Nearly 20% risk patients with suicidal ideation will self-harm inside five years, study finds

Almost one-fifth of people who go to hospital with suicidal ideation will return having self-harmed within five years, Irish researchers have found.

The authors of a study published this month in the Lancet argue "early intervention for those with suicidal thinking is critical" given the subsequent risk of self-harm.

The research was led by Dr Eve Griffin at the National Suicide Research Foundation (NSRF) along with the school of public health at University College Cork (UCC) and the North's Public Health Agency.

The study, based on data from the Northern Ireland Registry of Self-harm, showed that more than 1,000 patients who presented at hospitals with suicidal ideation for the first time between 2014 and 2019 returned to hospitals having self-harmed.

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The researchers examined 9,792 cases and found there was a 40 per cent risk people would present again with suicidal ideation and an 18 per cent risk they would self-harm.

The risk of self-harm within 12 months was 10 per cent and the study also found the risk of “transition from ideation to self-harm” was greatest after the first or second time they went to hospital, with the risk dropping after further presentations.

Dr Griffin, a research fellow at the NSRF, which is based at UCC, said it was “quite a unique study” in that it is one of the first to focus on ideation rather than solely on self-harm.

Dr Griffin said people who attend hospital with suicidal ideation had “quite a distinct profile” from those who self-harm, yet there were no formal clinical guidelines specifically addressing how hospital staff should treat those patients.

Anecdotal evidence

Given the risk of future presentation, “every individual who presents with suicidal ideation should be treated seriously”, yet she said there was anecdotal evidence that that was not always the case.

Responses to self-harm vary significantly in hospitals across the Republic, with the National Self-Harm Registry’s annual report for 2018 finding admittance to a hospital bed varied from 10 per cent of patients to 63 per cent.

About 13 per cent of patients left the emergency department before a next care recommendation could be made.

Of those discharged, one-third were referred for an outpatient appointment and one-fifth were sent home without a referral.

Dr Griffin said it appears “sometimes the treatment you receive is more about where you present than why you present”.

In 2018, the University of Limerick hospital group, which includes University Hospital Limerick (UHL), had the lowest rate of admittance for self-harm patients, while Limerick city had the highest rate of self-harm among women and the second-highest rate among men.

Last week, a Limerick out-of-hours information service called for an independent investigation into “the treatment of vulnerable people at risk of suicide by emergency and mental health services in the midwest”. Haven Hub founder Leona O’Callaghan said: “In our experiences since opening last year as a service and engaging with many families and service users, there is a systematic failure in procedures that is seriously jeopardising the safety and lives of those at risk of suicide.”

A spokesman for HSE Mid West, which oversees mental health services in Limerick, said: “We always encourage people who need support to contact their GP in the first instance.

‘Timely assessment’

“The crisis service in the emergency department [at] UHL provides a consultant-led liaison psychiatry service where each person who presents with self-harm receives a timely assessment from a mental health specialist and [is] then linked to the appropriate care service. Decisions in relation to individual cases are the responsibility of the assessing clinician. In addition, the staffing of the service by [an] experienced clinical nurse specialist has led to the rate of inappropriate admissions being much reduced.

“Upon presentation to an emergency department with an episode of deliberate self-harm, admission to an acute psychiatric unit is not always the appropriate action or indeed in the best interests of the person presenting.”

A separate 2016 study involving the NSRF concluded there was no strong evidence to suggest medical admission reduces the risk of repeat self-harm.

In 2018, 9,785 people presented at emergency departments in the Republic having self-harmed, a 7 per cent increase on 2017. The registry in the North recorded 6,107 cases.

The registry in the Republic, operated by the NSRF, stopped collecting data on self-harm due to the coronavirus pandemic, but Dr Griffin said she expected information to be available again from next month. She said she would like to see data on suicidal ideation recorded routinely in Ireland.

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.