Drivers of Young People’s Self-Harm Presentations to Emergency Departments: A Berkshire Service Evaluation
T. Mehdi, M. Duffield, E. HallIntroduction
Epidemiological data indicate that lifetime self-harm is reported by approximately 16% of adolescents (Farkas et al .ECAP 2023 (10):3439-3458). A proportion present to hospital emergency departments (A&E) in a crisis self-harm presentation such as overdose, attempted hanging, self-injury or jumping. These attendances are often misinterpreted as evidence of a primary mental illness; in many cases, factors other than mental illness are the drivers of crisis. Over-attributing crisis to “mental illness” can prompt reactive interventions that miss root causes, waste resources, and fail to improve emotional stability or functioning in children and young people (CYP).
Objectives
Evaluate crisis presentations to Berkshire Child and Adolescent Mental Health (CAMHS) Rapid Response Team (1 Feb–30 Apr 2022); describe demographics and presenting features; identify drivers of crisis; and outline implications for multi-agency responses and care to support optimal outcomes for CYP.
Methods
Mixed-methods retrospective case-note review of all CYP referred to Berkshire CAMHS Rapid Response from two acute hospitals after A&E mental-health presentations (Feb–Apr 2022). Data source: electronic records. Qualitative: narratives describing the main contributing factor for attendance were coded and thematically analysed to identify patterns. Quantitative data included age, sex, presenting reason, self-harm type, autism/ADHD diagnosis or waitlist, other psychiatric diagnoses, CAMHS involvement, other service input, family adversity and education. Inter-rater reliability was checked on 10 cases, with unclear cases reviewed by two clinicians to reach consensus.
Results
213 self-harm crisis presentations were evaluated. Crises were largely associated with environmental factors, led by school (37.5%) and family factors (23.5%). Overall, 71% did not require ongoing CAMHS input (29% did). 55% were referred to other services, 39% were already receiving support, and 47% required multi-agency liaison. Neurodevelopmental needs were common: 22% had a diagnosis of autism or ADHD and a further 28% were awaiting assessment/referred on—indicating potentially 50% of CYP with neurodevelopmental profiles.
Image 1: Long description.