Psychological management following deliberate self-harm.

There are approximately 4,000 suicides in England and Wales each year. This is equivalent to one death every two hours. The overall rate of suicide in Britain has fallen slightly over recent years, but the rate among young people increased considerably during the 1980s. Suicide is now the third most common cause of death in people aged 15–30. About half those who die by suicide have a past history of non-fatal deliberate self harm (DSH). It has been argued that by providing a high standard of care to these patients the national rate of suicide could be reduced1. Paracetamol and other analgesics are the most commonly used substances in overdose and 40% of cases also involve the consumption of alcohol. The majority of episodes of DSH that are treated by medical services present initially to accident and emergency departments (AED). Over 90% involve self-poisoning and 30–50% of patients require a brief admission for further medical treatment2, resulting in over 200,000 admissions to British hospitals each year. One-fifth of those who have an episode of DSH repeat the act during the next year, and 1% die by suicide – a rate of suicide 100 times that of the general population3. The rate of DSH in Britain is currently 3 per 1,000 per year. This results in over 100,000 admissions to hospital each year, making DSH the most common reason for acute medical admission among women aged under 60. The rate of DSH was formerly far higher in women than men, but rates in men have increased over recent years and the male to female ratio is now 1:1.2. DSH in the elderly is less common, although a higher proportion of elderly patients state that at the time of the episode their intention was to kill themselves. Patients who present following an episode of DSH usually have multiple social and personal problems. Experiences of childhood sexual abuse4 and other sources of trauma in early life are common, as are current worries about unemployment, physical illness, relationship problems, etc. An important minority of patients also suffers from depression, schizophrenia and other treatable mental disorders. Attempts to identify factors that have motivated an episode of DSH are difficult to obtain through retrospective enquiry. While some patients clearly hoped to effect a change in the attitude or behaviour of others, a greater number state that they had wanted to escape a difficult situation, and a third group asserts that it was their intention to end their life5.