Self-harm is a public health priority. It usually occurs in the context of psychological distress and is frequently directly associated with suicidal intent, psychosocial stressors and for many, mental ill-health. Hospital-treated self-harm accounts for over 30,000 hospital admissions each year and is the strongest independent risk factor for later suicide.

Routine care for hospital-treated self-harm is variable and can be substandard. Many people report that they experienced stigmatising, judgemental and invalidating responses when presenting to health services for help after self-harm or when in suicidal crisis. Furthermore, care is not meeting many patients’ needs and linkage to mental health services after discharge is not routine. Despite this, there is no data infrastructure to support hospitals to address these issues. Instead, monitoring and service improvement relies on one-off or localised investigations.

Three key issues make hospital-treated self-harm surveillance data unfit for the purpose of service improvement. These include:

• Current surveillance mechanisms undercount the number of cases; resulting in service planning and modelling based on inaccurate snapshots of demand.
• Hospital-treated self-harm presentation data is not linked to outcome data; making it difficult for services to evaluate the impact of service delivery on key outcomes.
• Service improvement relies on local leaders’ interest and capacity to translate and use available data rather than standards or quality indicators that all can work towards.

Establishing a clinical quality registry for hospital-treated self-harm is a recognised mechanism that links data to improved care. Building collaborative capacity to transform existing units with emerging self-harm clinical registry capability into a network of sentinel units would enhance existing self-harm surveillance and be a concrete step in building sector capability for a hospital-treated self-harm clinical quality registry.