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Part of: Mental Health and Illness

Related to: Anxiety and Depression, Postnatal Depression, Suicide and Mortality of Undetermined Intent, Eating Disorders, Safe Places in Health-based Settings , Alcohol, Substance Misuse, Socio-economic Inequality, Wellbeing Emotional Health and Wellbeing of Children and Young People, Ill Health and Disability, Employment and Economic Activity, Patient Experience

Key Facts

Self-harm-hospital admissions due to self-harm-males and females -updated infographic

  • In the financial year 2012/13 there were 588 emergency hospital inpatient admissions for self-harm in Bath and North East Somerset.
  • In B&NES there was a significant increase in the rate of male hospital admissions for self-harm between the financial years 2011/12 and 2012/13.
  • Wards within B&NES with significantly high rates of self-harm indicate a relationship with Socio-economic Inequality
  • Hospital admissions for self harm among 10-24 yr olds during 2013/14 in B&NES were significantly higher than national.
  • During 2013/14 there were 72 emergency self-harm hospital admissions of under 18 year old B&NES residents, an average of between 1 and 2 admissions a week.
  • In B&NES a small proportion of people that self-harm have a very high number of repeat admissions
  • Intentional self-poisoning was the most common form of self-harm, in both men (92%) and women (92%) inpatient hospital admissions in B&NES
  • 32% of admissions of men and 23% of admissions of women for self-harm in Bath and North East Somerset had Alcohol mentioned in one of the secondary diagnoses field
  • Between 1 April 2013 and 30 April 2014, 1,600 self-harm presentations were made to the Bath Royal United Hospital, 31.7% attendances were repeat presentations. 63.6% of the presentations were female.

What does the data say?

Emergency hospital inpatient admissions for self-harm  1

It is important to note that admissions data does not represent the number of patients, as some patients are admitted more than once (see Repeat admissions at the bottom of the page). After the admissions data there are also a number of sections that outline numbers and rates of individual patients admitted.

During the seven year period (financial years 2006/07 -2012/13) there were 3,563 inpatient admissions to hospital due to self-harm in Bath and North East Somerset. These admissions were for 2,077 individuals. 2

In the financial year 2012/13 there were 588 emergency hospital inpatient admissions for self-harm in Bath and North East Somerset. These admissions were for 397 individuals. 3

The rate of emergency hospital admissions for self-harm in 2012/13 (financial year) in Bath and North East Somerset was 298.1 per 100,000 of the population (directly standardised) compared to 191.0 per 100,000 of the population (directly standardised) for England. 4

Hospital admissions as a result of self-harm among 10-24 year olds during 2012/13 in B&NES (456.1 per 100,000 population) is significantly higher than national (346.3 per 100,000 population). 5

Local provider feedback suggests that the higher local rate could in part reflects more positive identification of cases. 6

Admissions - Gender

More self-harm inpatient hospital admissions were for women than men, 2,202 admissions were women (62%) and 1,361 admissions were men (38%), between the financial years 2006/07 -2012/13.  7

In the financial year 2012/13 there were 332 emergency hospital inpatient admissions for women for self-harm in Bath and North East Somerset (56%), and 256 for men (44%). These admissions were for 222 individual women (56%), and for 175 individual men (44%).  8

The average age for women being admitted to hospital for self-harm during this period was 32 (median:28, range: 2-93) whereas men had an average age of 36 (median: 35 range: 1-97). 9

The rate of hospital inpatient admissions for self-harm stayed relatively stable year on year in this period for both men and women except between FY 2011/12 and FY 2012/13 when there was a statistically significant increase of 38% in the rate of male admissions, bringing them statistically in line with the rates of female admissions for the first time in this seven year period (see Figure 1). 10

This rise in the rate of male admissions between FY 2011/12 and FY 2012/13 is primarily linked to a statistically significant increase in the rate of male admissions of those aged 35-39 years. 11

Self-harm-hospital admissions due to self-harm-males and females-line graph

Figure 1:  Rates of hospital admissions due to self-harm in Bath and North East Somerset (financial years 2006/07 – 2012/13) – Males and females of all ages 12

Admissions - Age  13

In terms of the ages of hospital admissions for self-harm during this seven year period (financial years 2006/07 -2012/13), the highest rate of admissions for women has been for those aged 20-24 years (0.64 per 100 of population), followed by 25-29 year olds (0.61 per 100 of the population), and 30-34 year olds (0.59 per 100 of population).

The ages with the highest rates of hospital admissions for self-harm for men during this period were 25-29 year olds (0.42 per 100 of population), followed by 40-44 year olds (0.39 per 100 of population), and 20-24 year olds (0.38 per 100 of population).

Self-harm -hospital admissions due to self-harm-ages of males and females -bar graph

Figure 2:  Rates of hospital admissions due to self-harm in Bath and North East Somerset (financial years 2006/07 – 2012/13) – Males and females by age 14

Emergency self-harm hospital admissions of under 18 year olds15

During 2013/14 there were 72 emergency hospital admissions of under 18 year olds B&NES residents for intentional self-harm.

Therefore, there is an average of between 1 and 2 emergency hospital admissions of B&NES under-18 year olds every week for intentional self-harm.

Emergency self-harm hospital admissions of 10-24 year olds 16   

During 2013/14 there were 219 emergency hospital admissions of 10-24 year olds in B&NES for intentional self-harm. This is a directly standardised rate of 508.3 admissions for self-harm per 100,000 population aged 10 to 24 years, significantly higher than the England average rate of 412.1. 

Figure 3:Young people aged 10 to 24 years admitted to hospital as a result of self-harm (rate per 100,000 population aged 10 to 24 years)

In comparison with the 2008/09-2010/11 period, the rate of young people aged 10 to 24 years who were admitted to hospital as a result of self-harm in B&NES was similar in the 2011/12- 2013/14 period. The admission rate in the 2011/12- 2013/14 period was higher than the England average. 

Individual patients - Gender 17

Between the financial years 2006/07 and 2012/13 there were 1,237 individual women (60%), and 840 individual men (40%) admitted to hospital due to self-harm in Bath and North East Somerset.

In the financial year 2012/13 there were 222 individual women (56%), and 175 individual men (44%) admitted to hospital  due to self-harm in Bath and North East Somerset.

The rate of individual women admitted to hospital in Bath and North East Somerset due to self-harm has not significantly changed over the financial years 2006/07 to 2012/13 (remaining between 0.23 and 0.27 per 100 of the female population).

There has on the other hand been a significant increase in the rate of individual men admitted to hospital due to self-harm between the financial years 2009/10 and 2012/13, from 0.14 to 0.20 per 100 of the male population.

self-harm-individual men admitted due to self harm-2006-07-2012-13 bargraph

Figure 4: Rates of individual men admitted to hospital due to self-harm in Bath and North East Somerset (financial years 2006/07-2012/13) 18

Individual patients - Age 19

In terms of the ages of individual hospital patients for self-harm during the seven year period (financial years 2006/07 -2012/13), overall the highest numbers for women have been those aged 20-29 years with 430 patients, making up 28% of all female patients. This is followed by 10-19 year olds with 386 patients, making up 25% of all female patients. 20-29 year and 10-19 year old women have made up the first and second highest proportion of women to be admitted for self-harm every financial year since 2007/08.

The ages with the highest numbers of men admitted to hospital for self-harm overall during this period were 20-29 year olds, with 288 patients, making up 30% of all male patients. This is followed by 40-49 year olds with 169 patients, making up 23% of all male patients. During the seven year period (financial years 2006/07to 2012/13) apart from in 2008/09 and 2009/10 when the highest proportion of male patents were aged 40-49, the age group with the highest number of male patents has been the 20-29 year olds.

In relation to the significant increase in the rate of individual men admitted to hospital due to self-harm between the financial years 2009/10 and 2012/13, from 0.14 to 0.20 per 100 of the male population, this has largely been down to an increase in the rate of male patients aged between 30-39 years and 20-29 years, as these have increased by 0.17 and 0.16 per 100 of the male population respectively.

30-39 year old men have increased from a rate of 0.17 per 100 of the male population in 2009/10 to 0.34 per 100 in 2012/13 and 20-29 year old men have increased from a rate of 0.22 per 100 in 2009/10 to 0.38 in 2012/13.  However, it is important to note that neither of these increases can be said to be statistically significant and between 2011/12 and 2012/13 there has actually been a slight decline in the rate of 20-29 year old men admitted from 0.41 per 100 in 2011/12 to 0.38 per 100 in 2012/13.

New patients - Gender 20

The number of new female self-harm hospital inpatients has increased from 149 in the financial 2011/12 to 162 in the financial year 2012/13, an increase of 13. 

Though the number of new male self-harm hospital inpatients is lower than that for women, the number has increased by significantly more, from 95 in the financial 2011/12 to 130 in the financial year 2012/13, an increase of 35 men.

When referring to new patents in the financial year 2011/12 we are referring to patients that have not been admitted  to hospital for self-harm in the previous 5 financial years (since financial year 2006/07).  Therefore, when referring to new patents in the financial year 2012/13 we are referring to patients that have not been admitted  to hospital for self-harm in the previous 6 financial years (since financial year 2006/07). 

Socio-economic Inequality 21

Using hospital admissions data at LSOA level - there is a clear and significant relationship between socio-economic deprivation and incidents of self-harm.

Figure 5: Rate of hospital admissions for self-harm April 2006 to February 2014 by income deprivation (2010) 

Repeat admissions 22

In relation repeat inpatient admissions for self-harm in Bath and North East Somerset, during the 7 financial years 2006/07- 2012/13:

  • There were 1,517 repeat admissions
  • 42% of all admissions were repeat admissions
  • 1,033 repeat admissions were for women, making up 68% of repeat admissions.
  • 484 repeat admissions were for men, making up 32% of repeat admissions
  • 46% of admissions for women were repeat admissions
  • 37% of admissions for men were repeat admissions
  • 88 people (4%) admitted for self-harm were admitted to hospital 5 or more times.
  • 27 people (1%) admitted for self-harm were admitted to hospital 10 or more times.
  • 9 people (0.4%) admitted for self-harm were admitted to hospital 20 or more times.

In B&NES during the financial year 2012/13:

  • There were 191 repeat admissions
  • 32% of all admissions were repeat admissions
  • 110 repeat admissions were for women, making up 58% of repeat admissions.
  • 81 repeat admissions were for men, making up 42% of repeat admissions
  • 33% of admissions for women were repeat admissions
  • 32% of admissions for men were repeat admissions
  • 10 people (3%) admitted for self-harm were admitted to hospital 5 or more times.
  • 1% of people admitted for self-harm were admitted to hospital 10 or more times.
  • 0.3% admitted for self-harm were admitted to hospital 20 or more times.

It is important to note that though women made up a significantly higher proportion of inpatient admissions and repeat admissions for self-harm during the financial year 2012/13, the proportion of female admissions that were repeat admissions (33%), was virtually the same as the proportion of male admissions that were repeat admissions (32%).

Method of self-harm 23

In Bath and North East Somerset during the seven year period (financial years 2006/07 -2012/13), intentional self-poisoning was the most common form of self-harm, in both men (92%) and women (92%) inpatient hospital admissions.

During the seven year period, financial years 2006/07 -2012/13, 32% of admissions of men and 23% of admissions of women for self-harm in Bath and North East Somerset had Alcohol mentioned in one of the secondary diagnoses fields 1-5 (ICD 10 code X65 = Intentional self-poisoning by and exposure to alcohol).

In B&NES during the financial year 2012/13, 36% of admissions of men and 24% of admissions of women for self-harm in Bath and North East Somerset had Alcohol mentioned in one of the secondary diagnoses fields 1-5 (ICD 10 code X65 = Intentional self-poisoning by and exposure to alcohol).

The Bath Royal United Hospital self-harm register 24

The self-harm register collects data on all patients presenting to the RUH Bath following an episode of self-harm. Information comes from multiple sources including the emergency department, mental health screening, psychosocial assessment, and Avon & Wiltshire Mental Health Partnership NHS Trust’s (AWP) records on patients’ previous and current service use.

Between 1 April 2013 and 30 April 2014, 1,600 presentations were made. These presentations were made by 1,089 people, meaning 31.7% (505), attendances were repeat presentations.

Based on this period, on average, 28 people present for self-harm to the RUH per week as a consequence of self-harm. The number of presentations has been relatively stable. 

Previous self-harm – 1,109 (69.3%) of the self- harm RUH presentations during this period were from people with a history of self-harm.

Geography - information is available on patient postcode and so it is possible to identify which CCG area they live in. 686 (43%) of the presentations came from B&NES CCG, 750 (47%) from Wiltshire CCG, 67 (45) from Somerset CCG, and 97 (6%) were unknown.

Gender - 63.6%, (1,018) were female. 

Age - Presentations by patients in their late teens and early twenties were most common.

Figure 6: Number of presentations at the RUH for self-harm by age – 1 April 2013 -30 April 2014 (This graph excludes patients >=70 (n=29)) 25

Ethnicity - Patients were predominately white (80.4%). It is important to note that the ethnicity for 17.2% of presentations was unknown/not recorded.

Employment status – There was a high unemployment rate in the RUH self-harm patient population during this period (33.6%), over three times that of the national average.

19.5% of the patients were employed, 10.2% were students, 3.5% were retired, 3.3% were on sickness benefit, and 2.5% were recorded as other. But, it is important to note that the employment status is unknown/not recorded for 27.4% of presentations.

Methods of self-harm - Self-poisoning was by far the most common method of self-harm used (69.3%), followed by self-injury (17.3%). 13.5% of the patients had used both. Paracetamol was the most used drug as part of an episode of self-harm (41.2%), and   within the self-injury category most cases consisted of self-inflicted lacerations.

Substance misuse in young people – Between 1 April 2013 and 30 April 2014, alcohol was misused by 84 (33%) of the 255 young people (16-21yrs) presenting at the RUH for self-harm from B&NES, roughly 1 in 3. Episodes involving illicit drugs were less common in the young people presentations from B&NES, with 25 young people (9.8%).

 

Are we meeting the needs?

The Bath Royal United Hospital self-harm register 26

Mental health screening tool, Matrix – is the initial emergency department mental health screening tool used by non-mental health staff to triage and prioritise patients with mental health needs (including self-harm) on arrival at hospital. A total of 963 (60.2%) of the self-harm patients that presented at the RUH between 1 April 2013 and 30 April 2014 were assessed and given a risk categorisation with the mental health matrix at triage. Of those assessed, 111 (11.5%) patients were given low/green matrix risk, 639 (66.4%) where given medium/amber risk and 213 (22.1%) were high/red matrix risk.

Admission to an acute (RUH) hospital bed - A total of 1,158 (72.4%) of the RUH self-harm patients during this period were admitted to an RUH hospital bed as a result of their attendance following self-harm. Most patients were admitted to the observation ward (88.6%) and the remainder to other general hospital wards or unknown. Of the patients that were admitted to a hospital bed, 15 (1.3%) were admitted to the Intensive Therapy Unit (ITU). Of the unknown group, some patients will have been assessed, treated and discharged directly from the ED without being admitted to a hospital bed.

Psychosocial assessment - Of the RUH self-harm presentations for this period, 936 (60.2%) received a psychosocial assessment. This means that over 12% of admitted patients did not receive a psychosocial assessment.

Contact with mental health services – Though 69.3% of the self-harm presentations were of patients that had a history of previous self-harm, only 32.6% of these presentations were of people that were currently in contact with psychiatric services. However, 63.1% of the presentations were of patients that had previously been in contact with psychiatric services.

Outcomes - One patient can be referred on to a number of services (e.g alcohol services and community mental health teams) following a self-harm attendance. The frequencies of the different outcomes of the self-harm attendances to RUH between 1 April 2013 and 30 April 2014 are illustrated in the graph below. 

Figure 7: Outcome of attendances for self-harm at the RUH Bath – 1 April 2013 -30 April 2014   27

  • 1. Research Intelligence Team, Bath and North East Somerset Council (2013) Hospital Inpatient Admissions for Self-Harm in B&NES residents - financial years 2006/07-2012/13, in house analysis of SUS data
  • 2. Research Intelligence Team, Bath and North East Somerset Council (2013) Hospital Inpatient Admissions for Self-Harm in B&NES residents - financial years 2006/07-2012/13, in house analysis of SUS data
  • 3. Research Intelligence Team, Bath and North East Somerset Council (2013) Hospital Inpatient Admissions for Self-Harm in B&NES residents - financial years 2006/07-2012/13, in house analysis of SUS data
  • 4. Public Health England (2014) Bath and North East Somerset Clinical Commissioning Group, Community Mental Health Profile 2014, http://www.nepho.org.uk/pdfs/cmhp/E38000009.pdf (viewed 21.11.14)
  • 5. CHIMAT Child Health Profile - Bath and North East Somerset 2014
  • 6. B&NES NHS PCT, (2011) Emergency Hospital Admissions for Self Harm for LA – financial years 2006/07-2010/11, In house analysis
  • 7. Research Intelligence Team, Bath and North East Somerset Council (2013) Hospital Inpatient Admissions for Self-Harm in B&NES residents - financial years 2006/07-2012/13, in house analysis of SUS data
  • 8. Research Intelligence Team, Bath and North East Somerset Council (2013) Hospital Inpatient Admissions for Self-Harm in B&NES residents - financial years 2006/07-2012/13, in house analysis of SUS data
  • 9. Research Intelligence Team, Bath and North East Somerset Council (2013) Hospital Inpatient Admissions for Self-Harm in B&NES residents - financial years 2006/07-2012/13, in house analysis of SUS data
  • 10. Research Intelligence Team, Bath and North East Somerset Council (2013) Hospital Inpatient Admissions for Self-Harm in B&NES residents - financial years 2006/07-2012/13, in house analysis of SUS data
  • 11. Research Intelligence Team, Bath and North East Somerset Council (2013) Hospital Inpatient Admissions for Self-Harm in B&NES residents - financial years 2006/07-2012/13, in house analysis of SUS data
  • 12. Research Intelligence Team, Bath and North East Somerset Council (2013) Hospital Inpatient Admissions for Self-Harm in B&NES residents - financial years 2006/07-2012/13, in house analysis of SUS data
  • 13. Research Intelligence Team, Bath and North East Somerset Council (2013) Hospital Inpatient Admissions for Self-Harm in B&NES residents - financial years 2006/07-2012/13, in house analysis of SUS data
  • 14. Research Intelligence Team, Bath and North East Somerset Council (2013) Hospital Inpatient Admissions for Self-Harm in B&NES residents - financial years 2006/07-2012/13, in house analysis of SUS data
  • 15. Szapiel M, Public Health Information Specialist (2014) Injuries to children BANES 2013/14, Bristol City Council
  • 16. Public Health England (2015) Child Health Profile June 2015 - Bath and North East Somerset, http://www.chimat.org.uk/resource/view.aspx?RID=101746&REGION=101635 (downloaded 23/09/15)
  • 17. Research Intelligence Team, Bath and North East Somerset Council (2013) Hospital Inpatient Admissions for Self-Harm in B&NES residents - financial years 2006/07-2012/13, in house analysis of SUS data
  • 18. Research Intelligence Team, Bath and North East Somerset Council (2013) Hospital Inpatient Admissions for Self-Harm in B&NES residents - financial years 2006/07-2012/13, in house analysis of SUS data
  • 19. Research Intelligence Team, Bath and North East Somerset Council (2013) Hospital Inpatient Admissions for Self-Harm in B&NES residents - financial years 2006/07-2012/13, in house analysis of SUS data
  • 20. Research Intelligence Team, Bath and North East Somerset Council (2013) Hospital Inpatient Admissions for Self-Harm in B&NES residents - financial years 2006/07-2012/13, in house analysis of SUS data
  • 21. SUS data - Hospital admissions for self-harm between April 2006 and February 2014 by deprivation quintile, B&NES In house analysis
  • 22. Research Intelligence Team, Bath and North East Somerset Council (2013) Hospital Inpatient Admissions for Self-Harm in B&NES residents - financial years 2006/07-2012/13, in house analysis of SUS data
  • 23. Research Intelligence Team, Bath and North East Somerset Council (2013) Hospital Inpatient Admissions for Self-Harm in B&NES residents - financial years 2006/07-2012/13, in house analysis of SUS data
  • 24. Carroll R. (NIHR Doctoral Research Fellow School of Social & Community Medicine University of Bristol), Harrison A. (Consultant Nurse Avon & Wiltshire Mental Health Partnership NHS Trust) (2015) RUH (Bath & North East Somerset and Wiltshire) Self-harm Register: 1 April 2013 – 30 April 2014, Bath and North East Somerset Council, Avon & Wiltshire Mental Health Partnership NHS Trust
  • 25. Carroll R. (NIHR Doctoral Research Fellow School of Social & Community Medicine University of Bristol), Harrison A. (Consultant Nurse Avon & Wiltshire Mental Health Partnership NHS Trust) (2015) RUH (Bath & North East Somerset and Wiltshire) Self-harm Register: 1 April 2013 – 30 April 2014, Bath and North East Somerset Council, Avon & Wiltshire Mental Health Partnership NHS Trust
  • 26. Carroll R. (NIHR Doctoral Research Fellow School of Social & Community Medicine University of Bristol), Harrison A. (Consultant Nurse Avon & Wiltshire Mental Health Partnership NHS Trust) (2015) RUH (Bath & North East Somerset and Wiltshire) Self-harm Register: 1 April 2013 – 30 April 2014, Bath and North East Somerset Council, Avon & Wiltshire Mental Health Partnership NHS Trust
  • 27. Carroll R. (NIHR Doctoral Research Fellow School of Social & Community Medicine University of Bristol), Harrison A. (Consultant Nurse Avon & Wiltshire Mental Health Partnership NHS Trust) (2015) RUH (Bath & North East Somerset and Wiltshire) Self-harm Register: 1 April 2013 – 30 April 2014, Bath and North East Somerset Council, Avon & Wiltshire Mental Health Partnership NHS Trust