Incidence and general hospital costs of self-harm across England: estimates based on the multicentre study of self-harm.

Apostolos Tsiachristas,Jennifer Ness,Galit Geulayov,David Mcdaid,Deborah Casey,Keith Waters,Caroline Clements,Nav Kapur,Fiona Brand,Keith Hawton

doi:10.1017/s2045796020000189

Abstract

The aim of this study was to estimate incidence of self-harm presentations to hospitals and their associated hospital costs across England. We used individual patient data from the Multicentre Study of Self-harm in England of all self-harm presentations to the emergency departments of five general hospitals in Oxford, Manchester and Derby in 2013. We also obtained cost data for each self-harm presentation from the hospitals in Oxford and Derby, as well as population and geographical estimates from the Office for National Statistics. First, we estimated the rate of self-harm presentations by age and gender in the Multicentre Study and multiplied this with the respective populations to estimate the number of self-harm presentations by age and gender for each local Clinical Commissioning Group (CCG) area in England. Second, we performed a regression analysis on the cost data from Oxford and Derby to predict the hospital costs of self-harm in Manchester by age, gender, receipt of psychosocial assessment, hospital admission and type of self-harm. Third, the mean hospital cost per age year and gender were combined with the respective number of self-harm presentations to estimate the total hospital costs for each CCG in England. Sensitivity analysis was performed to address uncertainty in the results due to the extrapolation of self-harm incidence and cost from the Multicentre Study to England. There were 228 075 estimated self-harm presentations (61% were female) by 159 857 patients in 2013 in England. The largest proportions of self-harm presentations were in the age group 40-49 years (30%) for men and 19-29 years (28%) for women. Associated hospital costs were approximately £128.6 (95% CI 117.8-140.9) million in 2013. The estimated incidence of self-harm and associated hospital costs were lower in the majority of English coastal areas compared to inland regions but the highest costs were in Greater London. Costs were also higher in more socio-economically deprived areas of the country compared with areas that are more affluent. The sensitivity analyses provided similar results. The results of this study highlight the extent, hospital costs and distribution of self-harm presentations to hospitals in England and identify potential sub-populations that might benefit from targeted actions to help prevent self-harm and assist those who have self-harmed. They can support national as well as local health stakeholders in allocating funds and prioritising interventions in areas with the greatest need for preventing and managing self-harm.

Highlights

Self-harm, increasingly acknowledged as a major public health concern (Borschmann et al, 2018; Pilling et al, 2018; The Lancet Public, 2018; Ayre et al, 2019), is a key area in the national suicide prevention strategies of many countries and is a priority area in the Mental Health Gap Action Programme produced by the World Health Organization (World Health Organization, 2008)
In England, prevention of self-harm and suicide is a priority area in public health policy, being the focus of national strategy and clinical guidelines (NICE, 2011; UK Government, 2012, 2019). It was highlighted as a key issue in its own right when the national suicide prevention strategy in England was updated in 2017 and its prevention was recognised as fundamental priority for all organisations involved in delivering the strategy (HM Government, 2019)
Suicide rates are strongly related to self-harm rates (Geulayov et al, 2018), hospital management of self-harm remains variable across the country and there has until recently been little sign of service improvement over time (Cooper et al, 2013)

Summary

Introduction

Self-harm, increasingly acknowledged as a major public health concern (Borschmann et al, 2018; Pilling et al, 2018; The Lancet Public, 2018; Ayre et al, 2019), is a key area in the national suicide prevention strategies of many countries and is a priority area in the Mental Health Gap Action Programme produced by the World Health Organization (World Health Organization, 2008). In England, prevention of self-harm and suicide is a priority area in public health policy, being the focus of national strategy and clinical guidelines (NICE, 2011; UK Government, 2012, 2019). A recent UK study based on a single centre estimated hospital costs to be on average £809 per self-harm presentation, with an approximate extrapolation to England of an impact on the NHS budget of approximately £162 million each year (Tsiachristas et al, 2017). This is a concerning figure for local health service commissioners, which increasingly face budget constraints and pressure to improve efficiency in healthcare organisation and delivery.

Methods

Results

Discussion