Self-harm and healthcare over time in children and young people
Dr Amanda Marchant
Senior Research Analyst
Professor Ann John
“Our study reveals high rates of presentations with self-harm in primary care and among young males in emergency departments. The difference in admissions from emergency departments between boys and girls is important. We must make the most of emergency departments attendances to offer help.
Self-harm is a major public health concern. It is not rare in young people. One in four girls and one in seven boys aged 14 who responded to a survey said they had self-harmed in the previous year. The importance of giving young people who self-harm the right care and support cannot be understated.
Young people aged 10-19 with a history of self-harm are more than ten times as likely to die of unnatural causes and seventeen times more likely to take their own lives. They spend less time in school due to absences and exclusions. They are also more likely to have a range of other negative physical and mental health outcomes. If we can offer young people the right care and support, it is possible to change, and even save lives.
The team used routinely collected healthcare data for the whole population of Wales to learn more about how children and young people use healthcare services for self-harm, and whether this has changed between 2003 and 2015. They wanted to learn more about how many see their GPs, go to emergency departments, are admitted to hospital or are seen in outpatients. The team also investigated whether there were differences according to sex, age or level of deprivation/affluency.
- GPs were an important source of help and support. Children and young people discussed self-harm with their GP more than during contacts with any other healthcare setting.
- Over time, emergency department attendances increased for 10-19 year olds and hospital admissions increased for 10-14 year olds.
- Boys and young men tend to seek help from emergency departments more than from any other healthcare setting.
- Girls were more likely than boys to be admitted to hospital after attending emergency departments for self-harm. This was true even for those aged under 16, for whom clinical guidance always recommend admission for a full risk assessment.
- This study highlights the importance of GPs and emergency departments in supporting young people who self-harm, especially for boys and young men.
- Professionals from emergency departments need to be aware of the existing bias in the criteria for hospitalisation of boys presenting with self-harm.
- Any contact with healthcare services is an opportunity to help a potentially vulnerable young person, and it is important that we make the most of these opportunities. Doctors and healthcare workers need to have the right information and support to be able to offer young people the support they need and to decide when referral to more specialist care is needed.
Although this study examines self-harm across healthcare settings using information based on a large proportion of the population of Wales, it also has limitations. First, we cannot be sure a hospital admission was a direct result of an emergency department attendance with self-harm. Second, we were unable to study important factors, such as severity and the method of self-harm. Third, it is likely we did not find all emergency department presentations with self-harm, as there are known quality issues in the recording of these events. The same can be said in general about routinely collected data. This means our results reflect recorded healthcare presentations with self-harm, not all self-harm events in the community.
“This study showed that it is likely that responses from services to males and females, even as children, who have self-harmed and are in distress may be different. We very much focus on improving help-seeking for males but we also need to think about what happens when they do.