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Rates of adolescent visits to emergency departments for self-harm more than doubled since 2009


Emergency entrance CHEO.

Emergency entrance CHEO.

Wayne Cuddington / Postmedia

The number of teenagers who landed in Ontario's emergency departments because of self-harm has more than doubled between 2009 and 2017, raising questions about what is driving the troubling trend.

The research, led by Dr. William Gardner, a senior scientist at the CHEO Research Institute, was published in the Canadian Journal of Psychiatry on Tuesday.

The results surprised the researchers, Gardner said.

"What we found was that, yes, incidents of self-harm are increasing, as are emergency consultations with mental health problems. But I do not think any of the study team members expect such a dramatic increase from 2009 to 2017. "

Adolescents who intentionally injure themselves by cutting or poisoning risk being hurt repeatedly and committing suicide.

Although the data does not provide evidence on what lies behind the dramatic increase, its timing coincides with the introduction of the iPhone and the most common use of smartphones in society.

The first iPhones were sold in Canada from the summer of 2008, shortly before self-injury rates among teens began to jump. The use of smartphones has increased dramatically since then, especially among teenagers. Gardner said using smartphones could lead to increased self-mutilation in a number of ways.

"Involvement with social media can lead to increased rates of self-harm, at least for vulnerable adolescents. This can happen in a number of ways: by normalizing self-harm, by unleashing it, by having teenagers emulate colleagues who get hurt or by exposing young people to cyberbullying, "Gardner said. Social media can also benefit some troubled youth, he added, providing them with a way to escape social isolation and encouraging them to seek treatment.

The use of smartphones was not the only social change around 2009, although it may have been the most significant. The Bell Let's Talk campaign, launched in 2010, is part of a larger move to end the stigma surrounding mental illness. Gardner also said that the stress resulting from the 2008 financial crisis could have played a role in the increase.

The survey, based on numbers of emergency departments across the province between 2003 and 2017, puts concrete data on a trend that has been felt in hospitals and observed in communities in recent years.

The researchers found that the rates of youth emergency visits for self-mutilation decreased by 32 percent between 2003 and 2009, before increasing 135 percent between 2009 and 2017. Rates of mental health visits increased 78 percent between 2009 and 2017 for all young people . Rates of self-assault and mental health visits for women were higher and increased faster than for men.

Gardner, who is also a professor of epidemiology in Ottawa and senior chairman of research in child and adolescent psychiatry, said the findings raise concerns about treatment for adolescents presenting to emergency services with mental health problems.

"We have hundreds of kids looking for emergency departments in Ontario with these problems. The rate is rising every year. The rate is not decreasing. But the number of child psychiatrists at CHEO and child psychologists did not change during that period. The number of emergency department staff has not changed. This is really a problem.

The shortage of child and youth mental health workers across the province has been widely reported in recent years.

Researchers also note that although emergency departments are often the first contact that families have with the mental health system, they are not an ideal setting for the provision of mental health services for teens who have self-injured or are in crisis.

Community mental health monitoring following self-harm was associated with a reduced chance of repeating self-mutilation, Gardner said.

"Efforts should be made to increase the supply and access to evidence-based treatment for adolescents who self-harm or have mental health problems. Whenever possible, it is important to deliver these services to young people before they need to go to an emergency department. "

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