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Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4351 (Published 18 October 2017) Cite this as: BMJ 2017;359:j4351

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Re: Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care

This was an interesting paper to read and the authors should be commended for their publication of this important yet concerning statistic. Whilst crucial to document the epidemiology of child and adolescent self harm, mental health service provision, and access to pharmacological agents, I believe it a mistake to not also consider the physical treatment these patients are requiring in the same cohort. I wondered if this data is available?

Plastic Surgeons in this country see a large volume of self harm injuries. It is disappointing that the physical management of the patient's injury is so often disjointed from management with any mental health services; it was further disappointing that so few patients in your cohort had been referred for specialist mental health support. I would be interested to see the degree of intervention from a surgical perspective these patients would have experienced and whether or not this intervention was associated with an increased risk of further repeated self harm. The decisions to treat self harm injuries would ideally be made in an MDT setting with both surgical/medical and mental health services.

Competing interests: No competing interests

17 April 2018
Liam A McMorrow
Plastic Surgery Registrar
Middlesbrough, UK