and 37% of female acts

16. Trend in acts involving attempted hanging

17. Drugs used in intentional overdose acts

18. Trend in overdose acts involving street drugs

20. Cumulative risk of a repeated presentation 35-44yrs 45-54yrs 25-34yrs 55-64yrs 15-24yrs <15yrs 65yrs+ Self-cutting & overdose Self-cutting only Other Attempted drowning Attempted hanging Drug overdose only Four previous DSH presentations Three previous DSH presentations Two previous DSH presentations One previous DSH presentation No previous DSH presentation

21. The burden of repeated deliberate self harm presentations Persons Presentations Number of DSH acts in 2003-2009 Number (%) Number (%) One 37690 (78.2 %) 37690 (50.2 %) Two 5874 (12.2 %) 11748 (15.6 %) Three 2023 (4.2 %) 6069 (8.1 %) Four 881 (1.8 %) 3524 (4.7 %) Five 496 (1.0 %) 2480 (3.3 %) Six 345 (0.7 %) 2070 (2.8 %) Seven 203 (0.4 %) 1421 (1.9 %) Eight 132 (0.3 %) 1056 (1.4 %) Nine 109 (0.2 %) 981 (1.3 %) 10 or more 453 (0.9%) 8080 (10.8 %)

22. Next care following treatment in the emergency department, 2010

23. Next care by HSE Hospitals Group

25. Selected recommendations Implementation of clinical guidelines for assessment and aftercare of self harm patients Increase the range and availability of evidence-based treatment interventions for self harm patients Increase community mental health services for 16-18 year-olds

26. For further information Paul Corcoran National Suicide Research Foundation 1 Perrott Avenue, College Road, Cork 021 4277499 [email_address] www.nsrf.ie