There has been an 8 per cent rise in cases of self-harm in A&Es throughout the State, writes MICHELLE McDONAGH.
THE ECONOMIC downturn is taking its toll on the mental health of young Irish men, the National Suicide Research Foundation says in the wake of new figures which show a significant increase in deliberate self-harm among this group.
The Annual Report of the National Registry of Deliberate Self Harm 2008reveals an 8 per cent increase in overall deliberate self-harm presentations made to hospital emergency departments around the State, compared with 2007 levels.
In 2008, 11,700 deliberate self-harm presentations involving 9,218 individuals were made to emergency departments. The strongest increase (11 per cent) was among men – the highest rate since the start of the registry in 2002.
Almost half of all presentations were by people under 30, with the peak rate for women being in the 15-19 age group and for men aged between 20-24. An increase in self-harm was also observed in 10-14 year olds.
The authors of the report, Prof Ivan Perry, director of the registry, and Udo Reulbach, senior researcher with the National Suicide Research Foundation, noted that “the significant increase in deliberate self- harm among Irish men in 2008, in particular among young adult men, may reflect mental health and social problems associated with the economic downturn that started in Ireland in 2008”.
They highlighted the need to develop initiatives to increase awareness of mental health and wellbeing issues among the public and professionals involved in services supporting people who are unemployed or who are experiencing financial difficulties.
The report notes that the significant increase in deliberate self-harm in Ireland in 2008 may indicate a trend that started in 2007. It calls for continued support for programmes that have been initiated in recent years, including the national mental health awareness campaign and evidence-based mental health promotion initiatives undertaken by the National Office for Suicide Prevention (NOSP).
The proportion of deliberate self-harm patients who left the emergency department without admission increased between 2007 and last year and this, say the authors, which is a particular concern for those who used potentially lethal methods of self-harm, such as attempted hanging and drowning. As in previous years, drug overdose was again the most common method of self-harm, followed by self-cutting.
However, a significant increase in heroin overdoses in 2008 was noted, with a decrease in cocaine overdoses, which could also be linked to the current economic climate.
The report highlights the need to prioritise evidence- based mental health programmes for children and adults as well as specialist mental health services considering the high rates of deliberate self- harm in adolescents aged 15-19, and the increase in self-harm among 10-14 year olds.
The authors comment: “The variation in admission rates across hospitals and HSE regions and a relatively high proportion of self-harm patients who leave the emergency department without being seen underlines the need to prioritise the development of more uniform assessment procedures and evidence-based interventions specifically targeting patients who repeatedly engage in deliberate self-harm.”
The report recommends that the HSE implement minimum guidelines for the assessment of deliberate self-harm patients in line with guidelines of the National Institute of Clinical Excellence (NICE, 2004).
Prof Perry, who is also head of the department of epidemiology and public health at University College Cork, said the findings highlighted the value of routine monitoring of hospital presentations with deliberate self- harm.
“Clearly, there are no easy solutions to the issues raised in this report. Preventing suicide and self-harm is a daunting challenge for our society. However, it is imperative that, at a minimum in this period of recession, we implement the strategies for suicide prevention devised in recent years, in particular the evidence-based recommendations of Reach Out, our National Strategy for Action on Suicide Prevention,” he said.
For many years now, Dr Chris Luke, AE consultant at Cork University Hospital and Mercy University Hospital Cork, has been trying to get his message across that emergency departments have an important role to play in monitoring trends and changes in public health.
While he has not noticed any increase in self-harm presentations in his day-to-day work, he points to a significant increase in serious drug and alcohol intoxication and levels of violence and suggests some self- harm cases may be concealed behind drink and drugs.
In relation to the finding that many deliberate self-harm patients are leaving emergency departments without being seen, Dr Luke said there had always been people who left hospital without being seen. He highlighted the “grey area” between recreational intoxication by drugs or alcohol, which is sometimes lethal, and what is described afterwards as deliberate self-harm.
“With the increase in serious intoxication with drugs and alcohol we are seeing, there is no doubt that an awful lot more violence is coming down the line as well,” warned Dr Luke.
The 2008 Annual Report of the National Registry of Deliberate Self Harm is at www.nsrf.ie.
Support is available from The Samaritans (www.samaritans.ie or 1850 60 90 90). Aware (www.aware.ie or 1890 30 33 02) and also at www.mentalhealthireland.ie