This is the twenty-second annual report from the National Self-Harm Registry Ireland. It is based on data collected on hospital presentations of self-harm in the Republic of Ireland in 2024. This year, the Registry reports on data from 27 hospitals: 25 Emergency Departments (EDs) including two in Children’s Health Ireland hospitals, and two Model 2 hospitals. Data were not available for four hospitals in 2024. We estimated the number of presentations and people presenting to these hospitals using data from recent years to provide national estimates in 2024. All rate calculations presented in this report are based on those estimates.

In 2024, the National Self-Harm Registry Ireland estimated that there was a total of 12,621 selfharm presentations made by 9,436 individuals. The estimated age-standardised rate of individuals presenting to hospital following self-harm in 2024 was 181 per 100,000. This is 5% lower than the rate in 2023, and 19% lower than the peak rate recorded by the Registry in 2010 (223 per 100,000). In 2024, the national female rate of self-harm was 201 per 100,000, 7% lower than 2023. The female rate in 2024 is the lowest rate recorded by the Registry for women. The rate in 2024 also marks a continuation of the decrease observed for women since 2021. The male rate of self-harm in 2024 was 163 per 100,000, 2% lower than the rate in 2023.

Connecting for Life, Ireland’s National Suicide Reduction Strategy, operated for the ten-year period 2015–2024 and has been in its evaluation phase since 2024. A reduced rate of hospital-presenting self-harm was one of the two primary goals of Connecting for Life. The findings in this Report suggest that this was achieved. The rate in 2014, the year before Connecting for Life started, was 200 per 100,000 whereas we estimate that the rate in 2024 was 10% lower at 181 per 100,000. The estimated rate in 2024 suggests that there was a 7% reduction in the female rate of hospital-presenting self-harm, from 216 to 201 per 100,000, while the male rate reduced by 12% from 185 to 163 per 100,000.

As observed each year, the peak rate for women was in the 15–19-year-old age group at 652 per 100,000. The peak rate for men in 2024 was among 25–29-year-olds at 373 per 100,000. This is in contrast to the previous two years where the peak rate was among 20–24-year-olds and approximately 400 per 100,000. The rates in 2024 imply that one in every 153 girls in the 15–19-year age group, and one in every 268 men in the 25–29-year age group, presented to hospital with self-harm in 2024. 4 There were 651 presentations made by residents of homeless hostels/shelters and people of no fixed abode in 2024, accounting for approximately 6.2% of all presentations recorded by the Registry. This is comparable to the 6.9% reported in 2023.

Consistent with previous years, intentional drug overdose was the most common method of selfharm, involved in over three in five (61%) self-harm presentations in 2024. Minor tranquilisers were the most common drug type used, similar to previous years. Self-cutting was the other most common method, recorded in 30% of all presentations. Attempted hanging was involved in 8% of all selfharm presentations (12% for men, 5% for women). Attempted drowning was involved in 4% of presentations and, although rare as a method of selfharm, self-poisoning involving chemical substances was involved in 3% of presentations. Alcohol was involved in 32% of all presentations and was more often involved in male than female presentations (39% and 26% respectively). In general, the type of method used in self-harm was similar to recent years.

For 59% of presentations in 2024, the patient was assessed by a member of the mental health team in the presenting hospital (n = 5,050). For a further 6%, an assessment was arranged in the presenting hospital (n = 512). Most commonly, in 49% of presentations, individuals were discharged following treatment in the ED. For most of these individuals, four in five were provided with a recommended referral or follow-up appointment. In 14% of presentations, the individual left the ED before a next-care recommendation could be made. There was considerable variation in the recommendations for next care across health regions, particularly in relation to the proportion 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 as little as 17% and as much as 37% of adult presentations across the six health regions, while the proportion of adult patients who left before a recommendation could be made ranged from 12% to 21%. Similarly, the proportion of adults discharged following treatment in the ED ranged from 33% in HSE Dublin and North East to 61% in HSE South West. This observed difference 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.

In 2024, we gathered information on the current care for individuals presenting to hospital with self-harm. For a third of presentations (n = 3,520), it was noted that the individual was currently attending Mental Health Services (public/private/voluntary). In a further 2% of presentations, the patient had previously been referred and was awaiting an appointment with Mental Health Services (n = 225). For 3% of presentations, individuals were attending counselling or addiction services. Individuals were engaged with homeless services in 2% of cases. There was a similar proportion of presentations accounted for by repetition in 2024 as in 2023 (25% and 24%, respectively). Of the 7,940 self-harm patients who presented to hospital in 2024, 1,265 (16%) 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. The highest rate of repetition was reported in HSE South West (19%). In 2024, at least five self-harm presentations were made by 147 individuals. These patients account for 2% of all self-harm patients but their presentations represented 12% of all selfharm presentations. As in previous years, self-cutting was associated with an increased level of repetition whereby almost one in five individuals (18%) who used this method had a repeat presentation within the calendar year.