Despite this large burden, very little is known about the cost

They used more service provided accommodation, special education, and hospital services, incurred greater criminal justice costs, and received more social security benefits.Despite this large burden, very little is known about the cost effectiveness of interventions.22 In one of the few studies to date, Byford and colleagues23 undertook a cost effectiveness analysis of a home based social work intervention for children and adolescents who deliberately poisoned themselves. They found no significant differences between the two groups in terms of the main outcome measures or costs, although in a subgroup of children without major depression, suicidal ideation was significantly lower in the intervention group at follow up with no significant differences in cost.The design and delivery of effective treatments for this group are complex and have to accommodate considerable variations in presentation.1 A subgroup of patients needs emergency inpatient management; the majority require long term treatment approaches in the context of multi agency partnerships. A Cochrane review of psychosocial and pharmacological treatments for self harm24 found continuing uncertainty about which forms of treatment are most effective and insufficient evidence against which to make firm recommendations.

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