In 2009, there were 11,966presentations of deliberate self-harm, involving 9,493individuals, to emergency departments. The rate of presentations increased from 200/100,000 of the population in 2008 to 209/100,000 in 2009, a 5% increase. Repeat presentations accounted for more than one in five (21%) of all presentations. The biggest rise in the number of presentations was observed in men, with an increase of 10% on the 2008 figure.This is the second successive major increase in such cases, following an 11% increase reported in 2008.

 

For the first time, the report details and maps the incidence of male and female deliberate self-harm by HSE local health office (LHO) area of residence. This, the authors hope, will raise awareness of the problem of deliberate self-harm among LHO primary and community care service providers. Limerick LHO area had the highest male rate and the second highest female rate. Cork North Lee and Louth LHO areas had high rates of deliberate self-harm for men only. Four of the eight Dublin LHO areas (Dublin North Central, Dublin West, Dublin South West and Dublin North West) were associated with high rates of deliberate self-harm for both men and women. In contrast, the incidence of male and female self-harm was low in Dublin South East and Dun Laoghaire.

 

Concordant with previous reports, deliberate self-harm was largely confined to the younger age groups. Almost half (45%) of all presentations were among people aged under 30 years. Among females, those aged 15–19 years were most likely to present with deliberate self-harm. The increase in male presentations was observed in several age groups. The rate among men aged 20–24 years increased by 21%. There was an increase in the number of 10–14-year-olds presenting.

 

Drug overdose was the most common form of deliberate self-harm, occurring in 71% of all such episodes reported in 2009. Overdose rates were higher among females (78%) than among males (64%). On average, at least 31 tablets were taken in episodes of drug overdose. The total number of tablets taken was known in 74% of cases. Forty-two per cent of all drug overdoses involved a minor tranquilliser, 29% involved paracetamol-containing medicines and 21% involved anti-depressants/mood stabilisers. The number of deliberate self-harm presentations involving street drugs increased by 26% in 2009 (from 461 to 579).

 

There was evidence of alcohol consumption in 41% of all episodes of deliberate self-harm and this was more common among men (45%) than women (37%). Alcohol may be one of the factors underlying the pattern of presentation by time of day and day of week. Presentations peaked in the hours around midnight and almost one-third occurred on Sundays and Mondays.

 

Attempted hanging was involved in 608 of all deliberate self-harm presentations (7% of men and 3% of women). This is the highest number of attempted hangings recorded by the Registry, and was 18% higher in 2009 than in 2008. Self-cutting wasused in one in five cases (22%) and significantly more often by men (25%) than by women (19%). 

 

The emergency department was the only treatment setting for 44% of all deliberate self-harm patients, that is, they did not proceed to further treatment.

 

The report recommends the following measures to reduce the incidence of deliberate self-harm:

•  Provide increased support for evidence-based prevention and mental health promotion programmes.
• Develop and implement initiatives to increase awareness of mental health issues among the general public and service providers supporting the unemployed or people experiencing financial difficulties.
• Develop a system to enable deliberate self-harm data to be linked with suicide mortality data to enhance insight into predictors of suicide risk.
• Restrict access to minor tranquillisers as they are the most common type of medication involved in intentional acts of drug overdose.
• Increase awareness among addiction service professionals and service users of the risk of suicidal behaviour related to drug abuse.
•  Enhance health service capacity at specific times and increase awareness of the negative effects of alcohol misuse and abuse, such as increased depressive feelings and reduced self-control.
•  Consideration should be given by LHOs to the development of response plans and intervention programmes related to suicidal behaviour.
• Minimum guidelines for the assessment of deliberate self-harm patients should be implemented by the HSE in line with the guidelines of the National Institute for Clinical Excellence in the UK.
•  Provide uniform psychosocial and psychiatric assessment to all self-harm patients, paying particular attention to patients using highly lethal methods.
•    Prioritise national implementation of evidence-based treatments shown to reduce risk of repetition, such as cognitive behavioural, dialectical behavioural and problem-solving interventions.

1. National Registry of Deliberate Self Harm Ireland (2010) Annual report 2009. Cork: National Suicide Research Foundation. Available at www.drugsandalcohol.ie/13249