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Home > National Self-Harm Registry Ireland annual report 2019.

Joyce, Mary and Daly, Caroline and McTernan, Niall and Griffin, Eve and Nicholson, Sarah and Arensman, Ella and Williamson, Eileen and Corcoran, Paul (2020) National Self-Harm Registry Ireland annual report 2019. Cork: National Suicide Research Foundation.

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This is the eighteenth annual report from the National Self-Harm Registry Ireland. It is based on data collected on hospital-presenting self-harm in 2019 in the Republic of Ireland. Data were collected from all 33 hospital emergency departments (ED) including three paediatric hospitals and three local injury units. Main findings In 2019, the Registry recorded 12,465 presentations to hospitals due to self-harm, involving 9,705 individuals. The age-standardised rate of individuals presenting to hospital following self-harm in 2019 was 206 per 100,000. This was 2% lower than the rate in 2018, and 8% lower than the peak rate recorded by the Registry in 2010 (223 per 100,000). In 2019, the national male rate of self-harm was 187 per 100,000, 3% lower than 2018. The female rate of self-harm in 2019 was 226 per 100,000, 1% lower than 2018. Consistent with previous years, the peak rate for women was in the 15-19 years age group at 726 per 100,000, whereas the peak rate among men was in 20-24 year olds at 485 per 100,000. These rates imply that one in every 138 women in the age group 15-19 years, and one in every 206 men in the age group 20-24 years presented to hospital in 2019 as a consequence of self-harm.

There was variation in the rate of self-harm by region with the highest rates recorded in cities. The 2019 report presents data by administrative city/county, Health Service Executive Local Health Office (LHO) and Community Healthcare Organisation (CHO). Of note is the 26% reduction in the male self-harm rate in Cork City which decreased to 302 per 100,000, from 410 per 100,000 in 2018. Cork City had recorded the highest rate of male self-harm in the country in recent years (>400 per 100,000 since 2015). There were 668 presentations made by residents of homeless hostels and people of no fixed abode in 2019, accounting for approximately 5% of all presentations recorded by the Registry. This represents an increase of 24% in presentations made by this group when compared to 2018. This follows on from a decrease of 9% observed between 2017 and 2018.

Consistent with previous years, intentional drug overdose was the most common method of self-harm, involved in almost two-thirds (62%) of self-harm presentations in 2019. Self-cutting was the other most common method, recorded in 29% of all episodes. Attempted hanging was involved in 8% of all self-harm presentations (12% for men and 5% for women). Following an increase over a number of years, the number of presentations involving hanging in 2019 (n=1,029) was similar to that in 2018. While rare as a method of self-harm, the number of presentations involving attempted drowning increased by 11% from 2018 to 2019 (from 437 to 483).

Alcohol was involved in 31% of all presentations and was more often involved in male than female presentations (36% and 28% respectively). In 2019, 72% (n=8,435) of patients were assessed by a member of the mental health team in the presenting hospital, which was similar to 2018. Most commonly, 55% of cases were discharged following treatment in the emergency department. The majority of these (79%) were provided with a recommended referral or follow-up appointment. In 2019, 13% of patients left the emergency department before a next care recommendation could be made. There was considerable variation in recommended next care by hospital group, particularly in relation to the proportions of patients admitted to the presenting hospital, leaving before a recommendation, or receiving a mental health assessment. For example, inpatient care (irrespective of type and whether the patient refused) was recommended for between 14% and 36% of adult patients across six hospital groups while the proportion of adult patients who left before a recommendation ranged from 11% to 19%. Similarly, the proportion of adults discharged following emergency treatment ranged from 49% in the RCSI Hospital Group to 74% in the University of Limerick Hospital Group. This observed variation is likely to be due to variation in the availability of resources and services, but it also indicates that assessment and management procedures for self-harm patients are likely to vary across the country .

The proportion of presentations accounted for by repetition in 2019 was similar to previous years (22%). Of the 9,705 patients who presented to hospital following self-harm in 2019, 1,455 (15%) made at least one repeat presentation to hospital during the calendar year. Therefore, repetition continues to pose a major challenge to hospital staff and family members involved. In 2019, at least five self-harm presentations were made by 150 individuals, with no change from 2018. These represent just 1.5% of all self-harm patients but account for 9.6% of all self-harm presentations recorded. As in previous years, self-cutting was associated with an increased level of repetition whereby one in five individuals who used this method made a repeat presentation in 2019.

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