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Self-harm: half of inpatient cases dealt with by hospitals involve existing mental health service users

A third of all service user cases involve intentional self-harm with prescription drugs

*HSCIC must be quoted as the source of these figures
*Regional data are available

Just over half of adult self-harm cases dealt with by hospitals last year involved existing specialist mental health service users2, first-time analysis shows today.

Such service users accounted for 56 per cent (54,700 of 96,900) of self-harm inpatient care episodes3 in 2012-13, according to the Health and Social Care Information Centre (HSCIC).

Of the remaining care episodes, 11 per cent (10,5004) resulted in a mental health assessment on the same day as admission, while a further 11 per cent (11,0004) were assessed later in the year5.

Today's report also shows a third of self-harm episodes involving these services users related to intentional self-poisoning by prescription drugs7 generally used for treating conditions such as depression, epilepsy and schizophrenia.

The figures are presented for the first time following HSCIC linkage of two HSCIC data sets6 - Hospital Episode Statistics (HES) and the Mental Health Minimum Data Set (MHMDS) - providing a new level of detail about mental health hospital activity in England.

Key facts from this new special topic, which is part of the wider HSCIC annual Mental Health Bulletin, show that considering self-harm inpatient episodes involving adult mental health service users, in 2012-13:

  • Hospitals recorded just over 76,200 inpatient care episodes for 53,000 individual mental health service users - equating to an average of 1.4 episodes per individual. This means some service users had more than one care episode for self-harm during the year.
  • Just over a third (26,400 of 76,200) of episodes related to intentional self-poisoning using prescription drugs7, generally used for treating conditions such as depression, epilepsy and schizophrenia. Just under a third (almost 25,200) related to intentional self-poisoning using over-the-counter drugs, while the remaining third related to about 20 other self-harm codes7.
  • Women accounted for the majority of self-harm care episodes - accounting for 57 per cent (43,700) of cases. The peak age was 18 among women and 23 among men.

Key facts from today's wider Mental Health Bulletin, which is based on MHMDS data only, show that in England in 2012-13:

  • Almost one adult in 27 in England - or just over 1.5 million adults, were in contact with specialist mental health services, which is similar to last year.
  • Over a third (almost 36 per cent) of people who use specialist mental health services are aged 65 or above (just over 566,000 people in total) whereas people in this age group make up only 16.3 per cent of the overall population.
  • Almost one in six women aged 90 were recorded as mental health services users (16,800 per 100,000 of the population, or 57,600 in total) - the highest population rate by age and gender.

HSCIC chair Kingsley Manning said: "The subject of self-harm and to an extent mental health may still be seen as taboo topics to explore- but it is important to understand these areas and provide high quality information, to help inform debate and shape decision-making. This is of course vital when it comes to service planning and provision of care for people with often complex needs.

"Today's report gives several important areas of insight - including the extent to which those already in contact with specialist mental health services self-harm so seriously they require hospital inpatient care. Our data also shows that many of these self-harm incidents involve everyday drugs that can be bought over the counter."

The report is at: http://www.hscic.gov.uk/pubs/mhb1213

ENDS


Notes to editors

1. The Health and Social Care Information Centre (HSCIC) was established on April 1 2013 as an Executive Non Departmental Public Body (ENDPB). It is England's trusted data source, delivering high quality information and IT systems to drive better patient services, care and outcomes. Its work includes publishing more than 220 statistical publications annually; providing a range of specialist data services; managing informatics projects and programmes and developing and assuring national systems against appropriate contractual, clinical safety and information standards.

2. The group of Mental Health service users referred to in this report are adults aged 18 and over who were in contact with specialist mental health services funded by the NHS in England, in 2011-12.These services include community and rehabilitation services, residential care centres, day clinics and drop-in centres, as well as mental health inpatient services

3. A care episode refers to a finished consultant episode (FCE) - which is a continuous period of admitted patient care under one consultant within one healthcare provider. FCEs are counted against the period in which they end. Figures do not represent the number of different patients, as a person may have more than one episode of care within the same stay in hospital or in different stays in the same year.

4. Figures below one million in this press release have been rounded to the nearest 100 and those above one million have been rounded to the nearest 100,000.Percentages have been rounded to the nearest whole.

5. The remaining 20,600 inpatient episodes of care related to self-harm (for individuals aged 18 or over) have not been linked to MHMDS therefore these individuals are not considered to be Mental Health service users in 2012/13.These individuals may become MH service users at a later point, access primary mental health services or indeed never require these specialist services; there may also be a small proportion who were not linked (due to data quality issues) and are indeed MH service users.

6. The datasets used in today's report are Hospital Episode Statistics (HES) and the Mental Health Minimum Data Set (MHMDS). Hospital Episode Statistics (HES) are compiled from data sent by more than 300 NHS trusts and primary care trusts (PCTs) in England and from approximately 200 independent sector organisations for activity commissioned by the English NHS. Figures refer to recorded admissions and are reliant upon the accurate and complete recording of cause of hospital admission.

The Mental Health Minimum Data Set (MHMDS) contains record-level data about the care of adults and older people using secondary mental health services. MHMDS covers not only services provided in hospitals, but also in outpatient clinics and in the community, where the majority of people in contact with these services are treated. It brings together key information from the mental health care pathway that has been captured on clinical systems as part of patient care.

The HES-MHMDS linkage provides the ability to undertake national (within England) analysis along acute patient pathways for mental health service users, thereby enabling a much deeper understanding of MH (mental health) service users' interactions with acute secondary care.

7. ICD-10 codes in relation to self-harm (as defined by Clinical Coding team)

· X60 - Intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics

· X61 - Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not 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 autonomic 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

· Y87.0 - Sequelae of intentional self-harm - late effects

8. For media enquiries or interview requests please contact the press office on 0845 257 6990 or media@hscic.gov.uk.

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