Self-Harm in Ireland: Trends, risk factors and implications for intervention and prevention MENTAL HEALTH SUMMIT, 27 TH MAY 2016 DUBLIN Prof. Ella Arensman National Suicide Research Foundation WHO Collaborating Centre on Surveillance and Research in Suicide Prevention Department of Epidemiology and Public Health, UCC President, International Association for Suicide Prevention
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Self-Harm in Ireland:Trends, risk factors and implications for
intervention and prevention
MENTAL HEALTH SUMMIT, 27TH MAY 2016 DUBLIN
Prof. Ella ArensmanNational Suicide Research Foundation
WHO Collaborating Centre on Surveillance and Research in Suicide PreventionDepartment of Epidemiology and Public Health, UCC
President, International Association for Suicide Prevention
Overview
The National Self-Harm Registry Ireland
Trends in self-harm in Ireland and associated risk factors
Evidence based interventions for self-harm
SuicideApprox.550 p.a.
Medically treated self-harm
Approx. 11,000 p.a
“Hidden” cases of self-harm Approx. 60,000 p.a.
Suicide and medically treated self-harm in Ireland: the tip of the iceberg
Aims: To establish the extent and nature of hospital-treated self-
harm;
To monitor trends over time and also by area;
To contribute to policy and development in the area of suicidal behaviour;
To help the progress of research and prevention.
Definition self-harm:
‘an act with non-fatal outcome in which an individual
deliberately initiates a non-habitual behaviour, that without
intervention from others will cause self harm, or deliberately
ingests a substance in excess of the prescribed or generally
recognised therapeutic dosage, and which is aimed at realising
changes that the person desires via the actual or expected
physical consequences’. (Schmidtke et al, 2006)
National Self-harm Registry Ireland
The Registry is funded by the National Office for Suicide Prevention
% rate compared to 2007
Men +12%
Women +1%
All +6%
Trends in self-harm, 2004-2014
Self-harm by age and gender, 2014
Methods of self-harm by gender
Alcohol was involved in 38% of all cases (42% in men, 36% in women)
54%
19%
5%
8%
3%
12%
Drug overdose only
Self-cutting only
Overdose & self-cutting
Attempted hanging only
Attempted drowning only
Other69%
16%
4%
2%
2%
7%
Men Women
Janu
ary
Febr
uary
Mar
ch
April
May
June July
Augu
st
Sept
embe
r
Oct
ober
Nov
embe
r
Dec
embe
r
0.75
0.80
0.85
0.90
0.95
1.00
1.05
1.10
1.15
1.20 MalesFemales
The impact of alcohol on seasonal patterns of self-harm:
Non-Alcohol related self-harm
The impact of alcohol on seasonal patterns of self-harmAlcohol related self-harm
Janu
ary
Febr
uary
Mar
ch
April
May
June July
Augu
st
Sept
embe
r
Oct
ober
Nov
embe
r
Dec
embe
r
0.75
0.80
0.85
0.90
0.95
1.00
1.05
1.10
1.15
1.20 MalesFemales
Repetition of self-harm by recommended next care
Repetition by number ofself-harm presentations
Days since self-harm presentation Days since self-harm presentation
Recommended aftercare among those who repeat 10 times or more
Admission w
ard
Admission psych
iatry
Patien
t refused to
be admitted
Left w
ithout b
eing seen / w
ithout d
ecision
Not admitted
0
10
20
30
40
50
60
MaleFemaleAll patients
% o
f pre
sent
ation
s
Evidence based interventions taking into account differences among people who self-harm
Dialectical Behaviour Therapy – Individuals with a history of multiple self-harm acts, often associated with Borderline Personality Disorder and co-morbid mental health problems
Cognitive Behaviour Therapy – Individuals with single/infrequent self-harm acts, often associated with mood, anxiety disorders, and alcohol/drug abuse
Challenges
• The high levels of self-cutting and repeated self-harm among Irish men may pose challenges for the implementation of DBT as most DBT trials included women
• How can DBT and CBT be sustained in the long term, and integrated in the mental health services as one of the options of a menu of evidence based treatments offered to people with multiple self-harm acts
• Linking the national roll out of DBT and CBT to priorities of the national clinical programme and Connecting for Life, 2015-2020
“People who attempt suicide never want to die, what they want is a different life”
(R. Wieg, 2003; J. Zwagerman, 2015)
“
Thank you!
Prof. Ella ArensmanNational Suicide Research Foundation
WHO Collaborating Centre on Surveillance and Research in Suicide PreventionDepartment of Epidemiology and Public Health, UCC
President, International Association for Suicide PreventionT: 00353 214205551
E-mail: [email protected]
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