Deliberate self-poisoning in an Irish county hospital

Abstract

Deliberate self-harm and, in particular, deliberate selfpoisoning is a frequent cause of hospital admission. In England and Wales, deliberate self-poisoning is the single most common reason for admission to hospital of women and the second most common for men. In this edition of the Irish Journal of Medical Science, Dr Graham McMahon and Dr Kathleen McGarry report on patients admitted to Our Lady's Hospital, Navan, in 1997 with deliberate self-poisoning. Their research is welcome and is in keeping with the National Task Force report on suicide, which was published in 1998. 2 This report called for further research into this issue. Having data relevant to Irish hospitals and the Irish Health Service is extremely valuable. This study is a retrospective chart review of 111 patients admitted to Our Lady's Hospital, Navan, in 1997 following drug overdose. Females predominated in number, but males had higher suicidal intent. Paracetamol was the most common drug taken, although over half of the patients had consumed alcohol at the time of the overdose. There were no deaths among the study population. However, approximately 1% of those who attend hospital after deliberate self-harm die within the next year.' Approximately 2-3% commit suicide within the next five years. With this in mind, Drs McMahon and McGarry have highlighted the need to restrict the availability of paracetamol, which is due to be implemented in Ireland in October 2001. In the UK, legislation restricting pack sizes of paracetamol and salicylates has substantially reduced morbidity and mortality associated with self-poisoning. 4 In this study, six patients required ventilation because of tricyclic overdoses combined with alcohol. Tricyclic anti-depressants are potentially fatal in overdose because of their cardiotoxicity. Caution in the prescription of tricyclics is necessary if a person has suicidal ideation or intent. Other less cardiotoxic antidepressants are widely available and should be considered. The study did not deal in detail with the problems regarding management and follow up. It is still not clear what is the most effective management strategy for patients who deliberately harm themselves. Follow up is also particularly difficult, as nonattendance rates at outpatient clinics are very high. The Mid-Western and Southern Health Boards, in conjunction with the National Suicide Research Foundation, initiated the Suicide Data Collection study in 1995. The results are due later this year. An intervention programme is planned and the results are eagerly awaited. However, it is desirable that each hospital that deals with deliberate self-harm should have a selfharm services planning group. The planning group should include an A&E consultant, psychiatrist, physician, A&E nurse, psychiatric nurse, social worker, senior manager and GP representative. A self-harm team should be in place offering multidisciplinary assessment. There should be written guidelines regarding the management of patients, including follow up. In 1997, 433 people committed suicide in Ireland. It is estimated that a • quarter of all people who commit suicide have attended hospital in the previous year as a result of deliberate self-harm. The establishment of a deliberate self-harm service in each hospital could significantly reduce the suicide rate. In addition, the restrictions on the availability of paracetamol and the more cautious use of tricyclic anti-depressants should ensure a decrease in the rate of suicide.