We read with interest the article on young people who self-harm (Reference Young, Van Beinum and SweetingYoung et al, 2007) but feel the outcome of factors considered would have been more viable if a further subgroup analysis was performed in those patients who repeatedly self-harm. A significant amount of our time is taken up by people who self-harm repeatedly. This subset of clients are often entrenched in their behaviour patterns and use services disproportionately. Existing studies have not adequately analysed factors responsible for repetition of self-harm and we feel that Young et al missed an excellent opportunity to investigate this, albeit in a younger age-group.

An analysis of our data from the Integrated Care Pathway (Reference Rajwal and GashRajwal & Gash, 2006) showed repetition rates of 40% for 2004, 42% for 2005 and 43% for 2006 of all our referrals each year. This means that 18% of our patients in 2004, 18.9% in 2005 and 19.2% in 2006 were responsible for the above statistics year on year. These data are from adults of working age and only include repetition in the same calendar year. About 13% of our referrals are under 21, and 18% of those are for repetitions of self-harm. Hence a small proportion of our clients are responsible for a large proportion of our work.

Our data support Young et al on the lack of a gender bias in the prevalence of self-harm. Females comprised 50.2% of our referrals in 2006 but only 49.0% of those repeating self-harm. The old myth of a higher proportion of females self-harming was not borne out by our statistics, although we considered the entire adult age-group.

We would be interested to know whether the results of Young et al would be different in the subgroup with repeated self-harm.