NATIONAL SELF-HARM REGISTRY IRELAND · Executive Summary 4 Recommendations 5 Recent publications...

National Suicide Research Foundation

EVE GRIFFIN

NIALL McTERNAN

CONAL WRIGLEY

SARAH NICHOLSON

ELLA ARENSMAN

EILEEN WILLIAMSON

PAUL CORCORAN

NATIONAL SELF-HARM REGISTRY IRELAND

ANNUAL REPORT 2018

1

N S R F

Contents

Foreword 3

ExecutiveSummary 4

Recommendations 5

RecentpublicationsfromtheRegistry(2018-2019) 8

2018StatisticsataGlance 9

ImpactoftheRegistryatgloballevel 10

Methods 11

SectionI.Hospital Presentations 14

SectionII.Incidence Rates 28

AppendixI–Self-HarmbyHSEHospitalsGroupandHospital 36

AppendixII–RecommendedNextCarebyHospital 39

AppendixIII–RepetitionbyHospital 41

AppendixIV–Self-HarmbyResidentsoftheRepublicofIreland 43

2

TheNationalSelf-HarmRegistryIrelandteam

SuggestedCitation:

Griffin,E,McTernanN,Wrigley,C,Nicholson,S,

Arensman,E,Williamson,E,Corcoran,P.(2019).

NationalSelf-HarmRegistryIrelandAnnualReport

2018.Cork:NationalSuicideResearchFoundation.

Publishedby:

NationalSuicideResearchFoundation,Cork.

©NationalSuicideResearchFoundation2019

ISSN16494326

ThisreporthasbeencommissionedbytheHSE

NationalOfficeforSuicidePrevention.

HardcopiesoftheAnnualReport2018are

availablefrom:

NationalSuicideResearchFoundation

4thFloor

WesternGatewayBuilding

UniversityCollegeCork

Ireland

Tel:+353214205551

Email:[email protected]

ElectroniccopiesoftheAnnualReport2018

areavailablefromthewebsiteoftheNational

SuicideResearchFoundation:www.nsrf.ie

AcknowledgementsThefollowingistheteamofpeoplewhocollectedthedatathatformed

thebasisofthisAnnualReport.Theireffortsaregreatlyappreciated.

AlanO’Shea,aosdesign: GraphicDesign

SarahNicholson,NSRF ResearchOfficer

LeonFan,NSRF TechnicalSupport

TiernanHourihan,NSRF TechnicalSupport

WewouldliketoacknowledgetheassistanceofstaffoftheDepartment

ofHealth,theHSENationalOfficeforSuicidePrevention,therespective

HSEregionsandtheindividualhospitalsthathavefacilitatedtheworkof

theRegistry.

HSEDublin/MidlandsRegion

LiisaAula

EdelMcCarra

DiarmuidO’Connor

LauraShehan

HSEDublin/NorthEastRegion

AgnieszkaBiedrycka

AlanBoon

RitaCullivan

JamesMcGuiggan

HSESouthRegion

UrsulaBurke

TriciaShannon

KarenTwomey

UnaWalsh

HSEWestRegion

AilishMelia

CatherineMurphy

MaryNix

EileenQuinn

mailto:[email protected]

www.nsrf.ie

National Self-Harm Registry Ireland

3

WesternGatewayBuilding,UniversityCollegeCork

ForewordTheNationalSelf-HarmRegistryIreland(NSHRI)

wasestablishedoversixteenyearsagoatthe

requestoftheDepartmentofHealthandChildren,

bytheNationalSuicideResearchFoundation

workingincollaborationwiththeSchoolofPublic

Health,UniversityCollegeCork.Itisfundedby

theHealthServiceExecutive’sNationalOffice

forSuicidePrevention.Itistheworld’sfirst

nationalregistryofcasesofintentionalself-harm

presentingtohospitalemergencydepartments.

Inrecentyearstherehasbeenastabilisationin

therateofhospital-treatedself-harminIreland,

withanincreaseinself-harmdetectedin2018.

Theincreasewasrecordedforbothmenand

women,acrossallagegroups.Itisimportantto

highlighttheincreasingtrendinyoungpeople,

aswellasintheuseofmethodsassociatedwith

higherlethality.Thesestatisticsareofconcern,

andresearchwhichcanexaminethecausesof

suchtrendsshouldbeanurgentpriority.Such

emergingtrendssignaltheneedformulti-level

responsestopreventingself-harm,bothtargeted

interventionsforthoseengaginginself-harmas

wellaspublichealthinterventionsatapopulation

leveltoreducetheriskofself-harmforvulnerable

individuals.

TheRegistryrepresentsanimportantresource

inthecontextofbothnationalandinternational

suicidepreventionefforts.TheWorldHealth

Organisationhighlightedtheimportanceofsuch

systems,statingintheir2012report“Preventing

Suicide–AGlobalImperative”,that‘up-to-date

surveillanceofsuicidesandsuicideattemptsis

anessentialcomponentofnationalandlocal

suicidepreventionefforts’(p.16).Irelandwas

thefirstcountrytorecognisethis,throughthe

establishmentofTheNationalSelf-HarmRegistry

Ireland,whichhasbeenrecognisedasamodelof

bestpracticebytheWorldHealthOrganisation.

TheRegistryhasinformedcoreactionsinthe

IrishNationalStrategytoReduceSuicidein

Ireland,ConnectingforLife2015-2020,andis

akeycomponentoftheoutcomesframework

beingusedtomonitorprogressandexaminethe

impactofimplementedactions.TheRegistryhas

identifiedkeytrendsandriskfactorstoinform

policyandfurtherresearch.

In2019,twoHealthResearchBoardgrants,worth

morethan¤1million,wereawardedtoresearchers

attheNationalSuicideResearchFoundation

andtheSchoolofPublicHealthinUniversity

CollegeCork.Thefirstisafive-yearfellowship

whichaimstoexaminetheonsetofself-harm

inadolescenceaswellasidentifyingimportant

riskfactorsforrepeatself-harmandsuicide.The

second,afour-yearprogrammeofresearch,will

examinehowroutinemanagementofself-harmin

acutesettingsimpactsonpatientoutcomes,with

regardsrepeatself-harm,suicideandpremature

mortality.Theprojectwillalsoidentifythebarriers

andfacilitatorstoimplementingservicesin

Ireland,inordertoinformandoptimiseservice

delivery.Suchinnovativeresearchisessential

tofurtherunderstandhowbesttodevelop

appropriateresponsesandinterventionsforall

personswhoengageinself-harm.

Iwouldliketoacknowledgetheon-going

commitmentanddedicationofthedata

registrationofficersinensuringthehighquality

operationoftheRegistry.Wewouldalsoliketo

commendthehospitalstafffortheirdiligenceand

dedicationinmeetingtheneedsofindividuals

whopresenttohospitalasaresultofself-harm.

Dr Paul CorcoranHeadofResearch

NationalSuicideResearchFoundation,Cork.


4

Thisistheseventeenthannualreportfromthe

NationalSelf-HarmRegistryIreland.Itisbasedon

datacollectedonpersonspresentingtohospital

emergencydepartmentsfollowingself-harmin

2018intheRepublicofIreland.TheRegistryhad

nearcompletecoverageofthecountry’shospitals

fortheperiod2002-2005and,since2006,all

generalhospitalandpaediatrichospitalemergency

departmentsintheRepublicofIrelandhave

contributeddatatotheRegistry.

Main findings

In2018,theRegistryrecorded12,588presentations

tohospitalduetoself-harmnationally,involving

9,785individuals.Theage-standardisedrateof

individualspresentingtohospitalfollowingself-harm

in2018was210per100,000.Thiswasasignificant

increaseof6%ontherateof199per100,000in2017.

Theratein2018was12%higherthanin2007,the

yearbeforetheeconomicrecession.

In2018,thenationalmalerateofself-harmwas193

per100,000,7%higherthan2017.Thefemalerate

ofself-harmin2018was229per100,000,5%higher

than2017.Thus,thefemalerateofself-harmin2018

was7%higherthanitwasin2007whereasthemale

ratein2018was19%higherthanitspre-recession

level.

Consistentwithpreviousyears,thepeakratefor

womenwasinthe15-19yearsagegroupat766per

100,000,whereasthepeakrateamongmenwas

in20-24year-oldsat543per100,000.Theserates

implythatoneinevery131girlsintheagegroup

15-19andoneinevery184menintheagegroup

20-24yearspresentedtohospitalin2018asa

consequenceofself-harm.In2018,themalerateof

self-harmamong10-24year-oldsincreasedby8%.

Therateofself-harmamongwomenaged65-69

yearsincreasedby47%.

Therewasvariationintherateofself-harm

byregion,withthehighestratesrecordedin

urbanareas.The2018reportpresentsdataby

administrativecity/county,byLocalHealth

Office(LHO)andbyHSECommunityHealthcare

Organisation(CHO).

Therewere539presentationsmadebyresidents

ofhomelesshostelsandpeopleofnofixedabode

in2018,accountingforapproximately4%ofall

presentationsrecordedbytheRegistry.Thenumber

ofpresentationsbythosewithnofixedabodewas

9%lowerthan2017,but57%higherthanin2007.

Consistentwithpreviousyears,intentionaldrug

overdosewasthemostcommonmethodofself-

harm,involvedinalmosttwo-thirds(62%)of

self-harmpresentationsregisteredin2018.Self-

cuttingwasrecordedin30%ofallepisodesand

wasmorecommoninmen(31%)thaninwomen

(28%).Attemptedhangingwasinvolvedin9%of

allself-harmpresentations(12%formenand5%

forwomen).At1,072,thenumberofpresentations

involvingattemptedhangingwas24%higher

than2017(+22%formenand+30%forwomen).

Presentationsinvolvingself-cuttingincreasedby

17%in2018.Whilerareasamethodofself-harm,

thenumberofpresentationsinvolvingattempted

drowningincreasedby19%from2017to2018(from

367to437).Alcoholwasinvolvedin30%ofallcases.

Alcoholwassignificantlymoreofteninvolvedinmale

episodesofself-harmthanfemaleepisodes(34%

and27%,respectively).

In2018,72%(n=8,490)ofpatientswereassessedbya

memberofthementalhealthteaminthepresenting

hospital.In2018,13%ofpatientslefttheemergency

departmentbeforeanextcarerecommendation

couldbemade.Mostcommonly,56%ofcaseswere

dischargedfollowingtreatmentintheemergency

department.Themajorityofthese(79%)were

providedwitharecommendedreferralorfollow-up

appointment.Therewasconsiderablevariationin

recommendednextcarebyhospital,particularlyin

relationtotheproportionofpatientsadmittedtothe

presentinghospital,theproportionleavingbefore

arecommendationandtheproportionreceivinga

mentalhealthassessment.Thisobservedvariation

islikelytobeduetovariationintheavailabilityof

resourcesandservicesbutitalsosuggeststhat

assessmentandmanagementprocedureswith

respecttoself-harmpatientsarelikelytobevariable

andinconsistentacrossthecountry.

Theproportionofactsaccountedforbyrepetition

in2018(22.3%)wassimilartopreviousyears.Ofthe

9,785self-harmpatientswhopresentedtohospital

in2018,1,427(14.6%)madeatleastonerepeat

presentationduringthecalendaryear.Therefore,

repetitioncontinuestoposeamajorchallengeto

hospitalstaffandfamilymembersinvolved.In2018,

atleastfiveself-harmpresentationsweremadeby

153individuals.Theserepresented2%ofallself-

harmpatients,butaccountedfor10%ofallself-harm

presentationsrecorded.Asinpreviousyears,self-

cuttingwasassociatedwithanincreasedlevelof

repetition.Riskofrepetitionwasgreatestinthedays

andweeksfollowingaself-harmpresentationto

hospitalandtheriskincreasedmarkedlywitheach

subsequentpresentation.

Executive Summary


5

Recommendations

In2018,therateofself-harminIrelandincreased

by6%,followingaperiodofstabilisationover

thepastsevenyears,since2010.Theobserved

increaseinself-harmin2018wasevidentacross

allagesandforbothmenandwomen,with

anincreaseinpresentationsrecordedinmost

hospitals.Thisincreasecanbeattributedto

presentationsinvolvingattemptedhanging,self-

cuttingandstreetdrugs.Thesetrendsunderline

theneedtofurtherdevelopmentalhealthservices

inIrelandforindividualsengaginginself-harm,

particularlyforyoungpeople.Inaddition,activities

toreduceaccesstomeans,earlyinterventionand

preventionmeasures,andregulationofillegalor

restrictedsubstancesarecriticaltoreducingthe

incidenceofself-harminIreland.

Self-harm among young people

Thehighestratesofself-harmareconsistently

seeninyoungpeople.Thefindingsofthisreport

showafurtherincreaseinself-harmamong

youngpeopleaged10-24years,followinga22%

increaseinratesbetween2007and2016.1A

recentstudyshowedasimilarincreasein‘non-

suicidalself-harm’(NSSH)inEnglandbetween

2000and2014,particularlyamongwomenaged

16-24years,atrendassociatedwithanincreasein

self-cutting.2Changesinmentalhealthsymptoms

maybecontributingtoincreasingratesofself-

harm,3particularlyamonggirls,giventhestrong

associationsbetweenmentaldisordersand

self-harminadolescents.AEuropeansurvey

foundthat4%ofyoungpeopleaged15-24years

reportedchronicdepression,withtheratehighest

inIrelandat12%.4Thereisaneedtoensuretimely

andappropriatechildandadolescentmental

healthservicesinIrelandandtheRegistryfindings

supporttheprioritiesidentifiedbytheHSE’s

NationalServicePlan2019.5Inparticular,both

evidence-basedmentalhealthprogrammesand

appropriatereferralandtreatmentoptionsare

crucialtoaddresstheneedsofyoungpeoplein

thekeytransitionstagesbetweenchildhoodand

adolescenceandintoadulthood.Increasesinself-

harmamongchildrenaged10-14yearsindicate

thattheageofonsetofself-harmisdecreasing.

Thesetrendsunderlinetheneedforpreventative

interventions,suchasschool-baseduniversal

mentalhealthprogrammesthathavebeenfound

tobeeffectiveinpreventingsuicideattemptsin

youngadolescents.6Programmesinprimaryand

post-primarysettingsarerequiredandshould

focusonpreventingsuicidalbehaviouraswellas

buildingresilience.

Restricting access to means

Theproportionofpresentationsinvolving

methodsassociatedwithhighlethalityhas

steadilyincreasedinrecentyears.Therehavebeen

furtherincreasesrecordedin2018,inbothmen

andwomen.Ithaspreviouslybeenrecommended

thatmoreinnovativeandintensifiedeffortsshould

bemadetoreduceself-harmandsuicideby

hanging,includemonitoringofmediaandsocial

mediaplatformswhichhavebeenassociatedwith

increasedsuicidesinvolvingasphyxiaandother

highlylethalmethods.7

Intentionaldrugoverdoseisthemostcommon

methodofself-harmrecordedbytheRegistry.

In2018,asharpincreaseintheuseofstreet

drugswasrecorded,involvedinoneinten

1Griffin,E,etal.(2018).Increasingratesofself-harmamong

children,adolescentsandyoungadults:A10-yearnational

registrystudy2007-2016.SocialPsychiatryandPsychiatric

Epidemiology,53:663-71.

2McManus,S,etal.(2019).Prevalenceofnon-suicidalself-harm

andservicecontactEngland,2000-14:Repeatedcross-

sectionalsurveysofthegeneralpopulation.LancetPsychiatry,

6:573-81.

3Bor,W,etal.(2014).Arechildandadolescentmentalhealth

problemsincreasinginthe21stcentury?Asystematicreview.

Australia&NewZealandJournalofPsychiatry,48:606–16.

4Eurofound(2019).Inequalitiesintheaccessofyoungpeople

toinformationandsupportservices.PublicationsOfficeofthe

EuropeanUnion,Luxembourg.https://www.eurofound.europa.

eu/sites/default/files/ef_publication/field_ef_document/

ef19041en.pdf

5HealthServiceExecutive(2019).NationalServicePlan2019.

https://www.hse.ie/eng/services/publications/serviceplans/

national-service-plan-2019.pdf

6 Wasserman,D,etal.(2015).School-basedsuicideprevention

programmes:TheSEYLEcluster-randomised,controlledtrial.

TheLancet,385:136-44.

7Sinyor,M,etal.(2018).Theassociationbetweensuicidedeaths

andputativelyharmfulandprotectivefactorsinmediareports.

CanadianMedicalAssociationJournal.190:E900-07.

https://www.eurofound.europa.eu/sites/default/files/ef_publication/field_ef_document/ef19041en.pdf



https://www.hse.ie/eng/services/publications/serviceplans/national-service-plan-2019.pdf

https://www.hse.ie/eng/services/publications/serviceplans/national-service-plan-2019.pdf

6

Recommendations

intentionaldrugoverdoses.Cannabiswasthemost

commonstreetdrugrecorded,particularlyamong

youngmen,reflectinganincreasedprevalence

ofcannabisuseamongthisdemographicinthe

generalpopulation.8Arecentsystematicreviewand

meta-analysis9foundthatcannabisconsumptionin

adolescencewasassociatedwithincreasedriskof

developingmajordepressioninyoungadulthood,

andanincreasedriskofsuicidalideationand

suicideattemptsinyoungadulthood.TheRegistry

detectedanincreaseintheinvolvementofcocaine

inself-harmpresentationsin2018,primarilyamong

thoseaged35-44years.Publichealthpoliciesto

addresstheuseofillegalsubstancesshouldbe

furtherdeveloped.Thereisgrowingevidencethat

suchactivitiescanresultinpositiveoutcomesfor

thegeneralpopulation.AnIrishstudyreportedthat

legislationintroducedin2010toendthetradeof

newpsychoactivesubstancesinheadshopsresulted

inadecreaseofdrug-relatedpsychiatricadmissions

betweenMay2010andSeptember2012,withthe

biggesteffectobservedamongyoungmalesaged

18-24years.10TheRegistryobservedadecreasein

thenumberofstreetdrugsinvolvedinintentional

overdosebetween2011and2013,aneffectmost

pronouncedamongmen.Howeversince2013,the

numberofpresentationsinvolvingstreetdrugshas

increasedby77%.

Alcoholisaconsistentfactorassociatedwithself-

harm,presentinapproximately30%ofpresentations

tohospital,andassociatedwithpeaksinattendances

atnight,weekendsandonpublicholidays.Alcohol

isanimportantprecipitatingfactorforself-harm,

asitmayhaveadisinhibitingeffect,aswellas

increasingaggressiveness,psychologicaldistressand

impulsivity.11Individualspresentingwithself-harm

mayalsohaveadiagnosisforanalcohol-related

disorder.Suchcomplexpresentationsindicate

theneedforactiveconsultationandcollaboration

betweenthementalhealthservicesandaddiction

treatmentservicesforpatientswhopresentwith

dualdiagnoses.12TheintroductionofthePublic

Health(Alcohol)Act2018isapositivedevelopment,

introducingevidence-basedpoliciestoreducethe

burdenofalcoholharmonoursocietybyimproving

health,safetyandwellbeing.TheRegistrywill

monitortheimpactofthelegislationandassociated

measuresonalcohol-relatedself-harm.

Clinical management of self-harm

Thereportedproportionofpatientsreceivinga

mentalhealthassessment(72%)aspartoftheircare

issimilartopreviousyears,andhigherthanthat

reportedinothercountries.TheNationalClinical

ProgrammefortheAssessmentandManagement

ofpeoplepresentingtotheEmergencyDepartment

followingSelf-Harmhasnowbeenimplemented

across24adultemergencydepartmentsinIreland.13

Oneoftheaimsoftheprogrammeistoimprovethe

responsereceivedbyeveryindividualpresenting

withself-harm,regardlessofthenatureofthe

self-harminvolved.TheProgrammeprovidesa

numberofevidence-basedrecommendationsonthe

managementofself-harminemergencydepartment

(seenextpage).

8Bates,G.(2017).ThedrugssituationinIreland:anoverview

oftrendsfrom2005to2015.CentreforPublicHealthat

LiverpoolJohnMooresUniversity.

9Gobbi,G,etal.(2019).Associationofcannabisusein

adolescenceandriskofdepression,anxiety,andsuicidality

inyoungadulthood:Asystematicreviewandmeta-analysis.

JAMAPsychiatry,76:426-34.

10Smyth,BP,etal.(2019).Legislationtargetingheadshops

sellingnewpsychoactivesubstancesandchangesindrug-

relatedpsychiatricadmissions:Anationaldatabasestudy.

EarlyInterventioninPsychiatry,1-8.

11Hufford,MR.(2001).Alcoholandsuicidalbehavior.Clinical

PsychologyReview,21,797–811.

12DepartmentofPublicHealthHSESouth(2019).Afocuson

alcoholandhealthinCorkandKerry.AreportoftheDirector

ofPublicHealth.Cork:DepartmentofPublicHealthHSE

South.https://www.drugsandalcohol.ie/30602/

13HealthServiceExecutive(2016).NationalClinicalProgramme

fortheAssessmentandManagementofPatientsPresenting

totheEmergencyDepartmentfollowingSelf-Harm.https://

www.hse.ie/eng/services/publications/clinical-strategy-

and-programmes/national-clinical-programme-for-the-

assessment-and-management-of-patients-presenting-to-

emergency-departments-following-self-harm.pdf

https://www.drugsandalcohol.ie/30602

https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/national-clinical-programme-for-the-assessment-and-management-of-patients-presenting-to-emergency-departments-following-self-harm.pdf





7

Recommendations

Eve GriffinManager,NationalSelf-HarmRegistryIreland,

NationalSuicideResearchFoundation,Cork

Niall McTernanDataManager,NationalSelf-HarmRegistry

Ireland,NationalSuicideResearchFoundation,

Cork

Conal WrigleyResearchPsychologist,NationalSelf-Harm

RegistryIreland,NationalSuicideResearch

Foundation,Cork

Sarah NicholsonResearchOfficer,NationalSelf-HarmRegistry

Ireland,NationalSuicideResearchFoundation,

Cork

Ella ArensmanChiefScientist,NationalSuicideResearch

Foundation,Cork

ResearchProfessor,SchoolofPublicHealth,

UniversityCollegeCork

Eileen WilliamsonChiefExecutiveOfficer,NationalSuicide

ResearchFoundation,Cork

Paul CorcoranHeadofResearch,NationalSuicideResearch

FoundationCork

Howeverthefindingsfromthe2018Registry

reportindicatethatthereisstillconsiderable

variationinrecommendednextcareacross

hospitals,andonaverage,oneineightpatients

leavetheemergencydepartmentwithout

beingseenbyaclinicianorwithoutanextcare

recommendation.Ongoingsupportiswarranted

fortheimplementationoftheNationalClinical

Programmeandtheapplicationofmeasuresto

standardizeprovisionofcare.

All patients should receive an empathic, compassionate and timely response within the emergency department

In all cases every effort should be made to encourage the patient to call a relative/supportive friend to assist in the assessment and management

All patients receive an expert biopsychosocial assessment of needs and risks

All patients should receive follow up and connecting to next appropriate care

Evidence-basedrecommendationsfromtheTheNationalClinicalProgrammefortheAssessmentand

ManagementofpeoplepresentingtotheEmergencyDepartmentfollowingSelf-Harm.13


8

RecentpublicationsfromtheRegistry(2018-2019)

Background

Riskofself-harmrepetitionhasconsistentlybeenshowntobehigherfollowingself-cuttingcomparedtointentionaldrugoverdose(IDO)andotherself-harmmethods.Theutilityofpreviousevidenceislimitedduetothelargeheterogeneousmethodcategoriesstudied.Thisstudyexaminedriskofhospitalpresentedself-harmrepetitionaccordingtospecificcharacteristicsofself-harmmethods.Dataonconsecutiveself-harmpresentationstohospitalemergencydepartments(2010–2016)wereobtainedfromtheNationalSelf-HarmRegistryIreland.Associationsbetweenself-harmmethodandrepetitionwereanalysedusingsurvivalanalyses.

Findings

Overall,65,690self-harmpresentationsweremadeinvolving46,661individuals.Self-harmmethodsassociated

withincreasedriskofself-harmrepetitionwereminorandsevereself-cutting,intentionaldrugoverdoses(IDOs)involvingmultipledrugsincludingpsychotropicdrugsandself-harmbybluntobject.Minorself-cuttingwasthemethodassociatedwithhighestrepetitionrisk.RepetitionriskwassimilarfollowingIDOsoffourormoredrugsinvolvingpsychotropicdrugs,severeself-cuttingandbluntobject.

Conclusion

Self-harmmethodandtheassociatedriskofrepetitionshouldformacorepartofbiopsychosocialassessmentsandshouldinformfollow-upcareforself-harmpatients.TheobserveddifferencesinrepetitionassociatedwithspecificcharacteristicsofIDOunderlinetheimportanceofsafetyplanningandmonitoringprescribingforpeoplewhohaveengagedinIDO.

Background

Self-harmpresentationscanvarybothwithinandbetweenregionsduetoanumberofcomplexandmulti-facetedfactors.InNorthernIreland,self-harmratesarehigherthanthosereportedinneighbouringjurisdictionsandelevatedratescanbefoundamongmenandinurbanareas.Todate,therearerelativelyfewstudieswhichhaveexploredtherelationshipbetweenarea-levelfactorsandself-harmpresentations.Thisstudytookanecologicalapproach,usingmeasuresofpopulationdensity,socialfragmentationandamultipledeprivationmeasuretoexaminetheassociationofarea-levelcharacteristicsandhospitaltreatedself-harmpresentations.

Findings

Overall,14,477individualspresentedtohospitalsinNorthernIrelandbetween2013and2015.Withinthiscohort,therateofself-harmwashigheramongmen(478per100,000)comparedtowomen(467per100,000)andcityresidentsinBelfast(680per100,000)andDerry(751per100,000)comparedtothoseintherestofNorthernIreland(261per100,000).Apositiveassociationwas

foundbetweenincreasingratesofself-harmandmeasuresofdeprivation,socialfragmentationandpopulationdensity.Ratesofself-harmweremorethanfourtimeshigherinthemostdeprivedareas.Ratesofself-harmwerealsomorethanfourtimeshigherinareaswiththehighestsocialfragmentationscoresandmorethanthreetimeshigherinthemostdensely-populatedareas.Inparticular,areasdeprivedintermsofemployment,crimeanddisorder,educationskillsandtrainingandhealthanddisabilityhadthehighestratesofself-harm.Theseassociationsweremorepronouncedformen.

Conclusion

Thesefindingshighlightthechallengesfacedbyhealthservicesinrespondingtoself-harm,engagingvulnerablepopulationsandtacklinghealthinequalities.Self-harmratesarehighestforthoseresidinginhighlydeprivedareas,whereunemployment,crimeandlowlevelsofeducationarechallenges.Communityinterventionstailoredtomeettheneedsofspecificareasmaybeeffectiveinreducingsuicidalbehaviour.

METHOD OF SELF-HARM AND RISK OF SELF-HARM REPETITION: FINDINGS FROM A NATIONAL SELF-HARM REGISTRY

THE ASSOCIATION BETWEEN SELF-HARM AND AREA-LEVEL CHARACTERISTICS IN NORTHERN IRELAND: AN ECOLOGICAL STUDY

Source:CullyG,Corcoran,P,Leahy,D,GriffinE,Dillon,C,Cassidy,E,Shiely,F,ArensmanE(2019).Methodofself-harmandriskofself-harmrepetition:findingsfromanationalself-harmregistry.JournalofAffectiveDisorders,246:843-50.https://doi.org/10.1016/j.jad.2018.10.372

Source: GriffinE,BonnerB,DillonCB,O’HaganD,CorcoranP(2019).Theassociationbetweenself-harmandarea-levelcharacteristicsinNorthernIreland:anecologicalstudy.Europeanjournalofpublichealth.https://doi.org/10.1093/eurpub/ckz021

https://doi.org/10.1016/j.jad.2018.10.372

https://doi.org/10.1093/eurpub/ckz021

Presentations

12,588

210per 100,000

1 in every 476had a self-harm act

Female: 15-19 year-olds(766 per 100,000)

1 in every 131

Male: 20-24 year-olds(543 per 100,000)

1 in every 184

Rates in young peopleaged 10-24 years increasedby 29% between 2007-2018

PEAKRATESWERE

AMONGYOUNGPEOPLE

Persons

9,785

2018 Statistics at a Glance

Monday, Tuesday and Sundayhad the highest number

of self-harm presentations

Peak time

11pm

Men Women

Almost half (44%) of presentations were made

between 7pm-3am

7pm

3am

2 in every 3 involved overdose

72%received an assessment in the ED

79% received a follow-up recommendation after discharge

13% left ED before a recommendation was made

3 in every 10involved alcohol

3 in every 10involved self-cutting

M T W

F S S

T

62%34% 27% 30%

RATES:

TIME:

METHOD:

TREATMENT:

1 in 7persons

had a repeatattendance in 2018

20182007

+29%

9

NationalSelf-HarmRegistryIreland


10

Impact of the Registry at global level

TheWorldHealthOrganisation’s(WHO)report

“Preventingsuicide:aglobalimperative”published

in2014,identifiedaneedformanycountries

tohaveguidanceonthesurveillanceofsuicide

attemptspresentingtogeneralhospitals.Currently,

thenumberofcountriesthathaveestablisheda

surveillancesystemforsuicideattemptsislimited,

andcomparisonbetweenestablishedsystemsis

oftenhinderedbydifferencesbetweensystems.

Eachyear,closeto800,000peopledieasaresult

ofsuicide,andforeachsuicide,therearelikelyto

havebeenmorethan20suicideattempts.Having

engagedinoneormoreactsofattemptedsuicide

orself-harmisthesinglemostimportantpredictor

ofdeathbysuicide.Consequently,long-term

monitoringoftheincidence,demographicpatterns

andmethodsinvolvedincasesofattempted

suicideandself-harmpresentingtohospitalsina

countryorregionprovidesimportantinformation

thatcanassistinthedevelopmentofsuicide

preventionstrategies.

In2015,theWHOrecognisedtheNSRFasaWHO

CollaboratingCentreforSurveillanceandResearch

inSuicidePrevention(WHOCC)andin2018

commissionedthedevelopmentofanE-Learning

Programme,basedontheWHOPracticeManualfor

EstablishingandMaintainingSurveillanceSystems

forSuicideAttemptsandSelf-Harm(2016).

TheaimsoftheE-LearningProgrammeareto

facilitatesurveillanceofsuicideattemptsandself-

harmatgloballevelandtoimprovetheaccurate

reportingofhospitalbasedsuicideattempts

andself-harm.In2018,theNSRFandWHOCC,

incollaborationwiththeDepartmentofMental

HealthandSubstanceAbuseoftheWorldHealth

Organisation(WHO),producedtheE-Learning

programme,basedontheWHOPracticeManual.

Theworkinvolvedpreparingdifferentmodules,

includingatrainingmodulewithadditionaltest

vignettes.

TheE-LearningProgrammeisatoolforcountries

touseinsettingupapublichealthsurveillance

systemforsuicideattemptsandself-harmcases

presentingtogeneralhospitals.Thisprogramme

facilitatestrainingandcapacitybuildinginplaces

whereface-to-facetrainingcanbechallenging.

SincethelaunchoftheE-LearningProgramme,it

hasbeenaccessedintensivelybymanycountries,

andpreparationsarecurrentlyunderwayto

translatetheprogrammeintoRussian.

TheE-LearningProgrammecanbeaccessedhere:

https://suicideresearchpreventionelearning.com/

E-Learning Programme for Establishing and Maintaining Surveillance Systems for Suicide Attempts and Self-Harm

https://suicideresearchpreventionelearning.com

11


Methods

BackgroundTheNationalSuicideResearchFoundationwas

foundedinNovember1994bythelateDrMichaelJ

KelleherandisgovernedbyaBoardofDirectors.The

NationalSuicideResearchFoundationteamisledby

MsEileenWilliamson(ChiefExecutiveOfficer),Dr

PaulCorcoran(HeadofResearch)andProfessorElla

Arensman(ChiefScientist).DrPaulCorcoranisalso

HeadoftheNationalSelf-HarmRegistryIreland.DrEve

GriffinistheManageroftheRegistry.

FundingstatementTheNationalSelf-HarmRegistryIrelandisanational

systemofpopulationmonitoringfortheoccurrence

ofhospital-treatedself-harm.Itwasestablished,at

therequestoftheDepartmentofHealthandChildren,

bytheNationalSuicideResearchFoundationandis

fundedbytheHealthServiceExecutive’sNational

OfficeforSuicidePrevention.Thisreporthasbeen

commissionedbytheNationalOfficeforSuicide

Prevention.

DefinitionandterminologyTheRegistryusesthefollowingasitsdefinitionof

self-harm:‘anactwithnon-fataloutcomeinwhich

anindividualdeliberatelyinitiatesanon-habitual

behaviour,thatwithoutinterventionfromotherswill

causeself-harm,ordeliberatelyingestsasubstance

inexcessoftheprescribedorgenerallyrecognised

therapeuticdosage,andwhichisaimedatrealising

changesthatthepersondesiresviatheactualor

expectedphysicalconsequences’.Thisdefinition

wasdevelopedbytheWHO/EuroMulticentreStudy

WorkingGroupandwasassociatedwiththeterm

‘parasuicide’.Internationally,thetermparasuicidehas

beensupersededbytheterm‘deliberateself-harm’and

consequently,theRegistryhasadoptedtheterm‘self-

harm’.Thedefinitionincludesactsinvolvingvarying

levelsofsuicidalintentandvariousunderlyingmotives

suchaslossofcontrol,cryforhelporself-punishment.

Inclusioncriteria• Allmethodsofself-harmareincludedi.e.,drug

overdoses,alcoholoverdoses,lacerations,attempted

drownings,attemptedhangings,gunshotwounds,

etc.whereitisclearthattheself-harmwas

intentionallyinflicted.

• Allindividualswhoarealiveonadmissiontohospital

followingaself-harmactareincluded.

ExclusioncriteriaThefollowingcasesareNOTconsideredtobeself-harm:

• Accidentaloverdosese.g.,anindividualwhotakes

additionalmedicationinthecaseofillness,without

anyintentiontoself-harm.

• Alcoholoverdosesalonewheretheintentionwasnot

toself-harm.

• Accidentaloverdosesofstreetdrugsi.e.,drugsused

forrecreationalpurposes,withouttheintentionto

self-harm.

• Individualswhoaredeadonarrivalathospitalasa

resultofsuicide.

QualitycontrolThevalidityoftheRegistryfindingsisdependenton

thestandardisedapplicationofthecase-definition

andinclusion/exclusioncriteria.TheRegistryhas

undertakenacross-checkingexerciseinwhichpairsof

dataregistrationofficersindependentlycollectdata

fromtwohospitalsforthesameconsecutiveseriesof

attendancestotheemergencydepartment.Results

indicatedthatthereisaveryhighlevelofagreement

betweenthedataregistrationofficers(Kappa

statisticof0.90in2017).Furthermore,thedataare

continuouslycheckedforconsistencyandaccuracy.

DatarecordingSince2006,theRegistryhasrecordeditsdataonto

encryptedlaptopcomputersandtransferredthe

dataelectronicallytotheofficesoftheNational

SuicideResearchFoundation.Dataforallself-harm

presentationsmadein2018wererecordedusingthis

bespokeelectronicsystem.

DataitemsAminimaldatasethasbeendevelopedtodetermine

theextentofself-harm,thecircumstancesrelatingto

boththeactandtheindividualandtoexaminetrends

byarea.Whilethedataitemsbelowwillenablethe

systemtoavoidduplicaterecordingandtorecognise

repeatactsofself-harmbythesameindividual,itis

impossibletoidentifyanindividualonthebasisofthe

datarecorded.

InitialsInitiallettersfromanindividualself-harmpatient’s

namearerecordedinanencryptedformbythe

Registrydataentrysystemforthepurposesof

avoidingduplication,ensuringthatrepeatepisodesare

recognisedandcalculatingincidenceratesbasedon

personsratherthanevents.

12

Methods

GenderMaleorfemalegenderisrecordedwhenknown.

Date of birthDateofbirthisrecordedinanencodedformatto

furtherprotecttheidentityoftheindividual.Aswellas

beingusedtoidentifyrepeatself-harmpresentations

bythesameindividual,thedateofbirthisusedto

calculateage.

Area of residencePatientaddressesarecodedtotheappropriate

electoraldivisionandsmallareacodewhereapplicable.

Date and hour of attendance at hospital

Brought to hospital by ambulance

Method(s) of self-harmThemethod(s)ofself-harmarerecordedaccording

totheTenthRevisionoftheWHO’sInternational

ClassificationofDiseasescodesforintentionalinjury

(X60-X84).Themainmethodsareoverdoseofdrugs

andmedicaments(X60-X64),self-poisoningsby

alcohol(X65),poisoningswhichinvolvetheingestion

ofchemicals,noxioussubstances,gasesandvapours

(X66-X69)andself-harmbyhanging(X70),by

drowning(X71)andbysharpobject(X78).Some

individualsmayuseacombinationofmethodse.g.,

overdoseofmedicationsandself-cutting.Inthisreport,

resultsgenerallyrelatetothe‘mainmethod’ofself-

harm.Inkeepingwithstandardsrecommendedbythe

WHO/EuroStudyonSuicidalBehaviour,thisistakenas

themostlethalmethodemployed.Foractsinvolving

self-cutting,thetreatmentreceivedwasrecordedwhen

known.

Drugs takenWhereapplicable,thenameandquantityofthedrugs

takenarerecorded.

Medical card statusWhethertheindividualpresentinghasamedicalcard

ornotisrecorded.

Mental health assessmentWhethertheindividualpresentinghadareviewor

assessmentbythepsychiatricteaminthepresenting

hospitalemergencydepartmentisrecorded.

Recommended next careRecommendednextcarefollowingtreatmentinthe

hospitalemergencydepartmentisrecorded.

ConfidentialityConfidentialityisstrictlymaintained.TheNational

SuicideResearchFoundationisregisteredwiththe

DataProtectionAgencyandcomplieswiththeIrish

DataProtectionActof1988,theIrishDataProtection

(Amendment)Actof2003andtheGeneralData

ProtectionRegulation2018.Onlyanonymiseddataare

releasedinaggregateforminreports.Thenamesand

addressesofpatientsarenotrecorded.

EthicalapprovalEthicalapprovalhasbeengrantedbytheNational

ResearchEthicsCommitteeoftheFacultyofPublic

HealthMedicine.TheRegistryhasalsoreceivedethical

approvalfromtherelevanthospitalsandHealthService

Executive(HSE)ethicscommittees.

RegistrycoverageIn2018,self-harmdatawerecollectedfromhospitalsin

theRepublicofIreland(pop:4,856,900).

Therewascompletecoverageofallacutehospitalsin

theIrelandEastHospitalGroup–MaterMisercordiae

UniversityHospital,MidlandRegionalHospital,

Mullingar,OurLady’sHospitalNavan,St.Columcille’s

Hospital,Loughlinstown,St.Luke’sHospital,Kilkenny,

St.Michael’sHospital,DunLaoghaire,WexfordGeneral

Hospitalandanotherhospitalwhoseethicscommittee

stipulatedthatitshouldnotbenamedinRegistry

reports.


theDublinMidlandsHospitalGroup–MidlandRegional

Hospital,Portlaoise,MidlandRegionalHospital,

Tullamore,NaasGeneralHospital,St.James’sHospital

andAdelaideandMeathHospitalTallaghtHospital

(adults).


theRCSIHospitalGroup–BeaumontHospital,Cavan

GeneralHospital,ConnollyHospital,Blanchardstown

andOurLadyofLourdesHospital,Drogheda.

Therewascompletecoverageofallacutehospitals

intheSouth/SouthWestHospitalGroup–Bantry

GeneralHospital,CorkUniversityHospital,University

Hospital,Kerry,MallowGeneralHospital,Mercy

UniversityHospital,Cork,SouthTipperaryGeneral

HospitalandUniversityHospital,Waterford.


intheUniversityofLimerickHospitalGroup–Ennis

Hospital,NenaghHospital,St.John’sHospital,Limerick

andUniversityHospital,Limerick.


intheSaoltaUniversityHealthCareGroup–Galway

UniversityHospital,LetterkennyGeneralHospital,Mayo

GeneralHospital,PortiunculaHospital,Ballinasloeand

SligoRegionalHospital.

Therewascompletecoverageofallhospitalsinthe

Children’sHospitalGroup–Children’sUniversity

HospitalatTempleStreet,NationalChildren’sHospital

atTallaghtHospitalandOurLady’sChildren’sHospital,

Crumlin.

Intotal,self-harmdatawerecollectedforthefull

calendaryearof2018forall36acutehospitalsthat

operatedinIrelandduringthisyear.Asmentioned

previously,since2006theRegistryhashadcomplete

coverageofallacutehospitalsinIreland.

13

Methods

In2013,anumberofhospitalemergencydepartments

werere-designatedasModel2statushospitalsaspart

oftheHSE’sSecuringtheFutureofSmallerHospitals

framework,withsomeofthesehospitalsclosingtheir

emergencydepartmentandothersoperatingon

reducedhours.Thehospitalswhichcontinuetohave

emergencydepartmentsonreducedhoursinclude:

BantryGeneralHospital,EnnisHospital,MallowGeneral

Hospital,NenaghHospital,St.Columcille’sHospital

LoughlinstownandSt.John’sHospitalLimerick.Data

fromthesehospitalscontinuetoberecordedbythe

Registryfor2018.

PopulationdataFor2018,theCentralStatisticsOfficepopulation

estimateswereutilised.Theseestimatesprovide

age-sex-specificpopulationdataforthecountryand

itsconstituentregionalauthorityareas.Proportional

differencesbetweenthe2018regionalauthority

populationestimatesandtheequivalentNational

Census2016figureswerecalculatedandappliedto

theNationalCensus2016populationfiguresforIrish

cities,countiesandHSEregionfiguresinorderto

derivepopulationestimatesfor2018.ForHSELocal

HealthOffice(LHO)areasandCommunityHealthcare

Organisation(CHO)areas,NationalCensus2016

populationdatawereutilised.

CalculationofratesSelf-harmrateswerecalculatedbasedonthenumber

ofpersonsresidentintherelevantareawhoengaged

inself-harmirrespectiveofwhethertheyweretreated

inthatareaorelsewhere.Crudeandage-specificrates

per100,000populationwerecalculatedbydividingthe

numberofpersonswhoengagedinself-harm(n)by

therelevantpopulationfigure(p)andmultiplyingthe

resultby100,000,i.e.(n/p)*100,000.

Europeanage-standardisedrates(EASRs)are

theincidenceratesthatwouldbeobservedifthe

populationunderstudyhadthesameagecomposition

asatheoreticalEuropeanpopulation.Adjustingfor

theagecompositionofthepopulationunderstudy

ensuresthatdifferencesobservedbygenderorby

areaareduetodifferencesintheincidenceofself-

harmratherthandifferencesinthecompositionof

thepopulations.EASRswerecalculatedasfollows:for

eachfive-yearagegroup,thenumberofpersonswho

engagedinself-harmwasdividedbythepopulationat

riskandthenmultipliedbythenumberintheEuropean

standardpopulation.TheEASRisthesumofthese

age-specificfigures.

AnoteonsmallnumbersCalculatedratesthatarebasedonlessthan20events

maybeanunreliablemeasureoftheunderlyingrate.In

addition,self-harmeventsmaynotbeindependentof

oneanother,althoughtheseassumptionsareusedin

thecalculationofconfidenceintervals,intheabsence

ofanyclearknowledgeoftherelationshipbetween

theseevents.

TheRegistryrecordedfourcasesofself-harmfor

whichpatientinitials,genderordateofbirthwere

unknown.Thesefourcaseshavebeenexcludedfrom

thefindingsreportedhere.Inaddition,asmallnumber

ofself-harmpatientspresentedtohospitalmorethan

onceonthesamecalendarday.Thishappenedfor

avarietyofreasonsincludingbeingtransferredto

anotherhospital,abscondingandreturning,etc.These

patientswereconsideredasreceivingoneepisodeof

careandwererecordedonceinthefinalisedRegistry

databasefor2018.

AnoteonconfidenceintervalsConfidenceintervalsprovideuswithamarginoferror

withinwhichunderlyingratesmaybepresumedtofall

onthebasisofobserveddata.Confidenceintervals

assumethattheeventrate(n/p)issmallandthat

theeventsareindependentofoneanother.A95%

confidenceintervalforthenumberofevents(n),isn +/- 2√n.Forexample,if25self-harmpresentationsare

observedinaspecificregioninoneyear,thenthe95%

confidenceintervalwillbe25 +/- 2√25or15to35.Thus,

the95%confidenceintervalaroundaraterangesfrom

(n - 2√n) / pto(n + 2√n) / p,wherepisthepopulationat

risk.Iftherateisexpressedper100,000population,

thenthesequantitiesmustbemultipliedby100,000.

A95%confidenceintervalmaybecalculatedto

establishwhetherthetworatesdifferstatistically

significantly.Thedifferencebetweentheratesis

calculated.The95%confidenceintervalforthisrate

difference(rd)rangesfromrd - 2√(n1 / p12 + n2 / p2

2)to

rd + 2√(n1 / p12 + n2 / p2

2).Iftherateswereexpressedper

100,000population,then2√(n1 / p12 + n2 / p2

2)mustbe

multipliedby100,000beforebeingaddedtoand

subtractedfromtheratedifference.Ifzeroisoutside

oftherangeofthe95%confidenceinterval,thenthe

differencebetweentheratesisstatisticallysignificant.

Mappingofself-harmdataRatesofself-harmbygenderaccordingtocity/county

ofresidenceareillustratedinthereportusingmaps.

QGIS,version2.18.16,wasusedtogeneratethemaps

(www.qgis.org).

www.qgis.org

14

SECTIONI:

Hospital Presentations


Individualswhopresentedtohospitalwithself-harmintheRepublicofIreland

Fortheperiodfrom1Januaryto31December2018,theRegistryrecorded12,588self-harmpresentationsto

hospitalthatweremadeby9,785individuals.Thus,thenumberofself-harmpresentationswas8%higherthan

2017andthenumberofpersonsinvolvedincreasedby7%.Table1summarisesthechangesinthenumberof

presentationsandpersonssincetheRegistryreachednearnationalcoveragein2002.

PRESENTATIONS PERSONS

YEAR Number %difference Number %difference

2002 10,537 - 8,421 -

2003 11,204 +6% 8,805 +5%

2004 11,092 -1% 8,610 -2%

2005 10,789 -3% 8,594 -<1%

2006 10,688 -1% 8,218 -4%

2007 11,084 +4% 8,598 +5%

2008 11,700 +6% 9,218 +7%

2009 11,966 +2% 9,493 +3%

2010 12,337 +3% 9,887 +4%

2011 12,216 -1% 9,834 -<1%

2012 12,010 -2% 9,483 -4%

2013 11,061 -8% 8,772 -8%

2014 11,126 +<1% 8,708 -<1%

2015 11,189 +1% 8,791 +1%

2016 11,445 +2% 8,876 +1%

20171 11,620 +2% 9,114 +3%

2018 12,588 +8% 9,785 +7%

Table 1: Numberofself-harmpresentationsandpersonswhopresentedintheRepublicofIrelandin2002-2018

(2002-2005figuresextrapolatedtoadjustforhospitalsnotcontributingdata).

1Figuresfor2017havebeenupdatedtoincludeanadditional20caseswhichwerelateregistered.

Theage-standardisedrateofindividualspresentingtohospitalintheRepublicofIrelandfollowingself-harmin

2018was210(95%ConfidenceInterval(CI):206to215)per100,000.Thiswasasignificantincrease(+6%)on

therateof199(95%CI:195to203)per100,000from2017.Theincidenceofself-harminIrelandisexaminedin

detailinSectionIIofthisreport.

Thenumberofself-harmpresentationsintheRepublicofIrelandbyhospitalgroup,ageandgenderaregiven

inAppendix1.Oftherecordedpresentationsin2018,45%weremadebymenand55%weremadebywomen.

15

HospitalPresentations

Self-harmepisodesweregenerallyconfinedtotheyoungeragegroups.Halfofallpresentations(50%)wereby

peopleunder30yearsofageand86%ofpresentationswerebypeopleagedlessthan50years.

Inmostagegroupsthenumberofself-harmactsbywomenexceededthenumberbymen.Thiswasmost

pronouncedinthe10-19yearagegroupwherethereweretwiceasmanyfemalepresentations.Thenumberof

self-harmpresentationsmadebymenwasslightlyhigherthanthenumbermadebywomeninthe20-39year

agegroup.

Thenumberofself-harmpresentationsmadebyresidentsofhomelesshostelsandpeopleofnofixedabode

was539,representing4.0%ofallpresentations.Thisfigureis9%lowerthanthatrecordedin2017(n=591).A

minority(50;0.4%)ofpresentationsweremadebyhospitalinpatients.

Self-harmbyHSEhospitalgroup

BasedonprovisionalfiguresacquiredfromtheHSEBusinessInformationUnit,self-harmaccountedfor0.91%

oftotalattendancestogeneralemergencydepartmentsinthecountry.Thispercentageofattendances

accountedforbyself-harmvariedbyHSEhospitalgroupfrom0.27%intheChildren’s,to0.87%intheSaolta

University,0.89%intheUniversityofLimerickandIrelandEast,1.00%intheRCSI,and1.05%intheSouth/

SouthWestand1.14%intheDublinMidlandshospitalgroup.

Theproportionofself-harmpresentationsineachhospitalgroupin2018rangedfrom3%intheChildren’s,7%

intheUniversityofLimerick,to15%intheSaoltaUniversityandRCSI,18%intheDublinMidlands,20%inthe

South/SouthWestand22%intheIrelandEasthospitalgroup.

Thegenderbalanceofrecordedepisodesin2018(at45%mento55%women)variedbyhospitalgroup

(Figure1).Self-harmpresentationsbywomenoutnumberedthosebymeninallhospitalgroups.

Figure 1: Genderbalanceofself-harmpresentationsbyHSEhospitalgroup,2018

Annualchangeinself-harmpresentationstohospital

Thenationalincreaseinthenumberofself-harmpresentationstohospitalin2018wasreflectedatthelevel

oftheindividualhospitals(Figures2aand2b).Overall,28generalhospitalssawanincreaseinself-harm

presentationsbetween2017and2018,whilefourgeneralhospitalssawadecreaseduringthesameperiod.2

2Itshouldbenotedthatinsmallhospitals,largepercentagechangesarebasedonrelativelysmallnumbers.

RCSI Hospital Group

Ireland East Hospital Group

University of Limerick Hospital Group

0% 20% 40% 60% 80% 100%

Children's Hospital Group

Dublin Midlands Hospital Group

Saolta University Health Care Group

South/South West Hospital Group

Percentage of episodes

HSE

Hosp

ital G

roup

Men Women

31%

41%

43%

44%

47%

48%

48%

69%

59%

57%

56%

53%

52%

52%

16


Figure 2a: Hospitalsreceivingmoreself-harmpresentationsin2018.

Note:Thisfigureexcludesthreehospitalswheretheincreaseswerebasedonsmallnumbers(<5).

Figure 2b: Hospitalsreceivingfewerself-harmpresentationsin2018.

0 10 20 30 40 50

University Hospital KerryMayo General Hospital

Adelaide and Meath Hospital, TallaghtNational Children's Hospital at Tallaght Hospital

Midland Regional Hospital, PortlaoiseOur Lady's Children's Hospital, CrumlinOur Lady of Lourdes Hospital, Drogheda

Sligo Regional HospitalBeaumont Hospital

University Hospital, LimerickMidland Regional Hospital, Tullamore

Cork University HospitalWexford General Hospital

Midland Regional Hospital, MullingarGalway University Hospital

South Tipperary General HospitalConnolly Hospital, Blanchardstown

St. Luke's Hospital, KilkennySt. James's Hospital

Mater Misericordiae University HospitalNaas General Hospital

Cavan General HospitalLetterkenny General Hospital

OtherPortiuncula Hospital, Ballinasloe

% change from 2017 to 2018

-50 -40 -30 -20 -10 0

Our Lady’s Hospital, Navan

Children’s University Hospital at Temple Street

University Hospital, Waterford

Bantry General Hospital

% change from 2017 to 2018

17


Episodesbytimeofoccurrence

Variation by Month

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total

Men 469 430 465 422 528 475 500 470 457 503 459 483 5661

Women 577 513 550 616 677 552 551 641 565 604 565 516 6927

Total 1046 943 1015 1038 1205 1027 1051 1111 1022 1107 1024 999 12588

Table 2:Numberofself-harmpresentationsin2018bymonthformenandwomen.

Figure 3:Percentagedifferencebetweentheobservedandexpectednumberofself-harmpresentationsby

monthin2018.

Themonthlyaveragenumberofself-harmpresentationstohospitalsin2018was1,049.Figure3illustratesthe

percentagedifferencebetweenobservedandexpectednumberofpresentations,accountingforthenumber

ofdaysineachcalendarmonth.In2018,thereweremoreself-harmpresentationsthanmightbeexpectedin

May(+13%),August(+4%)andOctober(+4%).Theendofyearfallinpresentationswassimilartoprevious

years.BetweenNovemberandMarch,therewere,onaverage,4%fewerpresentationsthanmightbeexpected.

Variation by Day

Figure 4: Numberofpresentationsbyweekday,2018.

Perc

enta

ge

-14

-10

-6

-2

2

6

10

14

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

Num

ber o

f pre

sent

atio

ns

Men Women

0100200300400500600700800900

100011001200

Mon Tues Wed Thurs Fri Sat Sun

18


Monday Tuesday Wednesday Thursday Friday Saturday Sunday Total

Men924 798 745 783 802 758 851 5661

(16.3%) (14.1%) (13.2%) (13.8%) (14.2%) (13.4%) (15%) (100%)

Women1139 1004 910 966 936 871 1101 6927

(16.4%) (14.5%) (13.1%) (13.9%) (13.5%) (12.6%) (15.9%) (100%)

Total2063 1802 1655 1749 1738 1629 1952 12588

(16.4%) (14.3%) (13.1%) (13.9%) (13.8%) (12.9%) (15.5%) (100%)

Note:Onaverage,eachdaywouldbeexpectedtoaccountfor14.3%ofpresentations.

Table 3: Self-harmpresentationsin2018byweekday.

Asinpreviousyears,thenumberofself-harmpresentationswashighestonMondays,TuesdayandSundays.

Thesedaysaccountedfor46%ofallpresentations.NumbersfellafterTuesdaybeforerisingagainonSunday.

During2018,therewereanaverageof34self-harmpresentationstohospitaleachday.Therewere24daysin

2018onwhich45ormoreself-harmpresentationsweremade,includingJanuary1st,NewYear’sDay(n=49),

May1st,MayBankHoliday(n=50)andDecember27th(n=56).Thereweresixdaysin2018onwhich20or

fewerself-harmpresentationsweremade,includingDecember31st,NewYear’sEve(n=20).

Variation by Hour

Figure 5: Numberofpresentationsbytimeofattendance.

Asinpreviousyears,therewasastrikingpatterninthenumberofself-harmpresentationsseenoverthe

courseoftheday.Thenumbersforbothmenandwomengraduallyincreasedduringtheday.Thepeak

formenwas11pm,whilethepeakforwomenwas6pmand11pm.Almosthalf(44%)ofthetotalnumberof

presentationsweremadeduringtheeight-hourperiod7pm-3am.Thiscontrastswiththequietesteight-hour

periodoftheday,from5am-1pm,whichaccountedforjust19%ofallpresentations.

Overhalf(53%)werebroughttohospitalbyambulanceandafurther3%werebroughtbyotheremergency

servicessuchasAnGardaSiochana.Theproportionofcasesbroughttotheemergencydepartmentby

ambulanceorotheremergencyservicesvariedoverthecourseofthedayfrom43%forpresentations

betweennoonand4pmto72%forthosewhopresentedbetweenmidnightand8am.

Time (24 Hour Clock)

Num

ber o

f pre

sent

atio

ns

Men Women

0

50

100

150

200

250

300

350

400

450

500

8 10 12 14 16 18 20 22 0 2 4 6

19


Methodofself-harm

Overdose Alcohol Poisoning Hanging Drowning Cutting Other Total

Men3159 1921 135 704 254 1754 450 5661

(55.8%) (33.9%) (2.4%) (12.4%) (4.5%) (31%) (7.9%) (100%)

Women4633 1871 134 368 183 1954 353 6927

(66.9%) (27%) (1.9%) (5.3%) (2.6%) (28.2%) (5.1%) (100%)

Total7792 3792 269 1072 437 3708 803 12588

(61.9%) (30.1%) (2.1%) (8.5%) (3.5%) (29.5%) (6.4%) (100%)

Table 4: Methodsofself-harminvolvedinpresentationstohospitalin2018.

Approximately62%ofallself-harmpresentationsinvolvedadrugoverdose,whichwasmorecommonlyused

asamethodofself-harmbywomenthanbymen.Itwasinvolvedin56%ofmaleand67%offemaleepisodes.

Alcoholwasinvolvedin30%ofallcases.Alcoholwassignificantlymoreofteninvolvedinmaleepisodesof

self-harmthanfemaleepisodes(34%and27%,respectively).

Cuttingwastheonlyothercommonmethodofself-harm,involvedin30%ofallepisodes.Cuttingwasmore

commoninmen(31%)thaninwomen(28%).Presentationsinvolvingself-cuttingincreasedby17%in2018.

In93%ofallcasesinvolvingself-cutting,thetreatmentreceivedwasrecorded.Onequarter(25%)received

steristripsorsteribonds,54%didnotrequireanytreatment,19%requiredsutureswhile2%werereferredfor

plasticsurgery.Menwhocutthemselvesmoreoftenrequiredintensivetreatment.Respectively,20%received

suturesand3%werereferredforplasticsurgerycomparedto16%and2%ofwomenwhocutthemselves.

Attemptedhangingwasinvolvedin9%ofallself-harmpresentations(12%formenand5%forwomen).At

1,072,thenumberofpresentationsinvolvingattemptedhangingwas24%higherthan2017(+22%formen

and+30%forwomen).Overall,thenumberofself-harmpresentationsinvolvinghangingincreasedbetween

2007and2018from444to1,072.Whilerareasamethodofself-harm,thenumberofpresentationsinvolving

attempteddrowningincreasedby19%in2018(from367to437)whilepresentationsinvolvingingestionof

poisonoussubstancesorgasesincreasedby22%(from227to269).

Thegreaterinvolvementofdrugoverdoseasafemalemethodofself-harmisillustratedinFigure6.Drug

overdosealsoaccountedforahigherproportionofself-harmpresentationsintheolderagegroups,in

particularforwomen,whereasself-cuttingwaslesscommon.Self-cuttingwasmostcommonamongyoung

people–in38%ofpresentationsbyboysand36%ofpresentationsbygirlsagedunder15years.

Figure 6: Methodofself-harmusedbygenderandagegroup,2018.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

<15yrs 15-24yrs 25-34yrs 35-44yrs 45-54yrs 55yrs+

Age group

Men

Age group

Women

Other

Attempted drowning only

Attempted hanging only

Overdose & self-cutting

Self-cutting only

Drug overdose only

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

<15yrs 15-24yrs 25-34yrs 35-44yrs 45-54yrs 55yrs+

20


Drugsusedinoverdose

Thetotalnumberoftabletstakenwasknownin69%ofallcasesofdrugoverdose.Onaverage,29tablets

weretakenintheepisodesofself-harmthatinvolveddrugoverdose.Three-quartersofdrugoverdoseacts

involvedlessthan36tablets,halfinvolvedlessthan20tabletsandonequarterinvolvedlessthan12tablets.

Onaverage,thenumberoftabletstakeninoverdoseactswashigherinmenthanwomen(mean:31vs.28).

Figure7illustratesthepatternofthenumberoftabletstakenindrugoverdoseepisodesforbothgenders.

Half(50%)offemaleepisodesand46%ofmaleepisodesofoverdoseinvolved10-29tablets.

Figure 7: Thepatternofthenumberoftabletstakenindrugoverdose,bygender.

Note:Somedrugs(e.g.compoundscontainingparacetamolandanopiate)arecountedintwocategories.

Figure 8: Thevariationinthetypeofdrugsused.

Number of tablets

Perc

enta

ge o

f ove

rdos

e ac

ts

Men Women

0

10

20

30

40

<10 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+

Percentage of all overdose episodes Men Women

0 10 20 30 40 50

SalicylateSalicylate Compound

ParacetamolParacetamol Compound

OpiateOpiate Compound

NSAIDS and other analgesicsMinor TranquilliserMajor Tranquilliser

SSRITCAD

Other anti-depressants (including Mood Stabilisers)Anti-epileptics/Barbiturates

Other drugsStreet Drugs

Herbal/Homeopathic

21


Figure8illustratesthefrequencywithwhichthemostcommontypesofdrugswereusedinoverdose.

Approximatelyone-third(35%)ofalloverdosesinvolvedaminortranquilliserandsuchadrugwasused

significantlymoreoftenbymenthanwomen(41%vs.31%,respectively).Amajortranquilliserwasinvolved

in10%ofoverdoses.Intotal,48%ofallfemaleoverdoseactsand34%ofallmaleoverdoseactsinvolvedan

analgesicdrug.Paracetamolwasthemostcommonanalgesicdrugtaken,involvedinsomeformin30%of

drugoverdoseacts.Paracetamol-containingmedicationwasusedsignificantlymoreoftenbywomen(36%)

thanbymen(22%).Oneinfiveacts(19%)ofoverdoseactsinvolvedananti-depressant/moodstabiliser.The

groupofanti-depressantdrugsknownasSelectiveSerotoninReuptakeInhibitors(SSRIs)werepresentin11%

ofoverdosecases.Streetdrugswereinvolvedin17%ofmaleand4%offemaleoverdoseacts.‘Otherclassified

drugs’weretakeninmorethanonequarter(26%)ofalloverdoseswhichreflectsthewiderangeofdrugs

takendeliberatelyinactsofdrugoverdose.

Thenumberofself-harmpresentationstohospitalinvolvingdrugoverdosein2018(7,792)washigherthanthe

numberrecordedin2017(7,538).Therewassomefluctuationinthenumberofpresentationsinvolvingeach

ofthedrugtypesdescribedhere.Mostnotably,therewereincreasesinthenumberofself-harmpresentations

involvingopiatecompoundmedication(+31%),salicylatecompoundmedication(+29%),minortranquillisers

(+8%)andmajortranquillisers(+6%).Decreasesinthenumberofself-harmpresentationsinvolvingtricyclic

antidepressants(-6%),otherantidepressants(-7%)andotherdrugs(-7%)werealsorecorded.

Figure 9: Trendsinrateofstreetdrugsinintentionaloverdosebygender,2007-2018.

In2018,therewasanincreaseinthenumberofself-harmpresentationstohospitalinvolvingstreetdrugsby

27%(from583to742).Since2007,therateper100,000ofintentionaldrugoverdoseinvolvingstreetdrugs

hasincreasedby54%(from9.9to15.3per100,000).Themalerateincreasedby57%(from14.6to22.8per

100,000)whilethefemaleratehasincreasedby50%(from5.3to7.9per100,000).Cocaineandcannabis

werethemostcommonstreetdrugsrecordedbytheRegistryin2018,presentin5%and3%ofoverdoseacts,

respectively.Cocainewasmostcommonamongmen,involvedin15%ofoverdoseactsby25-34year-olds.

Cannabiswasmostcommonamongmenaged15-24year-olds–presentin8%ofoverdoseacts.

Rate

per

100

,000

Men Women

0

5

10

15

20

25

30

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

22


Recommendednextcare

Overall,in13%of2018cases,thepatientlefttheemergencydepartmentbeforeanextcarerecommendation

couldbemade.Followingtheirtreatmentintheemergencydepartment,inpatientadmissionwasthenext

stageofcarerecommendedfor31%ofcases,irrespectiveofwhethergeneralorpsychiatricadmissionwas

intendedandwhetherthepatientrefusedornot.Ofallself-harmcases,24%resultedinadmissiontoaward

ofthetreatinghospitalwhereas7%wereadmittedforpsychiatricinpatienttreatmentfromtheemergency

department.Itmaynotalwaysberecordedintheemergencydepartmentthatapatienthasbeendirectly

admittedtopsychiatricinpatientcare.Therefore,directpsychiatricadmissionfiguresprovidedheremaybe

underestimated.Inaddition,someofthepatientsadmittedtoageneralhospitalwardwillsubsequentlybe

admittedaspsychiatricinpatients.Infewerthan1%ofcases,thepatientrefusedtoallowhim/herselftobe

admittedwhetherforgeneralorpsychiatriccare.Mostcommonly,56%ofcasesweredischargedfollowing

treatmentintheemergencydepartment.

Nextcarerecommendationsin2018werebroadlysimilarformenandwomen.Menmoreoftenleftthe

emergencydepartmentbeforearecommendationwasmade(16%vs.11%).Womenweremoreoftenadmitted

toageneralwardofthetreatinghospitalthanmen(28%vs.20%).

Overdose(N=7792)

Alcohol(N=3792)

Poisoning(N=269)

Hanging(N=1072)

Drowning(N=437)

Cutting(N=3708)

Other(N=848)

All(N=12588)

Generaladmission

31.8% 23.6% 28.3% 13.9% 10.8% 12.4% 12.4% 24.3%

Psychiatricadmission

5.0% 4.3% 9.3% 15.8% 10.1% 5.9% 10.7% 6.5%

Patientwouldnotallowadmission

0.5% 0.4% 0.7% 0.5% 0.5% 0.3% 0.9% 0.5%

Leftbeforerecommendation

12.6% 17.2% 9.3% 8.5% 13.0% 14.8% 11.6% 12.8%

Dischargedfromemergencydepartment

50.0% 54.4% 52.4% 61.4% 65.7% 66.5% 64.4% 55.8%

Table 5: Recommendednextcarein2018bymethodsofself-harm.

Recommendednextcarevariedaccordingtothemethodofself-harm(Table5).Generalinpatientcarewas

mostcommonfollowingcasesofdrugoverdoseandself-poisoning,lesscommonafterattemptedhanging

andleastcommonafterself-cuttingandattempteddrowning.Thefindinginrelationtoself-cuttingmaybe

areflectionofthesuperficialnatureoftheinjuriessustainedinsomecases.Ofthosecaseswherethepatient

usedcuttingasamethodofself-harm,67%weredischargedafterreceivingtreatmentintheemergency

department.Thegreaterthepotentiallethalityofthemethodofself-harminvolved,thehighertheproportion

ofcasesadmittedforpsychiatricinpatientcaredirectlyfromtheemergencydepartment.

NextcarevariedsignificantlybyHSEhospitalgroup(Table6).Theproportionofself-harmpatientswho

leftbeforearecommendationwasmadevariedfrom1%intheChildren’shospitalgroup,to19%inthe

RCSIhospitalgroup.Acrossthehospitalgroups,inpatientcare(irrespectiveoftypeandwhetherpatient

refused)wasrecommendedfor16%ofthepatientstreatedintheUniversityofLimerick,28%intheIreland

East,31%intheDublinMidlands,32%intheSouth/SouthWestandRCSI,38%intheSaoltaUniversityand

63%intheChildren’shospitalgroups.Asacorollarytothis,theproportionofcasesdischargedfollowing

emergencytreatmentrangedfromalowof36%intheChildren’sgrouptoahighof72%intheUniversityof

Limerickgroup.Thebalanceofgeneralandpsychiatricadmissionsdirectlyaftertreatmentintheemergency

departmentdifferedsignificantlybyhospitalgroup.Directgeneraladmissionsweremorecommonthandirect

psychiatricadmissionsinallhospitalgroups.

23


Ireland East

Hospital Group

Dublin Midlands Hospital

Group

RCSI Hospital

Group

South/ South West

Hospital Group

University of

Limerick Hospital

Group

Saolta University

Health Care

Group

Children’s Hospital

Group

Republicof

Ireland

(n=2741) (n=2305) (n=1934) (n=2532) (n=927) (n=1826) (n=323) (n=12588)

Generaladmission

24.7% 24.1% 25.2% 24.5% 9.7% 23.5% 62.8% 24.3%

Psychiatricadmission

3% 5.9% 6% 7.1% 5.9% 13.7% 0% 6.5%


0.2% 0.8% 0.4% 0.3% 0% 1.2% 0.3% 0.5%


12.9% 14.1% 18.8% 10.9% 12.4% 9.7% 0.9% 12.8%

Dischargedfromemergencydepartment

59.2% 55% 49.6% 57.2% 72% 51.9% 35.9% 55.8%

Note:Itmaynotalwaysberecordedintheemergencydepartmentthatapatienthasbeendirectlyadmitted

topsychiatricinpatientcare.Therefore,thefiguresfordirectpsychiatricadmissiondetailedinthistablemay

beunderestimates.

Table 6:Recommendednextcarein2018byHSEhospitalgroup.

In2018,13%ofpatientslefttheemergencydepartmentbeforearecommendationcouldbemade.Thefunnel

plotinFigure10illustratestheproportionofpresentationsresultinginthepatientleavingwithoutbeingseen

foreachhospital.Formosthospitals,theproportionwassimilartothenationalrate.However,therewere

eighthospitalsfallingoutsideofthedashedlines,whichindicatesthattheirrateisdifferenttothenational

rate.Thereisevidenceofanassociationwiththelocationofahospital,withtheproportionofpatientsleaving

beforerecommendationhigherininnercityhospitalemergencydepartments.

Note:Duetosmallnumbers,dataforLocalInjuryUnitsandChildren’sHospitalshavebeenexcluded.

Figure 10:Funnelplotoftheproportionleavingbeforerecommendation,accordingtohospital,2018.

Appendix2detailstherecommendednextcareforself-harmpatientsaccordingtohospital.Foreachhospital

group,thereweresignificantdifferencesbetweenthehospitalsintheirpatternofnextcarerecommendations.

Hospital rate (%) National rate (%) 95% CI

Number of self-harm presentations

Perc

enta

ge w

ho le

ft be

fore

reco

mm

enda

tion

0

5

10

15

20

25

30

0 100 200 300 400 500 600 700 800 900 1000

24


Self-harmcasesdischargedfromemergencydepartment

Informationonfollow-oncareorreferralsofferedwasrecordedforpatientsdischargedfromtheemergency

departmentfollowingtreatment(n=7,030).

• In33%ofepisodes,anout-patientappointmentwasrecommendedasanextcarestepforthepatient.

• Recommendationstoattendtheirgeneralpractitionerforafollow-upappointmentweregivento18%of

dischargedpatients.

• Ofthosenotadmittedtothepresentinghospital,11%weretransferredtoanotherhospitalfortreatment(8%

forpsychiatrictreatmentand3%formedicaltreatment).

• Otherservices(e.g.psychologicalservices,community-basedmentalhealthteamsandaddictionservices)

wererecommendedin17%ofepisodes.

• Approximatelyoneinfive(21%)ofpatientsdischargedfromtheemergencydepartmentweredischarged

homewithoutareferral.

Figure 11: Referralofself-harmpatientsin2018followingdischargefromtheemergencydepartment.

Referralsofferedtoself-harmpatientsvariedaccordingtoHSEhospitalgroup,with76%ofpatientsinthe

Children’shospitalgroupreferredforanout-patientappointmentcomparedwith17%intheSaoltaUniversity

groups.Referralstocommunity-basedmentalhealthteamswerehighestintheSaoltaUniversitygroup(33%),

withreferralstogeneralpractitionershighestintheDublin-Midlandsgroup(25%).

Mentalhealthassessment

Whetherthepatienthadamentalhealthassessmentinthepresentinghospitalwasknownin94%ofallcases.

Ofthoseknown,72%(n=8,490)ofpatientswereassessedbyamemberofthementalhealthteam(74%for

women,69%formen).Assessmentwasmostcommonfollowingattemptedhanging(80%)andattempted

drowning(77%).Thosewithalcoholonboardorwithself-cuttingwerelesslikelytoreceiveanassessment

(69%and70%,respectively).Aminority(4%)ofpatientsrefusedamentalhealthassessmentatthetimeof

presentation(n=472).

Morethanthree-quarters(81%)ofthosenotadmittedtothepresentinghospitalreceivedamentalhealth

assessmentpriortodischarge.Howeveronly18%ofpatientswholeftbeforerecommendationreceivedan

assessment.

Mentalhealthassessmentprovisionvariedaccordingtowhethertheself-harmattendancewasarepeat

presentationornot.In2018,almostthree-quarters(73%)offirstpresentationsofself-harmwereassessed,

comparedwith58%ofthosewithfiveormorepresentations.

Percentage of episodes

0 5 10 15 20 25 30 35

Referred for out-patient appointment

Discharged home

Referred to General Practitioner

Transfer to a psychiatric unit/ hospital

Referred to Community Based Mental Health Teams

Other

Referred to psychological services

Transfer to another hospital

Referred to addiction services

25


ThefunnelplotinFigure12illustratestheproportionofattendancesreceivingamentalhealthassessment

foreachhospital.Themajorityofhospitals(n=18)falloutsideofthedashedlines,indicatingthattheirrateis

differenttothatnationally.

Note:Duetosmallnumbers,dataforLocalInjuryUnitsandChildren’sHospitalshavebeenexcluded.

Figure 12:Funnelplotoftheproportionreceivingamentalhealthassessment,accordingtohospital,2018

Repetitionofself-harm

9,785individualspresentedtohospitalfor12,588self-harmepisodesin2018.Thisimpliesthatmorethan

oneinfive(2,803,22.3%)ofthepresentationsin2018wereduetorepeatacts,whichissimilartotheyears

2003-2009and2013-2017(range:20.5-23.1%).Ofthe9,785self-harmpatientswhopresentedtohospital,

1,427(14.6%)madeatleastonerepeatpresentationduringthecalendaryear.Thisproportioniswithinthe

rangereportedfortheyears2003-2017(13.3-16.4%).Atleastfiveself-harmpresentationsweremadeby

153individuals.Theyaccountedforjust1.6%ofallself-harmpatientsintheyearbuttheirpresentations

represented9.8%(n=1,239)ofallself-harmpresentationsrecorded.

Therateofrepetitionvariedaccordingtothemethodofself-harminvolvedintheself-harmact(Table7).Of

thecommonlyusedmethodsofself-harm,self-cuttingwasassociatedwithanincreasedlevelofrepetition.

Almostoneinfive(18.3%)whousedcuttingasamethodofself-harmintheirindexactmadeatleastone

subsequentself-harmpresentationinthecalendaryear.

Overdose Alcohol Poisoning Hanging Drowning Cutting Other All

Numberofindividualswhopresented

6187 2994 212 865 359 2638 613 9785

Numberwhorepeated

842 423 31 133 48 482 109 1427

Percentagewhorepeated

13.6% 14.1% 14.6% 15.4% 13.4% 18.3% 17.8% 14.6%

Table 7:Repeatpresentationafterindexself-harmpresentationin2018bymethodsofself-harm.

Therateofrepetitionwasbroadlysimilarinmenandwomen(15.0%vs.14.2%).Repetitionvariedsignificantly

byage.Approximately14%ofself-harmpatientsagedlessthan20yearsre-presentedwithself-harm.The

proportionwhorepeatedwashighest,at16.5%,for25-34year-olds.


Number of self-harm presentations

Perc

enta

ge w

ho re

ceiv

ed a

men

tal h

ealth

ass

essm

ent

0

10

20

30

40

50

60

70

80

90

100

0 100 200 300 400 500 600 700 800 900 1000

26


TherewaslittlevariationinrepetitionrateswhenexaminedbyHSEhospitalgroup(Table8).Thelowest

ratewasamongself-harmpatientswhopresentedtotheChildren’sandSouth/SouthWesthospitalgroups

(10.3%and13.9%respectively),withrepetitionratesrangingfrom14.5%-17.1%acrosstheothergroups.

Ireland East

Hospital Group

Dublin Midlands Hospital

Group

RCSI Hospital

Group

South/ South West

Hospital Group

University of Limerick

Hospital Group

Saolta University

Health Care

Group

Children’s Hospital

Group

Republic of Ireland


Men 949 850 717 994 326 625 94 4448

Women 1175 945 833 1056 427 842 196 5337

TOTAL 2124 1795 1550 2050 753 1467 290 9785

Numberwhorepeated

Men 153 167 116 136 53 85 6 669

Women 200 140 131 149 59 128 24 758

TOTAL 353 307 247 285 112 213 30 1427


Men 16.1% 19.6% 16.2% 13.7% 16.3% 13.6% 6.4% 15%

Women 17% 14.8% 15.7% 14.1% 13.8% 15.2% 12.2% 14.2%

TOTAL 16.6% 17.1% 15.9% 13.9% 14.9% 14.5% 10.3% 14.6%

Table 8:Repetitionin2018bygenderandHSEhospitalgroup.

ThefunnelplotinFigure13illustratestherateofrepetitionforeachhospital.Theaveragerateofrepetition

nationallywas14.6%.Forthemajorityofhospitals,therateofrepetitionwassimilartothenationalrate,

indicatinglittlevariationintherateofrepetitionacrosshospitals.

Note:Duetosmallnumbers,dataforLocalInjuryUnitshavebeenexcluded.

Figure 13:Funnelplotoftherateofrepetitionaccordingtohospital,2018

Appendix3detailstherepetitionratebyhospitalformale,femaleandallpatientswhopresentedtohospital

followingself-harm.Cautionshouldbetakenininterpretingtherepetitionratesassociatedwithsmaller

hospitalsasthecalculationsmaybebasedonasmallnumberofpatients.


Number of individuals who presented

Perc

enta

ge w

ho re

peat

ed

0

5

10

15

20

25

0 100 200 300 400 500 600 700 800

27


Riskofrepetitionwasgreatestinthedaysandweeksfollowingaself-harmpresentation.Atotalof9,458

self-harmpresentationsweremadetohospitalemergencydepartmentsinthefirstninemonthsof2018.For

19.3%ofthese(n=1,823)therewasarepeatself-harmpresentationmadewithinthreemonths(91days).This

proportionvariedsignificantlybyHSEhospitalgroup:Children’s(7.8%),UniversityofLimerick(15.2%),South/

SouthWest(16.8%),SaoltaUniversity(18.3%),DublinMidlands(20.8%),RCSI(21.3%),andIrelandEast(22.2%).

Theproportionofself-harmpresentationsfollowedbyarepeatpresentationwithinthreemonthswashigher

forwomen(20.0%)thanmen(18.4%)andvariedaccordingtoage.Theproportionwaslowestamongthose

agedunder15years(10.0%)andover55years(13.2%),comparedwith18.3%among15-24year-oldsand21.6%

among25-54year-olds.Theproportionofself-harmpresentationsfollowedbyarepeatpresentationwithin

threemonthsalsovariedaccordingtomethodofself-harm(12.4%followinganattemptedhanging,14.4%

followinganattempteddrowning,16.8%followingadrugoverdose,24.9%followinganactofself-cuttingonly

and28.5%followinganactinvolvingdrugoverdoseandself-cuttingonly).

Variationintheproportionofself-harmpresentationsfollowedbyarepeatpresentationwithinthreemonths

wasalsoobservedbasedonrecommendednextcarefollowinganindexact.Theproportionwaslowestfor

thosewhowereadmittedtoageneralward(15.3%),comparedto18.4%ofthosewhoweredischargedfrom

theemergencydepartment,22.7%whowereadmittedtoapsychiatricwardand28.7%wholeftbeforea

recommendation.

However,thefactorhavingbyfarthestrongestinfluenceonlikelihoodofrepetitionwasthenumberofself-

harmpresentationsmadetohospital.Justoneinten(11.6%)firstpresentationsinJanuary-September2018

werefollowedbyarepeatpresentationinthenextthreemonths.Thisproportionwas33.3%followingsecond

presentations,51.4%followingthirdpresentations,62.3%followingfourthpresentationsand82.7%following

fifthorsubsequentpresentations.

28


SECTIONII:

Incidence Rates

Fortheperiodfrom1Januaryto31December2018,theRegistryrecorded12,588self-harmpresentationsto

hospitalthatweremadeby9,785individuals.Basedonthesedata,theIrishperson-basedcrudeandage-

standardisedrateofself-harmin2018was201(95%CI:197to206)and210(95%CI:206to215)per100,000,

respectively.Thus,therewasa6%increaseintheage-standardisedratein2018,whichaccountsforthe

changingagedistributionofthepopulation,from2017(199per100,000).

MEN WOMEN ALL

YEAR Rate %difference Rate %difference Rate %difference

2002 167 - 237 - 202 -

2003 177 +7% 241 +2% 209 +4%

2004 170 -4% 233 -4% 201 -4%

2005 167 -2% 229 -1% 198 -2%

2006 160 -4% 210 -9% 184 -7%

2007 162 +2% 215 +3% 188 +2%

2008 180 +11% 223 +4% 200 +6%

2009 197 +10% 222 -<1% 209 +5%

2010 211 +7% 236 +6% 223 +7%

2011 205 -3% 226 -4% 215 -4%

2012 195 -5% 228 +1% 211 -2%

2013 182 -7% 217 -5% 199 -6%

2014 185 +2% 216 -<1% 200 +1%

2015 186 +1% 222 +3% 204 +2%

2016 184 -1% 228 +3% 205 +<1%

20171 181 -2% 219 -4% 199 -3%

2018 193 +7% 229 +5% 210 +6%

Table 9: Person-basedEuropeanage-standardisedrate(EASR)ofself-harmintheRepublicofIrelandin

2002-2018(extrapolateddatausedfor2002-2005toadjustfornon-participatinghospitals).

Theratein2018was6%lowerthanthepeakrateof223per100,000reportedfor2010.However,therate

in2018wasstill12%higherthanin2007,theyearbeforetheeconomicrecession.

1Figuresfor2017havebeenupdatedtoincludeanadditional20caseswhichwerelateregistered.

29

IncidenceRates

Figure 14: Person-basedEuropeanage-standardisedrate(EASR)ofself-harmintheRepublicofIrelandby

gender,2002-2018.

Populationfiguresandthenumberandrateofpersonswhopresentedtohospitalfollowingself-harmin2018

aregiveninAppendix4.

Variationbygenderandage

Theperson-basedage-standardisedrateofself-harmformenandwomenin2018was193(95%CI:187-198)

and229(95%CI:223-235)per100,000,respectively.Thus,therewasa7%increaseinthemalerateofself-

harmfrom2017,whilethefemalerateincreasedby5%.Takingrecentyearsintoaccount,themaleself-harm

ratein2018was19%higherthanin2007whereasthefemaleratewas7%higher.

Thefemalerateofself-harmin2018was19%higherthanthemalerate.Thisgenderdifferencehasbeen

decreasinginrecentyears.Thefemaleratewas37%higherin2004-2005,32-33%higherin2006-2007,and

10-24%higherin2008-2017.

Therewasastrikingpatternintheincidenceofself-harmwhenexaminedbyage.Theratewashighestamong

theyoung.At766per100,000,thepeakrateforwomenwasamong15-19year-olds.Thisrateimpliesthatone

inevery131girlsinthisagegrouppresentedtohospitalin2018asaconsequenceofself-harm.Thepeakrate

formenwas543per100,000among20-24year-oldsoroneinevery184men.Theincidenceofself-harm

graduallydecreasedwithincreasingageinmen.Thiswasthecasetoalesserextentinwomenastheirrate

remainedrelativelystable,atapproximately225per100,000,acrossthe30to54yearagerange.

Rate

per

100

,000

0

50

100

150

200

250

300

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

Men

Women

30

IncidenceRates

Figure 15: Person-basedrateofself-harmintheRepublicofIrelandin2018byageandgender.

Genderdifferencesintheincidenceofself-harmvariedwithage.Thefemaleratewas1.7timeshigherthan

themaleratein10-14year-olds(196vs.73per100,000)andtwiceashighin15-19year-olds(766vs.377per

100,000),respectively.Thefemalerateofself-harmwasagainhigherthanthemalerateacrossthe45-59-year

agerange.However,themaleratewas37%higherthanthefemaleratein25-29year-olds(456vs.332per

100,000)and18%higherin30-34year-olds(318vs.269per100,000).Since2009,theRegistryhasrecorded

asignificantlyhigherrateofself-harminmenaged25-29yearscomparedtowomenofthatage.

In2018,themalerateofself-harmamong10-24year-oldsincreasedby8%(from296to320per100,000).

Therateofself-harmamongwomenaged65-69yearsincreasedby47%(from58to85per100,000).

Self-harmwasrarein10-14year-olds.However,theincidenceofself-harmincreasedrapidlyoverashort

agerange.ThisisillustratedingreaterdetailinFigure16.In13-21year-olds,thefemalerateofself-harmwas

significantlyhigherthanthemalerate.Theincreasesinthefemalerateinearlyteenageyearswereparticularly

striking.Thepeakratesamongyoungerpeoplewerein18year-oldwomenand21year-oldmen,withratesof

826and606per100,000,respectively.

Figure 16: Person-basedrateofself-harmintheRepublicofIrelandin2018bysingleyearofagefor10-24

year-olds.

Age group

Rate

per

100

,000

Men Women

0100200300400500600700800900

1000

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85+

Age (in years)

Rate

per

100

,000

Men Women

0100200300400500600700800900

1000

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

31

IncidenceRates

Self-harmbyregion

Rates by city and county

Therewaswidespreadvariationinthemaleandfemaleself-harmratewhenexaminedbycity/countyof

residence.Thematicmaps(1and2)areprovidedtoillustratethevariationinthemaleandfemaleincidenceof

hospital-treatedself-harmbycity/countyofresidence.Themaleratevariedfrom115per100,000forLeitrim

to410per100,000forCorkCity.ThelowestfemalerateswererecordedforMonaghan(150per100,000)

withthehighestratesrecordedforLimerickCityresidentsat459per100,000.Relativetothenationalrate,a

highrateofself-harmwasrecordedformaleandfemalecityresidentsandformenlivinginTipperarySouth,

Carlow,KerryandLouthandforwomenlivinginTipperarySouth,Carlow,KerryandMayo.In2018highrates

forbothmenandwomenwereseeninCorkCity,wherethemaleratewas1.1timeshigherthanthenational

averageandthefemaleratewas38%higher.InLimerickCitythemaleandfemalerateswereapproximately

twicethenationalaverage.

Atanationallevel,thefemaleself-harmrateexceededthemalerateby19%.Themagnitudeofthisgender

differencevariedbycity/county.ThefemaleratefarexceededthemalerateinLeitrim(+112%),Westmeath

(+87%),LimerickCounty(+69%)andGalwayCity(+53%).Theoppositepatternofasignificantlylowerfemale

ratewasobservedinCorkCity(-23%),Louth(-5%)andKilkenny(-5%).

Figure 17a: Person-basedEuropeanage-

standardisedrate(EASR)ofself-harminthe

RepublicofIrelandin2018bycity/countyof

residenceformen.

Figure 17b: Person-basedEuropeanage-

standardisedrate(EASR)ofself-harminthe

RepublicofIrelandin2018bycity/countyof

residenceforwomen.

EASR per 100,000

0 100 200 300 400 500 600

Cork CityLimerick City

Tipperary SouthCarlow

KerryLouth

Galway CitySouth Dublin

DonegalDublin City

SligoWaterford City

Tipperary NorthKilkenny

LaoisWicklow

OffalyMayo

WexfordClare

KildareFingalMeath

Galway CountyCavan

Cork CountyLongford

Waterford CountyMonaghanWestmeath

Dun Laoghaire-RathdownLimerick County

RoscommonLeitrim

Irish

mal

e ra

te(1

93 p

er 1

00,0

00)

EASR per 100,000

0 100 200 300 400 500 600

Limerick CityGalway City

Tipperary SouthCork City

CarlowKerry

Dublin CityMayo

WestmeathWexford

South DublinWaterford CB

LeitrimTipperary North

DonegalLaoisLouth

WicklowGalway County

SligoLongford

Limerick CountyOffalyMeathFingal

KilkennyClare

Dun Laoghaire-RathdownKildare

Cork CountyWaterford County

CavanRoscommon

Monaghan

Irish

fem

ale

rate

(229

per

100

,000

)

32

IncidenceRates

Map 2: Person-basedEuropeanage-standardisedrate(EASR)ofself-harmintheRepublicofIrelandin2018

bycity/countyofresidenceforwomen.

Male rate of self-harm (per 100,000)

Self-harm rate greater than 236

Self-harm rate between 204 and 236



Self-harm rate less than 145

Cork City

Limerick City

Waterford City

Dublin City

Dublin areaGalway City

Female rate of self-harm (per 100,000)






Cork City

Limerick City

Waterford City

Dublin City

Galway City Dublin area


bycity/countyofresidenceformen.

33

IncidenceRates

Comparedto2017,significantincreasesinthefemalerateofself-harmwereobservedinKerry(+57%)and

Mayo(+49%)withasignificantdecreaseobservedinRoscommon(-39%).Formen,significantincreaseswere

observedinTipperaryNorth(+46%),Fingal(+38%)andSouthDublin(+23%).

Rates by HSE Community Healthcare Organisation (CHO)

In2018,theincidenceofself-harmwashighest,at230per100,000inCHOArea5(SouthTipperary,Carlow/

Kilkenny,Waterford,Wexford)andlowestinCHOArea6(Wicklow,DunLaoghaireandDublinSouthEast)at

167per100,000.Themalerateofself-harmvariedfrom139per100,000inCHOArea6to216per100,000in

CHOArea4(Cork/Kerry).Thefemalerateofself-harmvariedfrom196per100,000inCHOArea6to250per

100,000inCHOArea5.

Men Women All

Po

pu

lati

on

Pe

rso

ns

Rate

95

% C

I

Po

pu

lati

on

Pe

rso

ns

Rate

95

% C

I

Po

pu

lati

on

Pe

rso

ns

Rate

95

% C

I

CHOArea1 196647 332 195 (+/-19) 197686 380 210 (+/-20) 394333 712 201 (+/-14)

CHOArea2 225087 331 162 (+/-16) 228022 507 241 (+/-20) 453109 838 200 (+/-13)

CHOArea3 191641 319 185 (+/-19) 193357 436 241 (+/-22) 384998 755 209 (+/-14)

CHOArea4 341730 673 216 (+/-15) 348845 720 221 (+/-15) 690575 1393 214 (+/-11)

CHOArea5 253523 482 213 (+/-17) 256810 587 250 (+/-19) 510333 1069 230 (+/-13)

CHOArea6 187477 253 139 (+/-17) 200684 371 196 (+/-19) 388161 624 167 (+/-13)

CHOArea7 346715 686 202 (+/-15) 356007 799 229 (+/-16) 702722 1485 211 (+/-11)

CHOArea8 306727 484 178 (+/-14) 309502 646 225 (+/-16) 616229 1130 197 (+/-11)

CHOArea9 304881 569 177 (+/-16) 316524 706 230 (+/-17) 621405 1275 205 (+/-11)

Table 10: Person-basedEuropeanage-standardisedrate(EASR)ofself-harmintheRepublicofIrelandin2018

byHSECommunityHealthcareOrganisation(CHO)areaofresidenceandgender

*PopulationderivedbytheNationalCensus2016

**Person-basedEuropeanage-standardisedrateper100,000population

34

IncidenceRates


byHSECommunityHealthcareOrganisation(CHO)formen.


byHSECommunityHealthcareOrganisation(CHO)forwomen.

Male rate of self-harm (per 100,000)






CH01

CH02

CH03

CH04

CH05

CH06

CH08

CH09

CH07

CH01

CH02

CH03

CH04

CH05

CH06

CH08

CH09

CH07

Female rate of self-harm (per 100,000)






35

IncidenceRates

Rates by HSE Local Health Office (LHO)

For2018,Table11detailsthepopulation(derivedbytheNationalCensus2016),numberofmenandwomen

whopresentedtohospitalasaresultofself-harmandtheincidencerate(age-adjustedtotheEuropean

standardpopulation)foreachLHOarea.Therewasmorethanatwo-folddifferenceintherateofself-harm

whenexaminedbyLHOarea.Therateformenrangedfrom104per100,000inDublinSouthEastto296per

100,000inSouthTipperaryandforwomenrangedfrom147per100,000inWestCorkto318per100,000in

SouthTipperary.

Table 11: Self-harmin2018byHSELocalHealthOffice(LHO)areaofresidenceandgender.

HSE Region and LHO

MEN WOMEN

Population*

SELF-HARM

Population*

SELF-HARM

Persons Rate** Rank Persons Rate** Rank

DU

BL

IN

MID

LE

INS

TE

R

Dublin South City 71533 112 145 27 73410 143 198 24

Dublin South East 62054 66 104 32 66642 99 159 30

Dublin South West 78334 208 269 2 82564 233 295 2

Dublin West 76727 174 227 8 78616 195 255 9

Kildare/West Wicklow 120121 192 168 17 121417 228 195 26

Laois/Offaly 81649 125 165 19 81009 163 217 20

Longford/Westmeath 64669 77 129 30 64974 149 247 10

Dun Laoghaire 64842 85 137 29 71232 133 202 23

Wicklow 60581 102 187 13 62810 139 239 13

DU

BL

IN

NO

RT

H E

AS

T

Cavan/Monaghan 68535 92 152 26 67859 105 168 28

Dublin North 126283 223 187 12 132869 267 218 19

Dublin North Central 72256 126 161 23 73715 179 239 14

Dublin North West 106342 220 194 10 109940 260 241 11

Louth 63633 140 234 5 65251 145 233 16

Meath 96776 142 163 21 98268 189 211 21

SO

UT

H

Carlow/Kilkenny 67879 143 233 6 68204 149 237 15

Cork North 46260 65 153 25 46466 67 165 29

Cork North Lee 95758 244 265 3 96348 237 262 5

Cork South Lee 98048 184 185 14 102936 200 196 25

Cork West 28609 34 143 28 28443 33 147 32

Kerry 73055 146 241 4 74652 183 274 4

Tipperary South 46979 122 296 1 46932 136 318 1

Waterford 64943 101 168 18 65674 121 209 22

Wexford 73722 116 179 15 76000 181 255 8

WE

ST

Clare 58785 83 158 24 60032 106 192 27

Donegal 79022 157 232 7 80170 174 240 12

Galway 127663 202 163 20 130395 315 256 6

Limerick 77864 153 204 9 78447 211 288 3

Mayo 65047 98 178 16 65460 148 256 7

Tipperary North/East Limerick 54992 83 163 22 54878 119 224 17

Roscommon 32377 31 109 31 32167 44 157 31

Sligo/Leitrim/West Cavan 49090 82 191 11 49657 101 221 18

*PopulationderivedbytheNationalCensus2016

**Person-basedEuropeanage-standardisedrateper100,000population

36


Appendices

HOSPITAL GROUP

IRELAND EAST

DUBLIN MIDLANDS RCSI SOUTH/

SOUTH WESTUNIVERSITY OF LIMERICK

SAOLTA UNIVERSITY CHILDREN’S REPUBLIC

OF IRELAND

Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female

0-4yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5-9yrs 0 0 0 0 0 <5 7 0 0 0 <5 <5 <5 <5 12 6

10-14yrs 11 32 6 16 5 26 23 70 <5 42 19 68 62 115 129 369

15-19yrs 133 289 150 220 120 223 162 308 41 111 103 229 33 104 742 1484

20-24yrs 206 198 215 188 182 148 227 251 68 72 126 159 <5 0 1025 1016

25-29yrs 231 176 147 139 146 101 176 116 69 70 105 80 0 0 874 682

30-34yrs 131 132 158 106 97 94 133 154 58 51 84 106 0 0 661 643

35-39yrs 144 138 124 165 107 93 131 73 45 48 79 88 0 0 630 605

40-44yrs 100 136 96 107 88 93 62 80 29 45 71 92 0 0 446 553

45-49yrs 78 172 81 93 73 78 89 104 36 25 59 89 0 0 416 561

50-54yrs 70 90 41 58 45 63 55 51 16 18 42 73 0 0 269 353

55-59yrs 52 83 28 59 32 46 49 49 12 17 38 42 0 0 211 296

60-64yrs 18 46 21 28 12 18 29 31 10 11 <5 23 0 0 94 157

65-69yrs 12 28 21 15 8 13 18 21 <5 12 8 13 0 0 71 102

70-74yrs 5 8 5 8 6 9 16 11 <5 <5 <5 6 0 0 40 46

75-79yrs 6 8 <5 <5 <5 <5 11 11 <5 <5 <5 <5 0 0 27 30

80-84yrs <5 <5 <5 <5 <5 0 <5 <5 0 0 <5 <5 0 0 10 9

85yrs+ <5 <5 0 <5 0 <5 <5 6 0 <5 <5 <5 0 0 <5 15

Total 1201 1540 1098 1207 924 1010 1192 1340 397 530 749 1077 100 223 5661 6927

APPENDIXI:

APPENDIX 1A:INDIVIDUALSWHOPRESENTEDTOHOSPITALWITHSELF-HARMINTHEHSEIRELANDEASTHOSPITALGROUP,2018

MA

TE

R

MIS

ER

ICO

RD

IAE

U

NIV

ER

SIT

Y

HO

SP

ITA

L

MID

LA

ND

R

EG

ION

AL

H

OS

PIT

AL

, M

UL

LIN

GA

R

OU

R L

AD

Y’S

H

OS

PIT

AL

,

NA

VA

N

ST. C

OLU

MC

ILL

E’S

H

OS

PIT

AL

, LO

UG

HL

INS

TO

WN

ST. LU

KE

’S

HO

SP

ITA

L,

KIL

KE

NN

Y

ST. M

ICH

AE

L’S

H

OS

PIT

AL

,

DU

N L

AO

GH

AIR

E

OT

HE

R

WE

XF

OR

D

GE

NE

RA

L

HO

SP

ITA

L

Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female

<16yrs 0 0 6 11 <5 <5 0 0 6 12 0 <5 0 12 <5 24

16-17yrs 6 28 8 11 <5 12 0 0 <5 15 <5 <5 27 51 <5 21

18-24yrs 69 84 24 37 14 17 <5 0 73 49 <5 <5 74 84 21 40

25-34yrs 143 131 28 18 18 16 0 <5 57 26 8 5 84 81 24 30

35-44yrs 87 76 14 14 12 18 <5 0 32 44 <5 <5 81 85 14 35

45-54yrs 46 55 8 33 13 25 <5 0 15 31 <5 6 49 69 14 43

55-64yrs 22 20 <5 23 8 8 0 0 15 22 <5 0 18 45 <5 11

65yrs+ <5 <5 <5 <5 <5 5 0 0 5 5 0 <5 8 20 8 8

Total 376 398 91 151 72 102 <5 <5 206 204 18 25 341 447 93 212

APPENDIX 1:INDIVIDUALSWHOPRESENTEDTOHOSPITALWITHSELF-HARMINTHEREPUBLICOFIRELANDBYHOSPITALGROUP,2018

37

AppendixI

ADELAIDE AND MEATH HOSPITAL, TALLAGHT

MIDLAND REGIONAL HOSPITAL, PORTLAOISE

MIDLAND REGIONAL HOSPITAL, TULLAMORE

NAAS GENERAL HOSPITAL ST. JAMES’S HOSPITAL

Male Female Male Female Male Female Male Female Male Female

<16yrs 0 0 10 20 <5 7 <5 <5 0 0

16-17yrs 25 52 11 16 <5 12 9 13 13 18

18-24yrs 106 83 29 29 13 17 60 61 90 95

25-34yrs 75 56 45 48 21 14 51 38 113 89

35-44yrs 73 93 19 28 10 16 39 62 79 73

45-54yrs 30 39 22 20 8 15 19 25 43 52

55-64yrs 14 38 5 8 <5 <5 <5 13 26 25

65yrs+ 10 11 <5 0 <5 <5 8 <5 7 12

Total 333 372 144 169 61 87 189 215 371 364

APPENDIX 1B:INDIVIDUALSWHOPRESENTEDTOHOSPITALWITHSELF-HARMINTHEHSEDUBLINMIDLANDSHOSPITALGROUP,2018

APPENDIX 1C:INDIVIDUALSWHOPRESENTEDTOHOSPITALWITHSELF-HARMINTHEHSERCSIHOSPITALGROUP,2018

BEAUMONT HOSPITAL CAVAN GENERAL HOSPITAL CONNOLLY HOSPITAL, BLANCHARDSTOWN

OUR LADY OF LOURDES HOSPITAL, DROGHEDA

Male Female Male Female Male Female Male Female

<16yrs 0 0 0 8 0 <5 9 32

16-17yrs 29 40 <5 16 7 21 13 26

18-24yrs 80 94 26 23 52 83 88 53

25-34yrs 73 62 21 14 84 76 65 43

35-44yrs 63 51 30 27 57 61 45 47

45-54yrs 33 29 10 20 19 52 56 40

55-64yrs 11 18 9 11 8 11 16 24

65yrs+ 7 8 0 <5 <5 9 7 7

Total 296 302 99 121 230 315 299 272

BANTRY GENERAL HOSPITAL

CORK UNIVERSITY HOSPITAL

UNIVERSITY HOSPITAL, KERRY

MERCY UNIVERSITY HOSPITAL, CORK

SOUTH TIPPERARY GENERAL HOSPITAL

UNIVERSITY HOSPITAL,

WATERFORD

Male Female Male Female Male Female Male Female Male Female Male Female

<16yrs 0 0 20 46 7 21 13 23 9 15 11 17

16-17yrs 0 0 11 37 <5 29 16 18 10 15 9 20

18-24yrs <5 7 68 100 54 49 110 79 36 45 40 108

25-34yrs <5 6 70 80 49 29 114 76 39 44 34 35

35-44yrs <5 <5 42 27 31 27 72 47 19 27 26 23

45-54yrs <5 <5 41 43 27 39 45 33 13 24 17 15

55-64yrs <5 <5 30 19 12 18 26 21 <5 10 6 11

65yrs+ <5 <5 16 13 6 12 14 7 5 10 7 7

Total 14 21 298 365 187 224 410 304 133 190 150 236

APPENDIX 1D:INDIVIDUALSWHOPRESENTEDTOHOSPITALWITHSELF-HARMINTHEHSESOUTH/SOUTHWESTHOSPITALGROUP1,2018

1TherewerenopresentationsrecordedatMallowGeneralHospitalin2018.

38

AppendixI

APPENDIX 1E:INDIVIDUALSWHOPRESENTEDTOHOSPITALWITHSELF-HARMINTHEHSEUNIVERSITYOFLIMERICKHOSPITALGROUP,2018

ENNIS HOSPITAL NENAGH HOSPITAL ST. JOHN’S HOSPITAL, LIMERICK

UNIVERSITY HOSPITAL, LIMERICK

Male Female Male Female Male Female Male Female

<16yrs 0 0 0 0 0 0 9 59

16-17yrs 0 0 0 0 0 0 11 44

18-24yrs <5 <5 <5 <5 0 0 89 119

25-34yrs 0 <5 <5 0 0 0 126 117

35-44yrs 0 10 0 0 0 0 74 83

45-54yrs <5 <5 0 0 0 <5 51 39

55-64yrs 0 0 0 0 0 0 22 28

65yrs+ 0 0 0 0 0 0 10 20

Total <5 19 <5 <5 0 <5 392 509

APPENDIX 1F: INDIVIDUALSWHOPRESENTEDTOHOSPITALWITHSELF-HARMINTHEHSESAOLTAUNIVERSITYHEALTHCAREGROUP,2018

GALWAY UNIVERSITY HOSPITAL

LETTERKENNY GENERAL HOSPITAL

MAYO GENERAL HOSPITAL

PORTIUNCULA HOSPITAL,

BALLINASLOE

SLIGO REGIONAL HOSPITAL

Male Female Male Female Male Female Male Female Male Female

<16yrs 14 54 6 22 <5 17 0 <5 5 13

16-17yrs 10 37 5 14 7 <5 0 15 7 11

18-24yrs 64 113 57 45 29 41 20 33 22 34

25-34yrs 63 87 51 31 30 26 15 18 30 24

35-44yrs 56 49 37 47 14 37 16 20 27 27

45-54yrs 39 46 22 41 14 26 17 18 9 31

55-64yrs 12 17 12 8 9 18 <5 7 8 15

65yrs+ 6 10 0 0 7 11 <5 <5 <5 <5

Total 264 413 190 208 113 180 71 118 111 158

APPENDIX 1G:INDIVIDUALSWHOPRESENTEDTOHOSPITALWITHSELF-HARMINTHEHSECHILDREN’SHOSPITALGROUP,2018

CHILDREN’S UNIVERSITY HOSPITAL AT TEMPLE STREET

NATIONAL CHILDREN’S HOSPITAL AT TALLAGHT HOSPITAL

OUR LADY’S CHILDREN’S HOSPITAL, CRUMLIN

Male Female Male Female Male Female

<16yrs 47 102 34 68 17 53

16-17yrs <5 0 0 0 0 0

18-24yrs 0 0 <5 0 0 0

25-34yrs 0 0 0 0 0 0

35-44yrs 0 0 0 0 0 0

45-54yrs 0 0 0 0 0 0

55-64yrs 0 0 0 0 0 0

65yrs+ 0 0 0 0 0 0

Total 48 102 35 68 17 53

39

AppendixII

APPENDIXII:

APPENDIX 2A: RECOMMENDEDNEXTCAREBYHOSPITALINTHEHSEIRELANDEASTHOSPITALGROUP,2018

MA

TE

R

MIS

ER

ICO

RD

IAE

U

NIV

ER

SIT

Y

HO

SP

ITA

L

MID

LA

ND

R

EG

ION

AL

H

OS

PIT

AL

, M

UL

LIN

GA

R

OU

R L

AD

Y’S

H

OS

PIT

AL

, N

AV

AN

ST. C

OLU

MC

ILL

E’S

H

OS

PIT

AL

, LO

UG

HL

INS

TO

WN

ST. LU

KE

’S

HO

SP

ITA

L,

KIL

KE

NN

Y

ST. M

ICH

AE

L’S

H

OS

PIT

AL

,

DU

N L

AO

GH

AIR

E

OT

HE

R

WE

XF

OR

D

GE

NE

RA

L

HO

SP

ITA

L

(n=774) (n=242) (n=174) (n=5) (n=410) (n=43) (n=788) (n=305)

Admitted(generalandpsychiatric)

14.5% 36.4% 19.5% 0% 49.3% 32.6% 23.6% 40.3%


0.5% 0.4% 0% 0% 0% 0% 0% 0%


21.1% 9.9% 19% 0% 8.8% 9.3% 6.9% 12.8%

Notadmitted 64% 53.3% 61.5% 100% 42% 58.1% 69.5% 46.9%

Note:Itmaynotalwaysberecordedintheemergencydepartmentthatapatienthasbeendirectlyadmittedtopsychiatricinpatientcare.Therefore,thefiguresfordirectpsychiatricadmissiondetailedinAppendices2A-2Gmaybeunderestimates.

APPENDIX 2B:RECOMMENDEDNEXTCAREBYHOSPITALINTHEHSEDUBLINMIDLANDSHOSPITALGROUP,2018

ADELAIDE AND MEATH HOSPITAL,

TALLAGHT

MIDLAND REGIONAL HOSPITAL,

PORTLAOISE


TULLAMORE

NAAS GENERAL HOSPITAL

ST. JAMES’S HOSPITAL

(n=705) (n=313) (n=148) (n=404) (n=735)


26.2% 55% 24.3% 26.7% 26%


1.4% 0.3% 0% 2% 0%


10.8% 9.9% 9.5% 14.9% 19.7%

Notadmitted 61.6% 34.8% 66.2% 56.4% 54.3%


BEAUMONT HOSPITAL

CAVAN GENERAL HOSPITAL

CONNOLLY HOSPITAL, BLANCHARDSTOWN


(n=598) (n=220) (n=545) (n=571)


23.1% 50% 32.1% 31.7%


0.7% 0% 0.6% 0%


22.4% 14.5% 15% 20.3%

Notadmitted 53.8% 35.5% 52.3% 48%

APPENDIX 2C: RECOMMENDEDNEXTCAREBYHOSPITALINTHEHSERCSIHOSPITALGROUP,2018


40

AppendixII

APPENDIX 2D: RECOMMENDEDNEXTCAREBYHOSPITALINTHEHSESOUTH/SOUTHWESTHOSPITALGROUP1,2018



UNIVERSITY HOSPITAL, KERRY

MERCY UNIVERSITY

HOSPITAL, CORK



WATERFORD

(n=35) (n=663) (n=411) (n=714) (n=323) (n=386)


34.3% 50.7% 32.1% 14.1% 37.8% 24.9%


0% 0.2% 1.2% 0% 0.3% 0%


5.7% 6.6% 10.5% 13.3% 15.8% 10.9%

Notadmitted 60% 42.5% 56.2% 72.5% 46.1% 64.2%

Note:Itmaynotalwaysberecordedintheemergencydepartmentthatapatienthasbeendirectlyadmittedtopsychiatricinpatientcare.Therefore,thefiguresfordirectpsychiatricadmissiondetailedinAppendices2A-2Gmaybeunderestimates.1TherewerenopresentationsrecordedatMallowGeneralHospitalin2018.

APPENDIX 2E:RECOMMENDEDNEXTCAREBYHOSPITALINTHEHSEUNIVERSITYOFLIMERICKHOSPITALGROUP,2018

ENNIS HOSPITAL

NENAGH HOSPITAL

ST. JOHN’S HOSPITAL, LIMERICK


(n=21) (n=4) (n=1) (n=901)


9.5% 0% 0% 15.9%


0% 0% 0% 0%


0% 25% 0% 12.7%

Notadmitted 90.5% 75% 100% 71.5%

APPENDIX 2F: RECOMMENDEDNEXTCAREBYHOSPITALINTHEHSESAOLTAUNIVERSITYHEALTHCAREGROUP,2018






BALLINASLOE


(n=677) (n=398) (n=293) (n=189) (n=269)


25% 53.5% 31.7% 50.3% 40.9%


1.3% 0% 2.7% 1.6% 0.4%


12.1% 9.8% 8.5% 8.5% 5.9%

Notadmitted 61.6% 36.7% 57% 39.7% 52.8%

APPENDIX 2G: RECOMMENDEDNEXTCAREBYHOSPITALINTHEHSECHILDREN’SHOSPITALGROUP,2018





(n=150) (n=103) (n=70)


40% 76.7% 91.4%


0.7% 0% 0%


0% 1% 2.9%

Notadmitted 59.3% 22.3% 5.7%

41

AppendixIII

APPENDIXIII:

APPENDIX 3A:REPETITIONBYGENDERANDHOSPITALFORINDIVIDUALSWHOPRESENTEDWITHSELF-HARMINTHEHSEIRELANDEASTHOSPITALGROUP,2018

MA

TE

R

MIS

ER

ICO

RD

IAE

U

NIV

ER

SIT

Y

HO

SP

ITA

L

MID

LA

ND

R

EG

ION

AL

H

OS

PIT

AL

, M

UL

LIN

GA

R

OU

R L

AD

Y’S

H

OS

PIT

AL

, N

AV

AN

ST. C

OLU

MC

ILL

E’S

H

OS

PIT

AL

, LO

UG

HL

INS

TO

WN

ST. LU

KE

’S

HO

SP

ITA

L,

KIL

KE

NN

Y

ST. M

ICH

AE

L’S

H

OS

PIT

AL

,

DU

N L

AO

GH

AIR

E

OT

HE

R

WE

XF

OR

D

GE

NE

RA

L

HO

SP

ITA

L


Men 272 83 61 4 167 18 267 88

Women 291 120 76 1 165 19 363 158

Total 563 203 137 5 332 37 630 246

Numberwhorepeated

Men 53 10 10 0 24 2 47 8

Women 60 21 15 0 24 8 56 28

Total 113 31 25 0 48 10 103 36


Men 19.5% 12% 16.4% 0% 14.4% 11.1% 17.6% 9.1%

Women 20.6% 17.5% 19.7% 0% 14.5% 42.1% 15.4% 17.7%

Total 20.1% 15.3% 18.2% 0% 14.5% 27% 16.3% 14.6%

APPENDIX 3B: REPETITIONBYGENDERANDHOSPITALFORINDIVIDUALSWHOPRESENTEDWITHSELF-HARMINTHEHSEDUBLINMIDLANDSHOSPITALGROUP,2018

ADELAIDE AND MEATH HOSPITAL,

TALLAGHT


PORTLAOISE


TULLAMORE

NAAS GENERAL HOSPITAL

ST. JAMES’S HOSPITAL


Men 281 109 56 151 290

Women 306 131 71 163 291

Total 587 240 127 314 581

Numberwhorepeated

Men 50 25 6 24 77

Women 38 17 9 24 60

Total 88 42 15 48 137


Men 17.8% 22.9% 10.7% 15.9% 26.6%

Women 12.4% 13% 12.7% 14.7% 20.6%

Total 15% 17.5% 11.8% 15.3% 23.6%

APPENDIX 3C:REPETITIONBYGENDERANDHOSPITALFORINDIVIDUALSWHOPRESENTEDWITHSELF-HARMINTHEHSERCSIHOSPITALGROUP,2018

BEAUMONT HOSPITAL

CAVAN GENERAL HOSPITAL

CONNOLLY HOSPITAL, BLANCHARDSTOWN



Men 228 82 196 222

Women 252 102 257 237

Total 480 184 453 459

Numberwhorepeated

Men 41 13 32 37

Women 41 17 46 33

Total 82 30 78 70


Men 18% 15.9% 16.3% 16.7%

Women 16.3% 16.7% 17.9% 13.9%

Total 17.1% 16.3% 17.2% 15.3%

42

AppendixIII

APPENDIX 3D:REPETITIONBYGENDERANDHOSPITALFORINDIVIDUALSWHOPRESENTEDWITHSELF-HARMINTHEHSESOUTH/SOUTHWESTHOSPITALGROUP1,2018




KERRY

MERCY UNIVERSITY HOSPITAL,

CORK



WATERFORD


Men 14 258 258 333 118 136

Women 19 300 300 263 147 152

Total 33 558 558 596 265 288

Numberwhorepeated

Men 1 36 36 48 15 16

Women 2 35 35 33 22 34

Total 3 71 71 81 37 50


Men 7.1% 14% 14% 14.4% 12.7% 11.8%

Women 10.5% 11.7% 11.7% 12.5% 15% 22.4%

Total 9.1% 12.7% 12.7% 13.6% 14% 17.4%

1TherewerenopresentationsrecordedatMallowGeneralHospitalin2018.

APPENDIX 3E:REPETITIONBYGENDERANDHOSPITALFORINDIVIDUALSWHOPRESENTEDWITHSELF-HARMINTHEHSEUNIVERSITYOFLIMERICKHOSPITALGROUP,2018

ENNIS HOSPITAL

NENAGH HOSPITAL

ST JOHN’S HOSPITAL, LIMERICK



Men 2 2 0 323

Women 9 1 1 420

Total 11 3 1 743

Numberwhorepeated

Men 1 1 0 52

Women 2 1 1 57

Total 3 2 1 109


Men 50% 50% 0% 16.1%

Women 22.2% 100% 100% 13.6%

Total 27.3% 66.7% 100% 14.7%

APPENDIX 3F:REPETITIONBYGENDERANDHOSPITALFORINDIVIDUALSWHOPRESENTEDWITHSELF-HARMINTHEHSESAOLTAUNIVERSITYHEALTHCAREGROUP,2018





BALLINASLOE



Men 215 155 101 57 103

Women 312 162 152 95 133

Total 527 317 253 152 236

Numberwhorepeated

Men 31 24 11 12 8

Women 60 20 19 17 16

Total 91 44 30 29 24


Men 14.4% 15.5% 10.9% 21.1% 7.8%

Women 19.2% 12.3% 12.5% 17.9% 12%

Total 17.3% 13.9% 11.9% 19.1% 10.2%

43

AppendixIV

APPENDIX 3G: REPETITIONBYGENDERANDHOSPITALFORINDIVIDUALSWHOPRESENTEDWITHSELF-HARMINTHEHSECHILDREN’SHOSPITALSGROUP,2018





Men 43 35 16

Women 89 64 45

Total 132 99 61

Numberwhorepeated

Men 4 0 2

Women 12 6 7

Total 16 6 9


Men 9.3% 0% 12.5%

Women 13.5% 9.4% 15.6%

Total 12.1% 6.1% 14.8%

APPENDIXIV:

APPENDIX 4: SELF-HARMBYRESIDENTSOFTHEREPUBLICOFIRELAND,2018

Age group

MEN WOMEN

Population

SELF-HARM

Population

SELF-HARM

Persons Rate 95% CI* Persons Rate 95% CI*

0-4yrs 163300 0 0 (+/-0) 156000 0 0 (+/-0)

5-9yrs 182100 12 7 (+/-4) 174700 6 3 (+/-3)

10-14yrs 170500 124 73 (+/-13) 162100 318 196 (+/-22)

15-19yrs 161200 608 377 (+/-31) 155000 1188 766 (+/-44)

20-24yrs 147300 800 543 (+/-38) 142000 772 544 (+/-39)

25-29yrs 145200 662 456 (+/-35) 145900 485 332 (+/-30)

30-34yrs 161100 512 318 (+/-28) 174800 470 269 (+/-25)

35-39yrs 193100 485 251 (+/-23) 205200 460 224 (+/-21)

40-44yrs 183200 346 189 (+/-20) 186700 400 214 (+/-21)

45-49yrs 170200 302 177 (+/-20) 171000 390 228 (+/-23)

50-54yrs 152000 213 140 (+/-19) 154600 291 188 (+/-22)

55-59yrs 138600 166 120 (+/-19) 141300 244 173 (+/-22)

60-64yrs 122400 84 69 (+/-15) 124100 126 102 (+/-18)

65-69yrs 106800 57 53 (+/-14) 108900 93 85 (+/-18)

70-74yrs 87400 39 45 (+/-14) 90200 44 49 (+/-15)

75-79yrs 57600 26 45 (+/-18) 64200 27 42 (+/-16)

80-84yrs 37500 9 24 (+/-16) 47600 9 19 (+/-13)

85yrs+ 26200 3 11 (+/-13) 46800 14 30 (+/-16)

Total** 2405800 4448 193 (+/-6) 2451300 5337 229 (+/-6)

*95%ConfidenceInterval.**ThetotalratesareEuropeanage-standardisedratesper100,000.

4th Floor

Western Gateway Building

University College Cork

Ireland

Tel: +353 21 420 5551

Email: [email protected]

www.nsrf.ie

EVE GRIFFIN

NIALL McTERNAN

CONAL WRIGLEY

SARAH NICHOLSON

ELLA ARENSMAN

EILEEN WILLIAMSON

PAUL CORCORAN

NATIONAL SELF-HARM REGISTRY IRELAND · Executive Summary 4 Recommendations 5 Recent publications...

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