Self-harm: Early identification and effective
treatments
Dr Eve Griffin,
National Suicide Research Foundation
GROW Informa...
Overview
• Introduction to self-harm
• Hospital-treated self-harm in Ireland
• Treatment of self-harm
• Challenges and rec...
Suicide
Approx.
550 p.a.
Medically treated
DSH
Approx. 12,000 p.a
“Hidden” cases of self-harm
Approx. 60,000 p.a.
Suicide ...
What is self-harm?
• It is a non-fatal act
• It is deliberately initiated
• The individual knows it may cause physical har...
• Establish the extent of hospital-treated self-
harm in Ireland
• Monitor trends over time and by area
• In 2012, there w...
Registry
Hospitals
National
Office for
Suicide
Prevention
Politicians
Professional
Health Care
Workers
Academia
Internatio...
0
25
50
75
100
125
150
175
200
225
250
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Age-standardisedrateper100,0...
0
100
200
300
400
500
600
700
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85...
• More women present to an ED with self-harm than men
• 15-19 year-old females and 20-24 year-old males
• Almost three-qua...
Alcohol was involved in 38% of all cases (42% in men, 36% in women)
54%
19%
5%
7%
3%
12%
Drug overdose only
Self-cutting o...
Aftercare of self-harm patients (2004-2012)
11
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Admission ward Admission
psychiatry
P...
Repetition of self-harm
• Re-presenting to an ED with self-harm in the year following an initial act
• 1 in 5 presentation...
13
Method of self-harm Previous presentations
Number of DSH
acts in 2003-
2011
Persons Presentations
Number (%) Number (%)
One 48,066 77.1% 48,066 48.2%
Two 7,899 12.7%...
Evidence based interventions of self-harm
• Problem-solving interventions
• Individuals with single self-harm acts
• Cogni...
Challenges to treatment of self-harm in EDs
• Profile of self-harm patients
• Availability / staffing of services
• Attitu...
ED Psychiatric Assessment Services, 2013*
17
48%
4%
26%
7%
15%
24/7 Service
12 hours a day
8 hours a day
Less than 8 hours...
Attitudes held by clinical staff towards those who self-harm may affect
clinical practice and experiences and outcomes of ...
Actions
• The implementation of self-harm specialist nurses in hospital EDs
as part of the National Mental Health Programm...
NSRF Information Evening: 14th April
• Theme of self-harm
• Monday 14th April, River Lee Hotel, Cork City
• Representative...
21
Thank You!
evegriffin@ucc.ie
+353 21 420 5551
4.35 Western Gateway Building,
University College Cork
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Self-harm: Early identification and effective treatments Dr. Eve Griffin NSRF

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Presentation Overview

• Introduction to self-harm

• Hospital-treated self-harm in Ireland

• Treatment of self-harm

• Challenges and recommendations

• Actions from the Registry

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Self-harm: Early identification and effective treatments Dr. Eve Griffin NSRF

  1. 1. Self-harm: Early identification and effective treatments Dr Eve Griffin, National Suicide Research Foundation GROW Information Evening, “Understanding and minding your mental health”, Tuesday 18th March 2014, Silver Springs Hotel, Cork 1
  2. 2. Overview • Introduction to self-harm • Hospital-treated self-harm in Ireland • Treatment of self-harm • Challenges and recommendations • Actions from the Registry 2
  3. 3. Suicide Approx. 550 p.a. Medically treated DSH Approx. 12,000 p.a “Hidden” cases of self-harm Approx. 60,000 p.a. Suicide and medically-treated deliberate self- harm: The tip of the iceberg 3 National Registry of Deliberate Self-Harm
  4. 4. What is self-harm? • It is a non-fatal act • It is deliberately initiated • The individual knows it may cause physical harm to her or himself and may cause death • It includes suicide attempts but there may be other intentions involved 4
  5. 5. • Establish the extent of hospital-treated self- harm in Ireland • Monitor trends over time and by area • In 2012, there were 12,010 presentations to EDs in Ireland National Registry of Deliberate Self-Harm 5
  6. 6. Registry Hospitals National Office for Suicide Prevention Politicians Professional Health Care Workers Academia International agencies Who is the information for?
  7. 7. 0 25 50 75 100 125 150 175 200 225 250 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Age-standardisedrateper100,000 Women Men +20% +6% +12% Trends in the rate of self-harm 7
  8. 8. 0 100 200 300 400 500 600 700 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Rateper100,000 Age group Men Women Incidence rate by age and gender (2012) 8
  9. 9. • More women present to an ED with self-harm than men • 15-19 year-old females and 20-24 year-old males • Almost three-quarters of presentations involved drug overdose (69%) • Inpatient admission was the next stage of care in 38% of all cases • 15% of people presented more than once during the year Key outcomes
  10. 10. Alcohol was involved in 38% of all cases (42% in men, 36% in women) 54% 19% 5% 7% 3% 12% Drug overdose only Self-cutting only Overdose & self-cutting Attempted hanging only Attempted drowning only Other Men Women Methods of self-harm by gender 69% 16% 4% 2% 2% 7% 10
  11. 11. Aftercare of self-harm patients (2004-2012) 11 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Admission ward Admission psychiatry Patient refused to be admitted Left without being seen / without decision Not admitted Male Female
  12. 12. Repetition of self-harm • Re-presenting to an ED with self-harm in the year following an initial act • 1 in 5 presentations resulted in a follow-up presentation (2012) • Risk of repetition is greatest in the short-term • Risk of repetition varies by: • Age • Recommended next-care • Method of self-harm • Number of previous self-harm presentations 12
  13. 13. 13 Method of self-harm Previous presentations
  14. 14. Number of DSH acts in 2003- 2011 Persons Presentations Number (%) Number (%) One 48,066 77.1% 48,066 48.2% Two 7,899 12.7% 1,5798 15.8% Three 2,709 4.3% 8,127 8.2% Four 1,297 2.1% 5,188 5.2% Five - Nine 1,713 2.8% 11,010 11% 10 or more 635 1.0% 11,483 11.5% The extent of repeated self-harm presentations 14
  15. 15. Evidence based interventions of self-harm • Problem-solving interventions • Individuals with single self-harm acts • Cognitive Behaviour Therapy • Individuals with single/infrequent self-harm acts • Dialectical Behaviour Therapy • Individuals with a history of multiple self-harm acts • Pharmacological treatment (Hawton et al., 1998; Arensman et al, 2000; Arensman & Hawton, 2004; Cipriani et al., 2005) 15
  16. 16. Challenges to treatment of self-harm in EDs • Profile of self-harm patients • Availability / staffing of services • Attitudes of healthcare professionals 16
  17. 17. ED Psychiatric Assessment Services, 2013* 17 48% 4% 26% 7% 15% 24/7 Service 12 hours a day 8 hours a day Less than 8 hours a day On-call only * Based on data from 27 Irish EDS, NSRF, 2014
  18. 18. Attitudes held by clinical staff towards those who self-harm may affect clinical practice and experiences and outcomes of patients • General attitudes and feelings of helplessness • Knowledge and understanding of self-harm • Access to guidelines for care and management • Training in awareness and knowledge (Saunders et al, 2011) Attitudes of healthcare professionals 18
  19. 19. Actions • The implementation of self-harm specialist nurses in hospital EDs as part of the National Mental Health Programme (2013-2014) • Emergency Healthcare Staff Training Cork(2013) • The implementation of Dialectical Behavioral Therapy at national level (2013-2015) • The implementation of guidelines for assessment and management of self-harm patients presenting to Irish EDs (2013- 2014) 19
  20. 20. NSRF Information Evening: 14th April • Theme of self-harm • Monday 14th April, River Lee Hotel, Cork City • Representatives from GROW and Pieta House • Email info@nsrf.ie for more details 20
  21. 21. 21 Thank You! evegriffin@ucc.ie +353 21 420 5551 4.35 Western Gateway Building, University College Cork

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