EPP057
Drivers of Young People’s Self-Harm Presentations to Emergency Departments: A Berkshire Service Evaluation
T. Mehdi 1,*, M. Duffield 1, E. Hall 1
1Child and Adolescent Mental Health, Berkshire Healthcare Foundation NHS Trust, Reading, United Kingdom
Introduction: Epidemiological data indicate that lifetime self-harm is reported by approximately 16% of adolescents (Farkas et al.ECAP 2023 (10):3439-3458). A proportion present to hospital emergency departments (A&E) in a crisis self-harm presentation such as overdose, attempted hanging, self-injury or jumping. These attendances are often misinterpreted as evidence of a primary mental illness; in many cases, factors other than mental illness are the drivers of crisis. Over-attributing crisis to “mental illness” can prompt reactive interventions that miss root causes, waste resources, and fail to improve emotional stability or functioning in children and young people (CYP).
Objectives: Evaluate crisis presentations to Berkshire Child and Adolescent Mental Health (CAMHS) Rapid Response Team (1 Feb–30 Apr 2022); describe demographics and presenting features; identify drivers of crisis; and outline implications for multi-agency responses and care to support optimal outcomes for CYP.
Methods: Mixed-methods retrospective case-note review of all CYP referred to Berkshire CAMHS Rapid Response from two acute hospitals after A&E mental-health presentations (Feb–Apr 2022). Data source: electronic records. Qualitative: narratives describing the main contributing factor for attendance were coded and thematically analysed to identify patterns. Quantitative data included age, sex, presenting reason, self-harm type, autism/ADHD diagnosis or waitlist, other psychiatric diagnoses, CAMHS involvement, other service input, family adversity and education. Inter-rater reliability was checked on 10 cases, with unclear cases reviewed by two clinicians to reach consensus.
Results: 213 self-harm crisis presentations were evaluated. Crises were largely associated with environmental factors, led by school (37.5%) and family factors (23.5%). Overall, 71% did not require ongoing CAMHS input (29% did). 55% were referred to other services, 39% were already receiving support, and 47% required multi-agency liaison. Neurodevelopmental needs were common: 22% had a diagnosis of autism or ADHD and a further 28% were awaiting assessment/referred on—indicating potentially 50% of CYP with neurodevelopmental profiles.
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Conclusions: Emergency and crisis services should recognise that self-harm presentations in children and young people are heterogeneous: some presentations reflect mental illness, but many are driven by environmental stressors or unmet neurodevelopmental needs. Risk-led and premature mental-health interventions risk missing root causes, wasting resources and yielding poor outcomes. Responses from acute services should prioritise a holistic, needs-led assessment to distinguish psychiatric illness from contextual/developmental drivers. Where these predominate, CAMHS should provide targeted liaison to partner agencies to activate and steer relevant interventions addressing social, family, educational and developmental needs.
Disclosure of Interest: None Declared