{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:26:55Z","timestamp":1785432415801,"version":"3.56.0"},"reference-count":33,"publisher":"Royal College of Psychiatrists","issue":"4","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["BJPsych open"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec id=\"S205647242612033X_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Many people presenting to emergency departments after self-harm do not receive adequate care, even in well-resourced health systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S205647242612033X_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To identify patterns of health care service use across two periods: (a) during and (b) up to 1 year after an index emergency department self-harm presentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S205647242612033X_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>A retrospective population-based cohort study including 4668 individuals aged \u22659 years who presented to the Royal Melbourne Hospital emergency department for self-harm between January 2012 and December 2019. Linked administrative data captured &gt;1.3 million records across primary care, pharmacy, specialist mental and physical health services and emergency departments. Sequential pattern mining identified longitudinal service-use clusters. Multinomial regression explored associations with demographic, clinical, psychosocial and presentation characteristics. Cox proportional hazards models assessed associations between clusters and all-cause and suicide mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S205647242612033X_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Emergency department self-harm presentations triggered short-term increases in multi-sector contacts. However, most (68.7%) reverted to the same service-use cluster observed prior to their index presentation. Suicide risk was highest within 1 year, particularly among those in the specialist mental health services cluster (4.5% of the cohort).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S205647242612033X_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A small subgroup engage intensively with specialist mental health services yet remain at high suicide risk, while one in ten remain disengaged altogether, suggesting that an acute presentation of self-harm often fails to alter patients\u2019 care trajectories long-term. Policy alignment with national recommendations for integrated, community-based care could improve sustained, evidence-based support beyond acute crises.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjo.2026.12033","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T06:20:35Z","timestamp":1783664435000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Patterns in health service use during and up to 1 year after an acute episode of hospital-presenting self-harm: data linkage cohort study of over 1.3 million records"],"prefix":"10.1192","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1489-4573","authenticated-orcid":false,"given":"Katrina","family":"Witt","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01ej9dk98","id-type":"ROR","asserted-by":"publisher"}],"name":"The University of Melbourne"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Z. Q.","family":"Gan","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01ej9dk98","id-type":"ROR","asserted-by":"publisher"}],"name":"The University of Melbourne"},{"name":"Orygen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0987-2759","authenticated-orcid":false,"given":"Caroline X.","family":"Gao","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01ej9dk98","id-type":"ROR","asserted-by":"publisher"}],"name":"The University of Melbourne"},{"name":"Orygen"},{"name":"Monash University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Knott","sequence":"additional","affiliation":[{"name":"The University of Melbourne"},{"name":"Royal Melbourne Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3475-0558","authenticated-orcid":false,"given":"Annette","family":"Erlangsen","sequence":"additional","affiliation":[{"name":"Mental Health Center Copenhagen"},{"name":"Mental Health Center Copenhagen"},{"name":"The Australian National University"},{"name":"Johns Hopkins Bloomberg School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trine","family":"Madsen","sequence":"additional","affiliation":[{"name":"Mental Health Center Copenhagen"},{"name":"Mental Health Center Copenhagen"},{"name":"University of Copenhagen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9822-048X","authenticated-orcid":false,"given":"Lianne","family":"Schmaal","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01ej9dk98","id-type":"ROR","asserted-by":"publisher"}],"name":"The University of Melbourne"},{"name":"Orygen"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"S205647242612033X_ref17","doi-asserted-by":"publisher","DOI":"10.1080\/10550887.2020.1736757"},{"key":"S205647242612033X_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2022.114810"},{"key":"S205647242612033X_ref15","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(19)30402-X"},{"key":"S205647242612033X_ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmqr.2023.100249"},{"key":"S205647242612033X_ref33","doi-asserted-by":"publisher","DOI":"10.3961\/jpmph.24.448"},{"key":"S205647242612033X_ref5","first-page":"CD013668","article-title":"Psychosocial interventions for self-harm in adults","volume":"4","author":"Witt","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"S205647242612033X_ref14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0129062"},{"key":"S205647242612033X_ref11","first-page":"102165","article-title":"Five healthcare trajectories in the year before suicide and what they tell us about opportunities for prevention: a population-level case series study","volume":"63","author":"Chitty","year":"2023","journal-title":"eClin Med"},{"key":"S205647242612033X_ref21","volume-title":"Australia\u2019s Health 2018","year":"2018"},{"key":"S205647242612033X_ref2","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v67n1016"},{"key":"S205647242612033X_ref22","volume-title":"Mental Health and Suicide Prevention Stocktake, April 2021","year":"2021"},{"key":"S205647242612033X_ref24","volume-title":"Self-Harm: Assessment, Management, and Preventing Recurrence Guideline (NG225)","year":"2021"},{"key":"S205647242612033X_ref26","doi-asserted-by":"publisher","DOI":"10.1136\/bmjph-2023-000559"},{"key":"S205647242612033X_ref27","doi-asserted-by":"publisher","DOI":"10.1016\/j.hjdsi.2017.09.001"},{"key":"S205647242612033X_ref30","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocab261"},{"key":"S205647242612033X_ref8","volume-title":"2019\/20 Annnual Report: Advancing Health for Everyone, Every Day","year":"2020"},{"key":"S205647242612033X_ref9","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17249385"},{"key":"S205647242612033X_ref19","volume-title":"New Horizons: The Review of Alcohol and Other Drug Treatment Services in Australia","author":"Ritter","year":"2014"},{"key":"S205647242612033X_ref32","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2019-317248"},{"key":"S205647242612033X_ref3","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2010.102616"},{"key":"S205647242612033X_ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2021.108885"},{"key":"S205647242612033X_ref6","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2023.625"},{"key":"S205647242612033X_ref20","volume-title":"Mental Health and Suicide Prevention Agreement Review. 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Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e180"}}