Suicidal children seen by hospitals ‘tip of iceberg’

IRISH children who turn up at hospital A&E units after attempting suicide, or self-harm, represent only the “tip of the iceberg”, as many cases never attend, a leading child psychiatrist yesterday told an international conference on suicide.

A study jointly conducted by the Temple Street and Crumlin children’s hospitals found that a child as young as six years had tried to strangle himself. The Dublin study examined 484 cases of deliberate self-harm involving people between the ages of six and 16, covering five years in relation to Temple Street and 11 years in Crumlin.

All of the children presented at A&E units at the hospitals and 10.5% were aged 11 or under.

The average age was 13 and two-thirds were girls. However, cases among children that young are extremely rare and there’s no such thing as suicide for children under five, because they are not deemed to have reached the use of reason, according to prominent World Health Organisation (WHO) psychiatrist and neurologist Dr Jose Bertolote who is attending the conference in Killarney.

Presenting the findings, Dr Carol Fitzpatrick, professor of child psychiatry at UCD, said the cases coming to A&E units were the “tip of the iceberg”.

“One of the unexpected findings was that 65% had a history of deliberate self-harm in the past. We knew a considerable number had that history but did not think it was that high.”

Overdosing was the most common form of self-harm (71%), with cutting, strangulation, hanging, drowning, burning and other methods at 10% and under.

Prof Fitzpatrick said those trying to overdose took a wide variety of home medication, with paracetamol being the most common, including painkillers, antibiotics and sedatives. She said a huge variety of reasons were given, such as relationship difficulties, family conflicts and rows with parents in the case of younger children. Adolescents listed rows with peers, loss of friendships and bullying.

About half of the children involved were living with both parents, 29% with single parents and 15% were in State care.

Prof Fitzpatrick said services for these vulnerable children were very under-resourced, with waiting lists of 18 months to two years for children needing some specialist services. “It is unacceptable to have children languishing in a paediatric ward while waiting for an inpatient psychiatric bed.”

She also voiced concern at the fact that almost half of the cases in the study were not admitted to hospital, even though professional guidelines recommended that all young people showing suicidal behaviour should be admitted for in-depth assessment.

“We also feel further study needs to be done in relation to younger children, under 12, who engage in deliberate self-harm. Further studies of families is also needed,” Prof Fitzpatrick told the world conference of the International Association for Suicide Prevention.