Children as young as six in hospitals after self-harm

By Cormac O’Keeffe

Tuesday, March 16, 2010

CHILDREN as young as six are turning up at the country’s largest children’s hospital after deliberately harming themselves, according to new research.

Some 80% of the 197 children identified at Crumlin Children’s Hospital arrived outside normal working hours.

The research said on-call child psychiatric services needed to be “urgently developed” in Irish hospitals.

The authors, mainly from the child psychiatry department in Crumlin Hospital, examined all children presenting to the hospital with deliberate self-harm (DSH) and suicidal ideation between 1993 and 2003.

Of the 197 children:

* 11 were aged 10 or younger, including one six-year-old, two eight-year-olds, three nine-year-olds and five 10-year-olds.

* 15 were aged 11 and 33 were aged 12.

* 72 (or 37%) were aged 13.

* 55 were aged 14, with nine 15-year-olds and two aged 16.

Overdose was the method in the vast majority (81%) of cases. Other methods included cutting (4%), hanging (3%) and jumping (3%).

Some 7% of cases involved suicidal ideation only (thinking about suicide).

The research in the Irish Journal of Psychological Medicine, said 13 children, aged 5-14 years, had died by suicide between 1982 and 1991. This trebled to 38 in the next decade.

Based on details of 172 of the 197 cases, only 20% arrived during working hours (9am-5pm Monday to Friday). Most (55%) arrived between 8pm and 3am.

“In our sample, those presenting outside of normal hours represented a vulnerable and at-risk group, who made a specific suicide attempt, had used alcohol at the time of DSH, and had higher rates of family psychiatric illness (49%).”

The report said the fact that most presentations occur after hours had “important manpower implications”. It added that a fifth arrived at weekends and had to wait until Monday to avail of a child psychiatric assessment.

“Unless there is an on-call child psychiatric service it is likely that many of these children will either be discharged without psychiatric assessment or admitted to wards overnight without an adequate risk assessment.”

It said as Crumlin had a 24-hour on-call service, only 5% of children were not assessed. But it said the number was likely to be higher in hospitals with limited or no child psychiatric service.

It said there was just 55 consultant child psychiatrists in Ireland, or six per 100,000 population under 16.

“Deliberate self-harm in young people is a significant public health problem in Ireland and is a major risk factor for completed suicide,” the research concluded.

* Samaritans: 1850 60 90 60 or jo@samaritans.org

This appeared in the printed version of the Irish Examiner Tuesday, March 16, 2010