Self-harm in younger people: audit of prevalence and provision

This study investigated the frequency, the response to, and the pathways in care of young persons aged under 16 years (or under 18 years if attending secondary school) presenting to the Accident and Emergency Department (A&E) following deliberate self-harm (DSH). Retrospective case note review was used in two A&E departments and the Social Services Departments, Educational Psychology Services, Child and Family Consultation Services serving two local authority boroughs, a community-based counselling service and participants' general practices. Participants were 60 young people who presented to A&E following DSH over a 12-month period. Participants were identified from the department's records. The study group was predominantly female (52/60) and the self-harm mainly involved an overdose (54/60), with paracetamol the most common constituent. One-third of all cases did not receive a specialist assessment, contrary to recommendations, and one-fifth were not referred for any specialist follow-up care. There was a low frequency of recording relevant history in A&E, especially, information of previous self-harming behaviour and recent or current problems. A seasonal trend was detected with the rate of presentations falling off during the main school holiday periods. Following evidence that younger persons were being discharged from A&E without adequate assessment or follow-up provision, the service developed improvements in joint working across agencies and designed appropriate protocols for assessment and after-care. The impact of improved service provision is now under investigation in a long-term prospective study, including implementation of a standardized electronic record .