Question to the Department of Health and Social Care:

To ask the Secretary of State for Health, how many children and adolescents were admitted to hospital as a result of intentional self-harm in the last 10 years; and if he will make a statement.

Data on the number of finished admission episodes for self harm for 0 to 17 year olds for the years 2003-04 to 2012-13 is in the following table.

This data should not be interpreted as a count of people as the same person may have been admitted on more than one occasion. Reference should be made to the notes when interpreting the data.

The Government is committed to reducing self-harm.

The Mental Health Action Plan, Closing the Gap: Priorities for Essential Change in Mental Health (January 2014), sets out 25 of the most important changes that we want the National Health Service and social care to make in the next few years to improve the lives of people with mental health problems and help reduce health inequalities. It highlights how we will change the way frontline health services respond to self-harm.

In the revised Public Health Outcomes Framework, we have introduced a new indicator that is specifically about self-harm. Under this indicator, we will measure:

- attendances at emergency departments for self-harm per 100,000 population;

- percentage of attendances at emergency departments for self-harm that received a psychosocial assessment.

This two-part indicator helps us not only understand the prevalence of self-harm but also how emergency departments are responding. This information can then inform future commissioning.

The National Institute for Health and Care Excellence (NICE) guidelines make it clear that anyone who attends an emergency department for self-harm should be offered a comprehensive assessment of their physical, psychological and social needs. In 2004, NICE published a clinical guideline on self-harm. This covered the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. It sets out the care people who harm themselves can expect to receive from healthcare professionals in hospital and out of hospital; the information they can expect to receive; what they can expect from treatment and what kinds of services best help people who harm themselves. Following on from this guideline, in November 2011, NICE issued a clinical practice guideline on the longer-term management of self-harm.

We expect general practitioners to refer people who disclose self-harm for psychological support as appropriate. We are investing £54 million over the period 2011 – 2015-16 in the Children and Young People’s Improving Access to Psychological Therapies (CYP IAPT) programme which is giving children and young people improved access to the best evidenced mental health care. This includes Interpersonal Psychotherapy for Adolescents and Cognitive Behavioural Therapy for emotional disorders such as anxiety and depressive disorders, Obsessive Compulsive Disorder (OCD) and Post Traumatic Stress Disorder.

Achieving Better Access to Mental Health Services by 2020 contains the first waiting time standards for mental health.

It announces the introduction of improved investment in specialist intensive psychiatric mental health facilities for children and young people to reduce waiting times for intensive psychiatric care and to end the practice of young people being admitted to mental health beds far away from where they live or from being inappropriately admitted to adult wards. It announces the introduction of standard waiting times for Early Intervention in Psychosis services which will be of benefit to young people, and for the adult Improving Access to Psychological Therapies (IAPT) programme. It makes it clear that the waiting time standards announced are a first step. There will also be £30 million increased investment in liaison psychiatry to help people including young people presenting in accident and emergency departments with mental health problems. The vision is for comprehensive standards to be developed over the coming years for all ages, including for children and young people. However, where adult IAPT services are commissioned to provide a service to 16 and 17 year olds, the waiting time standard will apply to all those attending the service, regardless of their age.

Preventing suicide in England: A cross-government outcomes strategy to save lives was published on 10 September 2012 to coincide with the International Association for Suicide Prevention’s World Suicide Prevention Day.

The Department, through the National Institute for Health Research and the Policy Research Programme has invested significantly in mental health research and will continue to support high-quality research on suicide, suicide prevention and self-harm.

The Suicide Prevention Strategy, Preventing suicide in England: A cross-government outcomes strategy to save lives is backed by £1.5 million funding, through the Policy Research Programme, which is supporting six projects to help us better understand key aspects of suicide and self-harm, including looking at self-harm in young people and the role of the internet and social media.

The new e-portal – MindEd – launched in March 2014 includes content on self-harm, suicide and risk in children and young people.

Notes

¹Finished admission episodes. A finished admission episode (FAE) is the first period of inpatient care under one consultant within one healthcare provider. FAEs are counted against the year in which the admission episode finishes. Admissions do not represent the number of inpatients, as a person may have more than one admission within the year.

²Cause Code. A supplementary code that indicates the nature of any external cause of injury, poisoning or other adverse effects. Only the first external cause code which is coded within the episode is counted in HES. The cause codes used to identify episodes of self harm were:

A supplementary code that indicates the nature of any external cause of injury, poisoning or other adverse effects. Only the first external cause code which is coded within the episode is counted in HES.

The cause codes used to identify episodes of self harm were:

X60 – Intentional self-poisoning by and exposure to nonopioid analgesics, antipryretics and antirheumatics

X61 – Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsom and psychotropic drugs, note elsewhere classified

X62 – Intentional self-poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified

X63 – Intentional self-poisoning by and exposure to other drugs acting on the automatic nervous system

X64 – Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substances

X65 - Intentional self-poisoning by and exposure to alcohol

X66 - Intentional self-poisoning by and exposure to organic solvents and halogenated hydrocarbons and their vapours

X67 - Intentional self-poisoning by and exposure to other gases and vapours

X68 - Intentional self-poisoning by and exposure to pesticides

X69 - Intentional self-poisoning by and exposure to other and unspecified chemicals and noxious substances

X70 – Intentional self-harm by hanging, strangulation and suffocation

X71 - Intentional self-harm by drowning and submersion

X72 - Intentional self-harm by handgun discharge

X73 - Intentional self-harm by rifle, shotgun and larger firearm discharge

X74 - Intentional self-harm by other and unspecified firearm discharge

X75 - Intentional self-harm by explosive material

X76 - Intentional self-harm by smoke, fire and flames

X77 - Intentional self-harm by steam, hot vapours and hot objects

X78 - Intentional self-harm by sharp object

X79 - Intentional self-harm by blunt object

X80 - Intentional self-harm by jumping from a high place

X81 - Intentional self-harm by jumping or lying before moving object

X82 - Intentional self-harm by crashing of motor vehicle

X83 - Intentional self-harm by other specified means

X84 - Intentional self-harm by unspecified means

³Assessing growth through time (Admitted patient care).

HES figures are available from 1989-1990 onwards. Changes to the figures over time need to be interpreted in the context of improvements in data quality and coverage (particularly in earlier years), improvements in coverage of independent sector activity (particularly from 2006-07) and changes to NHS practice). For example, apparent reductions in activity may be due to a number of procedures which may now be undertaken in out-patient settings and so no longer include in admitted HES patient data. Conversely, apparent increases in activity may be due to improved recording of diagnosis or procedure information. Note that Hospital Episode Statistics (HES) include activity ending in the year in question and run from April to March, eg 2012-13 includes activity between 1 April 2012 and 31 March 2013.