• Grace Cully, Vincent Russell, Mary Joyce, Paul Corcoran, Caroline Daly, and Eve Griffin.
• School of Public Health, University College Cork, Cork, Ireland. grace.cully@ucc.ie.
• Ir J Med Sci. 2024 Oct 1; 193 (5): 244324512443-2451.

BackgroundPresentation to the emergency department (ED) with self-harm provides an important opportunity for intervention.AimsTo investigate characteristics and self-harm repetition risk of those discharged from the ED without a referral for mental health-related aftercare.MethodData on consecutive self-harm presentations to EDs for the years 2013-2019 (n = 55,770) were obtained from the National Self-Harm Registry Ireland. Multilevel Poisson and Cox regression models were estimated.ResultsHalf of the self-harm presenters were discharged from the ED (49.8%) and almost half of them did not receive a mental health-related referral (46.8%). Receipt of a psychosocial assessment was associated with a 50% reduced risk of non-referral (IRR 0.54; 95% CI 0.51-0.57). Non-referral was also less likely for young people (< 18 years), presentations involving attempted hanging, persons with previous self-harm presentations, and in the latter half of the study period (2017-2019 vs. 2013-2016), but was more likely for those brought by ambulance, presenting outside 9 am-5 pm and admitted to an ED medical assessment unit. Of those not referred, 19.3% had a repeat presentation within 12 months, compared to 22.4% of those referred. No difference in repetition risk between these two groups was evident in adjusted analyses. Self-harm history had the strongest association with repetition, with highest risk among individuals with four or more previous presentations (HR 9.30, 95% CI 8.14-10.62).ConclusionsThe findings underline the importance of assessing all individuals who present with self-harm and highlight the need for comprehensively resourced 24hr services providing mental health care in the ED.© 2024. The Author(s).

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