Data Insight: Childhood contact with social services, self-harm and suicidal or self-harm ideation in young adulthood

This Data Insight uses population-wide data in Northern Ireland (NI) to quantify the association between childhood contact with social services and presentation to an emergency department (ED) with self-harm or thoughts of suicide or self-harm in young adulthood. The analysis uses data developed as part of a wider project within the Administrative Data Research Centre Northern Ireland (ADRC NI) examining outcomes for children in contact with social services.

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Summary

This study provides the first UK, population-level evidence that young adults who had any contact with social services in childhood are significantly more likely to present to an ED with self-harm or thoughts of self-harm or suicide (hereafter ‘ideation’) than their peers with no history of contact. There is a clear stepwise increase in the likelihood of presenting with self-harm or ideation in adulthood as the level of interaction with social services in childhood increases.

Most of the young adults in this study that had contact with social services in childhood did not present to an ED with self-harm or ideation, and poor outcomes are not inevitable. However, over 40% of all young adults in NI that presented to an ED with self-harm or ideation during follow-up had a history of contact with social services. Understanding the magnitude of childhood adversity amongst adults that present to EDs with self-harm or ideation may inform clinicians’ understanding and therapeutic decision-making.

Background

The aim of the children’s social care system in NI, like the rest of the UK, is not only to keep a child safe from harm, but also to ensure children at risk of poor outcomes are supported to fulfill their potential. Children in contact with social services (i.e. children referred to child protection/family support measures at home or in care) have typically experienced difficult circumstances that leave them at increased risk of mental ill health.

Children in contact with social services experience, on average, poorer outcomes across the life course compared with their peers in the general population. However, there is limited evidence in relation to self-harm and suicidal ideation risk in adulthood.

To date, the evidence from large-scale, prospective studies is limited, with no such studies in the UK. This study utilised large, linked administrative datasets to examine the likelihood of self-harm or ideation in young adulthood given childhood contact with social services.

What we found

Overall, 4,026 of the 253,495 cohort members (1.6%) presented to an ED with self-harm and 1,669 (0.7%) with ideation during follow-up (Table 1). The largest absolute number of presenters were never in contact with social services (n=2,889), followed by those who were a child in need (n=1,178), a child in care (n=475), and lastly those assessed as not in need (n=346).

However, proportionately, 13.5% of care experienced young adults presented with self-harm or ideation compared to just 1.3% of those with no social care contact. While individuals with childhood social care contact comprised 10.8% of the cohort, they accounted for 40.9% of all young adults who presented with self-harm or ideation (Table 1).

The likelihood of self-harm or ideation increased stepwise with level of childhood contact with social services (Table 1). After full adjustment, the highest risk was found in care experienced young adults, who were 10 times more likely to present to an ED with self-harm and 13 times more likely to present with ideation than their peers with no childhood contact. However, even young adults who were referred to social services, but deemed “not in need” in childhood, maintained a higher likelihood of self-harm or ideation than peers never in contact with social services.

Why it matters

Mental ill health is a major public health concern, and although self-harm and ideation themselves are behaviours that require appropriate support, they are also the largest known predictors of death by suicide. Understanding who is most at risk and who may benefit most from targeted interventions is vital to improving mental health outcomes, reducing rates of death by suicide, and understanding prevention pathways.

Most children in contact with social services do not present to an ED with self-harm or ideation in young adulthood. However, the large and disproportionate burden of self-harm and ideation within this group underscores the need for a policy response. The evidence presents a prime opportunity to develop appropriate interventions targeted at young adults with a childhood history of contact with social services, or children still in contact with social services or approaching leaving care.