February 16, 2012

Kids who Hurt Themselves

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Joseph V. Madia, MD By:

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Self harming adolescents do not receive help

(dailyRx News) Deliberate self-harm is one of the most common reasons for an emergency room visit by young people in the U.S. Add to that sad fact, most of them are discharged without ever having a mental health assessment.

As many as 80 to 90 percent of adolescents and teens who hurt themselves on purpose meet the criteria for at least one psychiatric disorder, yet only six out of ten receive such a diagnosis or mental health care while in the hospital.

"Self-harm is an important warning sign for mental health disorders."

A recent national study of Medicaid data revealed these troubling facts. Jeff Bridge, PhD, the principal investigator in the study at Nationwide Children’s Hospital, led a team which examined the Medicaid files for 3,241 children ages 10 to 19, from all over the country.

They found that most of these young people entering hospital emergency rooms for deliberate self-harm were discharged to the community (72.9 percent), as opposed to receiving inpatient care.

And only 39 percent of all those patients discharged received any mental health assessment while in the emergency department. About the same proportion of the patients also did not receive any outpatient mental health care in the month following their emergency room visit.

“Emergency department personnel can play a unique role in suicide prevention by assessing the mental health of patients after deliberate self-harm and providing potentially life-saving referrals for outpatient mental health care,” said Bridge.

The National Institute for Clinical Excellence has recommended that all patients presenting to emergency departments with an episode of deliberate self-harm should receive a mental health evaluation before discharge.

Bridge acknowledges that without knowing if these self-harm episodes were done with or without suicidal intent, it's hard to know whether such young people are at high or low risk. However, deliberate self-harm is the main risk factor for suicide, and the greatest risk for suicide occurs immediately after a self-harming episode.

"The coordination between emergency services for patients who deliberately harm themselves and linkage with outpatient mental health treatment is often inadequate," Bridge said, adding that the study highlights the need to promote such ER mental health assessments and strengthen the training of ER personnel in adolescent mental health and suicide prevention.

The findings were published in a recent issue of the Journal of the American Academy of Child & Adolescent Psychiatry.

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Reviewed by: 
Joseph V. Madia, MD
Review Date: 
February 16, 2012

Last Updated:
February 16, 2012