EmCASH: Emergency Care After Self-Harm (EmCASH): what works for young people, why, and in what circumstances?

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What is self-harm?

Self-harm is when someone causes any kind of harm to themselves, even if they do not want to die. People can self-harm in different ways, such as cutting, taking too many pills, not eating enough, or using drugs. It is more common among young people and can increase the chance of dying early, both from suicide and other causes.

Why is this project important?

More and more young people are going to hospital after self-harm. However, many times they do not need medical treatment, and going to hospital can sometimes be distressing for them. Young people often end up in the emergency department after calling NHS 111 or an ambulance because they do not know where else they can go, but emergency services might not give them the help they really need.

It is important to learn how young people who self-harm are using these emergency services. This will help us improve the way services are organised, so young people can get the right care in the right place at the right time. This could make a big difference to their health and wellbeing over time.

What are we going to do?

This study is part of a bigger project that uses something called “realist evaluation.” This method understands that the same treatment might not work for everyone, and it asks, “What works for whom, in what situations, and why?”

In this study, we will look at data over three years from NHS 111, ambulances, and emergency departments in Yorkshire and Humber. It will show us how young people (25 years and under) are using these services after they self-harm.

How will we do it?

We will use special statistical tests called “process mining” and “logistic regression.” These will help us see where people are getting stuck, where there are gaps in services, and what might cause someone to self-harm again and return to the emergency department. This will give us a clear picture of how emergency NHS services are working right now.

What happens next?

We will share our findings with healthcare professionals through research papers and presentations at conferences, and with policymakers through discussions and reports. We will also share our findings with the public, including young people and their families, through videos on social media and a study website. We will work with a group of young people to figure out other ways to reach the public.

9 January 2026

In progress

This study aims to provide insights that will lead to improvements in how NHS emergency services respond to self-harm among young people (25 years and under). The anticipated benefits include:

– Opportunities to optimise patient pathways. By identifying variants in patient pathways, waiting times and bottlenecks, policymakers can adapt services to improve the likelihood of young people accessing timely care following self-harm.

– Advocating for reduced pressure on NHS emergency services. By highlighting inefficiencies and delays in care, this study will advocate for improved availability of safe and appropriate alternatives to emergency healthcare services for young people who self-harm. This will help to reduce unnecessary ambulance and hospital visits and to improve resource allocation.

– Improving patient outcomes. By understanding which factors lead to different outcomes and increased repeat visits to emergency services, this study can support improved clinical decision-making on an individual basis.

– Policy and service improvements. Representatives from the West Yorkshire ICB and NHS England have expressed enthusiasm for this project and its scope to inform policy and service improvements. Findings will be shared with policymakers and decision-makers to inform updates to self-harm treatment guidelines and service delivery models.

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Yorkshire and Humber Secure Data Environment