Hospital-treated deliberate self harm in Ireland Paul Corcoran National Suicide Research Foundation 14 September 2011 Nati...
Acknowledgements Data Registration Officers Other Registry and NSRF colleagues Health Service Executive Department of Heal...
Introduction Deliberate self harm is the single most important risk factor for suicide and a significant public health pro...
Registry objectives <ul><li>Establish the incidence of hospital treated deliberate self harm </li></ul><ul><li>To describe...
National Registry of Deliberate Self Harm  Coverage HSE Dublin/ Mid-Leinster HSE Dublin/ North East HSE South HSE West All...
<ul><li>Systematic monitoring of attendances to hospital emergency departments by data registration officers (DROs) </li><...
Number of deliberate self harm presentations and patients  +3% 9,493 +2% 11,966 2009 - 8,421 - 10,537 2002 Year Presentati...
Trend in deliberate self harm rate
Trend in deliberate self harm rate among 20-24 year-olds
Incidence rate by age and gender
Incidence rate by single year of age and gender for 10-24 year-olds
Time of deliberate self harm presentation to hospital
Self harm presentations by day in January
Self harm presentations by day in March
Method of self harm by sex and age Men Women Alcohol was involved in 44% of male and 37% of female acts
Trend in acts involving attempted hanging
Drugs used in intentional overdose acts
Trend in overdose acts involving street drugs
Repeated deliberate self harm presentations <ul><li>29% of deliberate self harm presentations are followed by a repeat pre...
Cumulative risk of a repeated presentation  35-44yrs 45-54yrs 25-34yrs 55-64yrs 15-24yrs <15yrs 65yrs+ Self-cutting & over...
The burden of repeated deliberate self harm presentations Persons Presentations Number of DSH acts in 2003-2009 Number (%)...
Next care following treatment in the emergency department, 2010
Next care by HSE Hospitals Group
Summary and considerations  <ul><li>The Irish rate of hospital-treated deliberate self harm is increasing </li></ul><ul><l...
Selected recommendations Implementation of clinical guidelines for assessment and aftercare of self harm patients Increase...
For further information Paul Corcoran National Suicide Research Foundation 1 Perrott Avenue, College Road, Cork 021 427749...
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Paul corcoran presentation at natl mental health care conf 14 sept 2011

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Paul Corcoran, Deputy Director - National Suicide Research Foundation

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Paul corcoran presentation at natl mental health care conf 14 sept 2011

  1. 1. Hospital-treated deliberate self harm in Ireland Paul Corcoran National Suicide Research Foundation 14 September 2011 National Mental Healthcare Conference, Dublin
  2. 2. Acknowledgements Data Registration Officers Other Registry and NSRF colleagues Health Service Executive Department of Health and Children
  3. 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
  4. 4. Registry objectives <ul><li>Establish the incidence of hospital treated deliberate self harm </li></ul><ul><li>To describe the pattern of presentations and the nature of the self harm behaviour involved </li></ul><ul><li>To monitor trends over time and by area </li></ul><ul><li>To estimate the risk of repeated self harm presenting to hospital </li></ul>
  5. 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
  6. 6. <ul><li>Systematic monitoring of attendances to hospital emergency departments by data registration officers (DROs) </li></ul><ul><li>DROs operate independently of the hospitals, follow standard operating procedures and show high levels of agreement in case-ascertainment </li></ul><ul><li>Identification of deliberate self harm presentations in accordance with an internationally-recognised definition (Platt et al, 1992) </li></ul><ul><li>Non-fatal outcome, deliberately initiated, varying intentions (e.g. wish to die, self-punishment) </li></ul><ul><li>Data entry via form on laptop computer and electronic data transfer to stand alone computer in the NSRF offices </li></ul>Registry Methods
  7. 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. 8. Trend in deliberate self harm rate
  9. 9. Trend in deliberate self harm rate among 20-24 year-olds
  10. 10. Incidence rate by age and gender
  11. 11. Incidence rate by single year of age and gender for 10-24 year-olds
  12. 12. Time of deliberate self harm presentation to hospital
  13. 13. Self harm presentations by day in January
  14. 14. Self harm presentations by day in March
  15. 15. Method of self harm by sex and age Men Women Alcohol was involved in 44% of male and 37% of female acts
  16. 16. Trend in acts involving attempted hanging
  17. 17. Drugs used in intentional overdose acts
  18. 18. Trend in overdose acts involving street drugs
  19. 19. Repeated deliberate self harm presentations <ul><li>29% of deliberate self harm presentations are followed by a repeat presentation within 12 months </li></ul><ul><li>Risk of repetition highest shortly after an index presentation </li></ul>
  20. 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. 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. 22. Next care following treatment in the emergency department, 2010
  23. 23. Next care by HSE Hospitals Group
  24. 24. Summary and considerations <ul><li>The Irish rate of hospital-treated deliberate self harm is increasing </li></ul><ul><li>Our rate is high in the European context but lower than in the UK </li></ul><ul><li>Repetition is common and most likely in the days and weeks after a presentation. </li></ul><ul><li>A small number of self harm patients account for many presentations. </li></ul><ul><li>Care after emergency treatment varies substantially across Ireland and a relatively high proportion of patients leave early. </li></ul>
  25. 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. 26. For further information Paul Corcoran National Suicide Research Foundation 1 Perrott Avenue, College Road, Cork 021 4277499 [email_address] www.nsrf.ie

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