Deliberate self-harm (DSH) out of hour's presentations

Objective: To establish time of presentation to paediatric accident and emergency (A&E) services of children with deliberate self-harm (DSH). Method: All children presenting to an acute paediatric hospital with DSH or suicidal ideation between 1993- 2003 were identified and time of presentation collected from their case notes. Results: Of the 172 children where the actual time of presentation was recorded, the majority of children - 137 (80%) presented to the hospital outside of the 'normal working hours' of 9am-5pm, Monday - Friday. These children represent an at-risk group, and were more likely to have consumed alcohol, to have made a suicide attempt, and to have a family history of psychiatric illness than children presenting with "normal working hours". Conclusion: DSH in young people is a significant public health problem in Ireland and is a major risk factor for completed suicide. Access to an out of hours on-call Child and Adolescent Psychiatry (CAP) services is essential if these children are to have a mental health assessment, as recommended by the Royal College of Psychiatry and National Institute of Clinical Excellence. These services need to be urgently developed.