Hospitals saw estimated 25% drop in cases of self-harm in April

Hospital presentations as a result of self-harm dropped by an estimated 25 per cent at the height of coronavirus restrictions compared with the same time in the previous two years.

Provisional figures from the National Self-Harm Registry show there were 306 presentations at eight hospitals around the State in April, down from an average of 408 in 2018 and 2019. This compares with a 40 per cent reduction in all-cause hospital presentations over the same period.

Dr Paul Corcoran, head of research at the National Suicide Research Foundation (NSRF), presented the unpublished figures at a webinar held to mark World Suicide Prevention Day on Thursday.

“Initially this looks like very good news. The concern about increased self-harm presentations has not materialised. The reduction is not as much as for all-cause emergency department presentations but it is quite significant,” he added.

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He said it was possible there was an increase in fatal self-harm but because of the registration system for suicides in Ireland it would be "three to four years before this could be verified, which is a big frustration". However, the profile of people who present at hospital tends to be different from fatal cases so the suggestion is "we may not have seen such an increase".

The event heard there was anecdotal evidence the rate of self-harm presentations had increased since stay-at-home restrictions were eased. Speakers also expressed concern about the potential long-term effects of a Covid-19 induced economic downturn on levels of self-harm and suicide.

NSRF chief scientist Prof Ella Arensman stressed the focus of suicide prevention policy should be on targeted supports for priority groups. "That work cannot be abandoned, that should be maintained and even intensified during very challenging times such as the Covid-19 pandemic."

“Knowing the evidence about priority groups that we were already supposed to focus on we were surprised that some specially trained staff in suicide prevention were redeployed in the first months.”

A HSE spokeswoman said five staff from the HSE National Office for Suicide Prevention (NOSP) were redeployed to “Covid-specific projects or work streams for varied time periods between March and June 2020. Since, no staff from the NOSP have been redeployed elsewhere.”

Suicide data

Prof Arensman added: “We were also suffering from the absence of real-time data on suicide. I keep saying to policymakers if you keep asking ‘do we have data?’, which we don’t on a national level, then now is the time to get that right.”

Provisional data from the Central Statistics Office released in May indicated there were 421 deaths by suicide in 2019. In Ireland, deaths are not officially determined as suicides until investigated by coroners.

Findings from the Suicide Support and Information System in Cork city and county which records individual suicides in collaboration with coroners show that construction workers and female healthcare workers were at higher risk of suicide. People with a history of self-harm, sexual abuse or chronic physical conditions are also at elevated risk.

Prof Arensman said there were some positive signs in that there was no significant increase in suicide or self-harm evident so far but the lack of real-time data meant it was difficult to draw firm conclusions. She said the NSRF was evaluating a pilot real-time system for suicide data based on the SSIS and hoped to expand it to other regions in Ireland.

Prof Arensman also expressed concern over the impact of Covid-19 on treatment for people who were suffering from severe mental health conditions as “the jury is still out on whether telemedicine or online self-management will be an effective alternative for people with severe conditions. There is emerging positive evidence for people with mild to moderate depression and anxiety but when it comes to people with severe clinical depression, ongoing increased anxiety or personality disorders, it is not proven that online or telemedicine will have the same effect.”

Prof Diego De Leo, a past president of the International Association for Suicide Prevention who initiated World Suicide Prevention Day in 2003, said there was limited evidence thus far for a significant increase in suicide internationally during the pandemic.

If you are affected by anything in this article, Samaritans can be contacted on 116 123 or email jo@samaritans.ie or jo@samaritans.org. Pieta House can be reached at freephone 1800 247 247.