Almost 4,900 children attend adult EDs in self-harm crises 

The study said 'limited access' to community-based services may require many children to attend the ED 'at times of crisis because there is nowhere else to go'.

Almost 4,900 children under the age of 17 attended adult emergency departments for self-harm and suicide-related thoughts over a five-year period, according to new Irish research.

The study reveals that almost half of the presentations of children and young adults occurred after weekday office hours — commenting that “at times of crisis there is nowhere else to go”.

The report found that an additional 4,400 young people aged 18-19 also attended the EDs.

It said the high rate of 18-19 year olds leaving EDs before being seen is of "particular concern" from a suicide risk perspective.

The study, the first of its type in Ireland, was conducted by a team of medical academics and clinicians in Cork and Dublin and the HSE National Clinical Programme for Self-harm and suicide-related ideation (NCPSHI).

It said that EDs are the default service for youths aged 16 to 18 and, in the absence of paediatric EDs, for children under 16.

Based on data from 24 non-paediatric hospitals EDs, between 2018 and 2022, it said that more than 72,000 people were referred to NCPSHI clinicians.

This included 4,882 children under the age of 17 years (7% of the total). Of those:

• A total of 53,359 presentations were assessed for self-harm, suicidal ideation and self-harm ideation for children and adults;
• Assessment figures increased from 9,718 in 2018 to 11,776 in 2022 — a rise of 21%;
• 4,287 children under the age of 17 were assessed (8% of the total);
• This comprised 1,475 children under the age of 15 and 2,812 aged 16-17;
• 4,391 young people aged 18-19 were also assessed (8%); 
• Girls comprised 69% of cases among the under 15s, 68% of 16-18 year olds and 62% of 18-19 year olds.

While more females presented, the research said a “higher proportion” of males presented with thoughts of suicide or self-harm.

Researchers said males had a risk of dying by suicide that was “twice as high” as females.

The study said over 40% of children under 15 presenting were currently attending mental health services.

It said that “limited access” to community-based services may require many children to attend the ED “at times of crisis because there is nowhere else to go” and young people often fall through the gap of mental health services.

It said that access to Camhs services is “unavailable” after-hours for most of the country, apart from two cities with “varying access” after-hours.

The report, published in Journal of Child & Adolescent Mental Health, said there is a concern regarding the “inappropriateness” of the ED environment for crisis mental health assessment in Ireland.

It said the low admission rate for under-15s to psychiatric units may be partly attributable to "limited access" to Camhs in-patient units "due to the shortage of beds available".