Policy brief: Self-harm & suicide in Northern Ireland: New evidence from linked administrative data

The information presented in this policy brief summarises findings from five published research papers by researchers based within the Administrative Data Research Centre Northern Ireland (ADRC NI, part of ADR Northern Ireland). These used whole population-wide linked administrative data to better understand who in Northern Ireland is most at risk of self-harm, self-harm/suicidal ideation, and death by suicide, in order to help inform policy and practice.

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Key findings

• Living with a parent with mental ill-health increases a child’s risk of death by suicide
• Almost a quarter of young people who died by suicide in Northern Ireland had presented to an emergency department with self-harm, suggesting emergency departments present a key opportunity for intervention
• Young adults with care experience are at a higher risk of self-harm and death by suicide
• Individuals who present to emergency departments with thoughts of self-harm or suicide are over 10 times more likely to die by suicide.

Recommendations for policy and practice 

The research shines a light on some sub-groups of the population who we know from the evidence are at an increased risk of self-harm, self-harm/suicidal ideation, and/or death by suicide. In response to these findings, the researchers have made five recommendations for policy/practice, which align with the objectives of the Protect Life 2 Strategy.

These are listed below for consideration:

1. Strengthen evidence-based interventions in emergency departments [Objectives 8.1 and 10]: Recognise emergency departments as crucial intervention points for self-harm and suicide prevention and develop targeted, evidence-based strategies. All individuals presenting to emergency departments with self-harm or suicidal ideation should be offered mental health assessments by specialised mental health teams at the time of presentation, with follow-up care plans established before discharge. Risk screening tools should not be used as no scale has sufficient positive predictive value for death by suicide.¹³ The responsibility for delivery of these interventions should not necessarily lie with emergency department staff. This comprehensive approach is crucial as almost a quarter of young people who died by suicide had previously presented to emergency departments with self-harm, and half of all suicide deaths among those presenting with suicidal ideation occurred within 12 months of presentation.
2. Enhance support for at-risk groups [Objectives 8.1 and 10.1]: Develop and implement enhanced mental health support across all settings for groups showing increased risk of self-harm, self-harm/suicidal ideation, and suicide risk. Prioritise groups most at risk, including: (i) those with a history of social care contact, who comprise 11.7% of the population but account for 39.7% of suicide deaths, (ii) children (especially those aged <24 years)  living with a parent(s) with poor mental health, who are 76% more likely to die by suicide, even after adjusting for their own mental health status, and (iii) individuals with a history of self-harm or suicidal ideation, particularly in the 12 months following emergency department presentation.
3. Develop guidelines for the clinical management and recommended best practice for individuals presenting to emergency departments with self-harm/suicidal ideation [Objective 8.1]: Establish comprehensive guidelines for managing patients presenting with self-harm/suicidal ideation at emergency departments, complementing existing NICE guidance on self-harm management, addressing a crucial gap.
4. Maximise the impact of the NI Registry of Self-Harm [Objectives 8.2 and 10]: Continue funding the Northern Ireland Registry of Self-Harm, and improve access and utilisation of this resource by integrating it within the Regional Data Warehouse. Currently, the process for access is protracted, resulting in time delays in accessing data and difficulty in completing real-time research. Better access will allow for better understanding of self-harming behaviour and enable more proactive interventions to prevent deaths. Unlike the National Confidential Inquiry which explores deaths after they occur, the registry provides a unique opportunity to identify and intervene with at-risk individuals before deaths occur. This aligns directly with Objective 8.2 to improve understanding of self-harming behaviour, and Objective 10.1 to identify priorities for local research into suicide and self-harm prevention.
5. Advocate for better legislation for data linkage and analysis [Objective 10.1]: Advocate for better legislation around the utilisation of health data resources, such as the NI Registry of Self-Harm, to inform policy and practice and ultimately improve the health and well-being of the NI population.