Abstract
Dear Editor,
We read with interest the recent national registry study by Daly et al., 1 which highlights the substantial risk of repeat self-poisoning following hospital attendance for intentional overdose. Their findings emphasise the chronic and relapsing nature of self-harm behaviour, particularly among younger individuals, and reflect challenges we are increasingly encountering in critical care.
In our unit, we have recently seen a rise in admissions related to decompensated mental health crises. Most worryingly, 1 patient required 11 ICU admissions over several months following recurrent ingestion of ethylene glycol (antifreeze), each episode occurring under Mental Health Act detention with ongoing psychiatric involvement. While isolated episodes of severe poisoning are familiar to critical care teams, recurrent high-acuity presentations of this severity raise distinct clinical, ethical, and operational pressures. Although Denatonium Benzoate (Bitrex) can act as a taste deterrent, there is currently no UK legislative requirement for its inclusion in antifreeze products, limiting its preventative effect.
The resource implications are considerable. These admissions require mechanical ventilation, vasopressor support, and intermittent renal replacement therapy, in addition to repeated antidote administration, advanced sedation strategies, and continuous one-to-one supervision. Previous work demonstrates that individuals who self-poison are at high risk of repetition, morbidity, and mortality.1,2 Nationally, hospital admissions related to self-harm remain elevated up to 2023–2024 (NHS England), and ICNARC critical care audit data indicate a rise in ICU admissions for self-harm and drug overdose in the UK during the post-pandemic period.3,4 The growing burden of acute psychiatric crises and self-harm presentations has been described as a “second pandemic,” with clear implications for capacity and service sustainability.
There is also a substantial psychological toll. Providing compassionate care in the context of recurrent self-harm can lead to moral distress and compassion fatigue among staff. 5 Regular debriefing, psychologically informed supervision, and reliable access to staff wellbeing services may help mitigate this burden, although provision remains inconsistent across organisations.
Structured and proactive collaboration between critical care, liaison psychiatry, and community mental health services is urgently needed. The NCEPOD Treat As One report highlighted persistent fragmentation between physical and mental healthcare. 6 Developing reliable, shared pathways for patients who present with recurrent high-risk self-poisoning may reduce further harm, improve continuity of care, and help safeguard staff wellbeing. A national framework or shared learning from centres with established protocols would be valuable in guiding consistent practice.
We would welcome correspondence from colleagues to understand whether similar patterns are being observed elsewhere and to identify effective, scalable models of integrated management.
