What was in the news and academic press about self-injury in February?
National Self-Harm Registry Ireland 2021
The National Self-Harm Registry Ireland records presentations for self-harm to hospital emergency departments in the Republic of Ireland. Released by the National Suicide Research Foundation, it is the first national registry in the world to record such cases1. Note that Irish institutions use the same terminology as in the United Kingdom. The National Suicide Research Foundation defines “self-harm” as a “non-fatal” and “deliberately initiated” act “associated with varying levels of suicidal intent and wide ranging motives”2. It includes non-suicidal self-injury but also suicide attempts.
The annual report for 2021 has been published in February 2024, 15 months later than usual due to restrictions during the covid pandemic and a cyberattack. Two hospitals were excluded from it. It recorded 11,415 self-harm presentations to hospitals made by 8,595 people.
Presentations for self-harm were higher in young people and gradually decreased in older populations. Consistent with the previous years, the registry found a peak of self-harm presentations for women aged 15-19 years, and for men aged 20-24. The sharpest contrast between male and female rates was in the 10-19 years age group in which girls presented more than 3 times more than boys. Only in the 35-44 years age group did men present more than women, although the difference remains small. This is reminiscent of findings we previously discussed, which shows that girls start engaging in self-injury earlier than boys but that the discrepancy tends to gradually decrease in older populations.
Unfortunately, this report confirms a worrying trend, which had been already noticed in the United Kingdom, with rates of self-harm in young adolescents aged 10 to 14 years increasing. The increase is particularly pronounced in girls, whose rates of presentations have been multiplied by 3 in a decade. This suggests children start engaging in self-harm at an earlier age.
Methods rates remain similar to those in the past years. Note that some patients used several methods of self-harm. Intentional drug overdose was the most common method, with almost two-thirds (61%) of self-harm presentations in 2021. It was more common in women than men. Alcohol, on the other side, was involved in 30% of presentations, more frequently in male patients than females. The second most common method of self-harm was self-cutting, used in almost a third (31%) of cases. It was more common among young people. There was no difference in rates of self-cutting between men and women but injuries tended to be more severe in male patients. The third most used method of self-harm was attempted hanging (9%), although to a much lesser extent than intentional drug overdose and self-cutting. Attempted hanging was more frequent in men than women.
About 15% of patients presented to the emergency departments at least twice, and cutting was associated with an increased risk of repetition (1 in 5 people who presented for self-cutting presented again in the same year). There was no difference in rates of repetitions between men and women but a greater number of people aged 25 to 44 presented multiple times. About 15% of patients under 20 who presented for self-harm also represented.
Wales’ Suicide and Self-harm Prevention Strategy
The Welsh government released a draft for its new strategy which aims to reduce death by suicide and support people who self-harm. It is accessible by members of the public who can share their views in order to improve the strategy3.
The new strategy for 2024-2034 understands that it’s approach needs to derive from a diversity of sectors, as suicide and self-harm do not stem from mental health issues only but can also be influenced by inequalities, socioeconomic disadvantages, addictions, financial strain or troubled childhood. Other policies and strategies could contribute to a reduction of suicide and self-harm, such as those targeting child poverty, bullying, loneliness, domestic abuse, racism, homophobia and issues affecting disabled people. The Online Safety Act will also contribute to diminishing children’s exposure to harmful content online, such as posts promoting self-harm.
The strategy identifies several priority groups which are deemed more at risk of suicide. Men are more at risk of suicide than women, particularly middle-aged men. People who self-harm or have self-harmed have also a higher risk, as we know self-harm is a risk factor for suicide. People in contact with mental health services also need specific care. A Welsh study found that 31% of people who died by suicide contacted the mental health services in the week before they died. Finally, people in contact with the justice system, those who suffer from substance disorder, autistic individuals, victims of domestic abuse and people living in deprived areas are also deemed priority.
As for self-harm, children and young people, especially females, are considered more at risk. Similarly to Irish data that we discussed above, Welsh hospitals face a gradual increase in presentations for self-harm in young people, particularly girls aged 10 to 14. Children and adolescents aged 11-16 who have been bullied are three times more likely to self-harm than those who haven’t.
To reach its goals, the strategy lists six objectives:
- Develop evidence based on diverse data and research to better understand suicide and self-harm in Wales, those more at risk and the most effective intervention. Establish structures to analyze and share this information to create resources and policies.
- Tackle the causes and the means of suicide through cross-governmental and cross-sectoral action.
- Deliver prevention and intervention to groups which are more at risk in settings in which they are most engaged. Offer services in the Welsh language.
- Increase knowledge and awareness about suicide and self-harm among those who could be in contact with people at risk.
- Offer a compassionate and person-centered response to those who have self-harmed, have suicidal thoughts or are bereaved by suicide so that they can recover free of stigma. React rapidly to any suspected suicide and identify clusters.
- Make sure media reportings and social media adhere to guidelines on how to communicate about self-harm and suicide in a safe and responsible way, and without stigma.
Fundings information will be included in the final strategy. The proposed strategy is reminiscent of Scotland’s Self-harm strategy and action plan 2023 to 2027, which focuses on working with partners from diverse sectors, gathering and sharing data and raising awareness about self-harm. But similarly it lacks concrete measures to reach these goals. It is still positive to see more and more governments adopt strategies to improve the population’s mental health.
The current draft remains open to the public for review and provides a questionnaire. Responses can be sent by June 11 2024 on their website4, via email to mentalhealthandvulnerablegroups@gov.wales or returned to the Mental Health Policy Team, Welsh Government, Cathays Park, Cardiff, CF10 3NQ.
References
[1] National Suicide Research Foundation. (n.d.). Self-Harm Registry – National Suicide Research Foundation. National Suicide Research Foundation. https://www.nsrf.ie/self-harm-registry/
[2] National Suicide Research Foundation. (n.d.). Information Leaflet. National Suicide Research Foundation. https://www.nsrf.ie/wp-content/uploads/2023/07/NSRF-Registry-leaflet-March2023.pdf
[3] Welsh Government. (2024, February 20). Draft Suicide and Self-harm Prevention Strategy 2024- 2034. gov.wales. https://www.gov.wales/sites/default/files/consultations/2024-02/consultation-document-draft-suicide-and-self-harm-prevention-strategy.pdf
[4] Welsh Government. (2024, February 20). Draft suicide and self-harm prevention strategy | GOV.WALES. gov.wales. https://www.gov.wales/draft-suicide-and-self-harm-prevention-strategy
Exploring self-harm 