title: The epidemiology and management of self-harm amongst adults in England.
abstract: BACKGROUND
  Previous research into the epidemiology and management of self-harm has been largely based in centres with a special interest in this behaviour or focused on hospital admissions only. There are no national data on the characteristics and management of people presenting to hospital following self-harm.
  
  
  METHODS
  Data were collected from 8-week service audits carried out in a stratified random sample of 31 general hospitals in England.
  
  
  RESULTS
  4033 episodes of self-harm resulting in presentation to Accident and Emergency Departments were identified. Overdose alone accounted for 79 per cent of episodes, 80 per cent of presentations were outside normal office hours (9 am - 5 pm, Monday to Friday) and the peak period of attendance was from 8 pm to 2 am. In only 56 per cent of episodes was a specialist psychosocial assessment conducted prior to discharge and less than half (46 per cent) led to admission to a hospital bed. Psychiatric admission occurred in 10 per cent. Episodes involving older subjects (>45 years) and those using methods other than laceration or overdose were the most likely to lead to assessment and admission.
  
  
  CONCLUSIONS
  Non-fatal self-harm is one of the strongest predictors of suicide, yet nearly half of all hospital attendances in England following self-harm do not lead to a specialist assessment. Patterns of service provision should take account of the observation that most self-harm attendances occur outside normal working hours and those at greatest risk of repetition are the least likely to receive assessments.
authors.affiliation: Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK. d.j.gunnell@bristol.ac.uk
authors.forename: David
authors.initials: D
authors.lastname: Gunnell
authors.forename: Olive
authors.initials: O
authors.lastname: Bennewith
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Peters
authors.forename: Allan
authors.initials: A
authors.lastname: House
authors.forename: Keith
authors.initials: K
authors.lastname: Hawton
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D062787:Drug Overdose / Q000453:epidemiology* / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy; D008875:Middle Aged; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000628:therapy*; D012737:Sex Factors; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D013995:Time; D000092864:Suicide Prevention