The number of children and teenagers presenting to Irish Emergency Departments (EDs) following self-harm is on the increase, the National Clinical Programme for Self-Harm and Suicide-Related Ideation (NCPSH) has warned.

According to the programme, in 2019, 561 children aged between 10 and 14 presented to EDs following self-harm, along with 2,202 young people aged between 15 and 19.

Furthermore, anecdotal evidence from schools, GPs and CAMHS suggests an increase in minor self-harming behaviour that is not presenting to EDs. It is widely acknowledged that people who self-harm are the group with the highest risk of contemplating suicide.

Among all age groups, almost half of all related presentations (47%) to EDs between 2018 and 2020 were due to suicidal ideation.

The NCPSH has launched a revised model of care for self-harm and suicide-related ideation, which aims to provide a framework to improve services in this area. The recommended changes have been informed by evidence, the experience of clinicians and managers, and by feedback from individuals and family members with lived experiences of self-harm and suicide.

“In 2016, a model of care was published by the HSE and the service was expanded. It established a clinical framework to ensure that any person who presents to the ED following self-harm or with suicide-related ideation receives a compassionate, empathic, validating response and a therapeutic assessment and intervention from a suitably trained mental health professional; that every effort is made to ensure that a family member or supportive adult is involved in assessment and safety planning, and that they are followed up and linked to appropriate next care.

“It is timely to describe how those non-ED services can be developed and also to address ongoing improvements required in ED settings,” explained Dr Vincent Russell, the HSE’s national clinical lead for self-harm and suicide-related ideation.

According to the revised model of care, mental health services should ensure that the NCPSH in the ED is delivered 24 hours a day, seven days a week, and ED staff should receive regular training on mental health and suicide awareness.

Each patient presenting to the ED following self-harm should be treated with respect and compassion and should be seen in a timely manner, while each ED should ensure there is high-quality, dedicated accommodation for the assessment of patients with mental health problems.

Each mental health service should ensure there is a clear pathway to transfer patients to a non-ED facility for mental health assessment, where there is no physical health problem and the need for mental health care is clearly differentiated.

There are a range of recommendations made around staffing, but the NCPSH is led by consultant psychiatrists, who should ensure that they have a “working knowledge of the programme and that all patients, including those presenting out of hours, receive all clinical components”.

Launching the revised model of care, the Minister for State for Mental Health, Mary Butler, also highlighted the importance of community care. She said that funding has been allocated to recruit an additional six new posts across four mental health services to deliver suicide crisis assessment nurse (SCAN) support for the NCPSH in 2022.

“This builds on the 12 SCAN posts already providing a service to GPs. In this context the updated model of care provides a real opportunity to expand the programme in primary care settings across the country, reaching people in their own local communities,” she noted.

The revised model of care can be viewed here.