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Reducing self harm

The Centre for Suicide Research investigate how best to prevent suicide and self-harm.

Over one million people die by suicide every year. The World Health Organization (WHO) estimates that it is the 13th leading cause of death worldwide. Professor Keith Hawton and his team from the Department of Psychiatry’s Centre for Suicide Research investigate how best to prevent suicide and self-harm, particularly in high risk groups. Any changes in the prevalence of suicide and deliberate self-harm can have important clinical implications for both general medical and psychiatric services.

In a ground-breaking study published in 1997 Keith Hawton and his team monitored self-harm and suicide over an 11 year period.  They highlighted a massive increase in the use of paracetamol in self poisoning over this period, to the extent that by 1995 the drug was used in almost half of all overdoses.  The team’s research revealed that the use of paracetamol in suicide tended to be impulsive and reflected its availability, increasing in line with sales figures.  In addition, they observed that deaths due to paracetamol overdose were lower in France where pack sizes were smaller. As a result of this, the team recommended reducing the pack sizes of paracetamol in order to limit the availability of the drug for impulsive self-harm.

In 1996-97 the Medicines and Health Products Regulatory Agency (MHRA) conducted a review of all the available data on paracetamol self-poisoning.  Keith Hawton was asked to be a member of the panel and his team’s research was reported to have been pivotal to the outcome of the review.  As a result of the review the Committee on the Safety of Medicines introduced legislation to reduce the maximum pack size of paracetamol, sold over the counter, from 100 to 32 tablets; with a limit of one pack per sale.  Even tighter controls were applied to non-pharmacy outlets.

The team went on to investigate the effect of the new legislation. In the first year following the changes there was a significant reduction in not only in deaths from deliberate paracetamol overdose but also liver transplants due to paracetamol poisoning and deaths due to accidental overdose.   A large follow up study in 2013 confirmed that theses beneficial effects have continued year in year out and show no sign of diminishing.

It is estimated that since 2008 this work has resulted in 370 fewer deaths in the UK alone.  These findings have been acknowledged globally and a further three countries have introduced restrictions on paracetamol pack sizes: Denmark, the Netherlands and Australia.

Keith Hawton’s findings were adopted by the 2002 National Suicide Prevention Strategy and continue to be recognised in the 2012 revision.  Professor Louis Appelby Chair of the National Suicide Prevention Strategy has concluded “findings from Prof Hawton’s research have been and continue to be highly influential”