Sentinel surveillance for self-harm: Existing challenges and opportunities for the future

Suicide is a leading cause of preventable death worldwide. Self-harm behavior (which includes suicide attempt, nonsuicidal self-injury, and both suicidal and nonsuicidal self-poisoning) is significantly more common than suicide and is probably the greatest predictor of future suicide. For these reasons, improving the monitoring of both suicide and self-harm is a key recommendation from the World Health Organization. Surveillance systems (also known as monitoring or sentinel systems) for self-harm can play an important role in suicide prevention by providing important epidemiological data on rates of, and risk factors for, self-harm presentations. Additionally, these systems can have the benefit of providing the data necessary to identify emergent methods of self-harm in a timely manner, such that appropriate preventive measures can be implemented. Data from these surveillance systems may also facilitate the identification of clusters of self-harm at the population level. Despite their benefits, challenges exist with such systems. Developing a real-time, robust surveillance system for something as complex as self-harm is inevitably going to present issues for many countries. Notwithstanding these challenges, data from these four surveillance systems have had a number of positive impacts. However, these types of systems are still few and far between, and even the existing systems still experience challenges with regard to the provision of accurate real-time data. This system is in its infancy but will ultimately provide accurate information about rates of, and risk factors for, self-harm presentations to hospital, as well as allowing for the impact of clinical and policy change to be evaluated.