# Self-harm in children involved in private and public family justice court proceedings: longitudinal national data linkage study

## TL;DR

Children involved in family court cases, especially private ones, are at higher risk of self-harm compared to those not involved in court proceedings.

## Contribution

This study is the first to use national linked data to show elevated self-harm risk in children in private family justice proceedings.

## Key findings

- Children in private and public court cases had significantly higher self-harm rates than non-court-involved children.
- The risk of self-harm was higher in less deprived areas and among children with no prior self-harm history.
- Contact with the family justice system could be an opportunity to provide preventative mental health support.

## Abstract

Little is known about self-harm in children involved in family justice proceedings, particularly in private family courts in England and Wales.

To examine records of self-harm in children involved in private and public law proceedings using population-level linked data.

A retrospective e-cohort study of children aged under 18 years, using linked health and family justice (Cafcass Cymru) data (2011–2018). Family court involvement was recorded from age 0 to 17 years. Incidence of self-harm was recorded from age 10 to 17 years to fit with the standard definition of self-harm. Annual incidence of self-harm over time across general practitioner (GP), emergency department and hospital admissions for individual children in private and public law proceedings were compared with a non-court cohort using Poisson regression. Self-harm following court proceedings was compared with an age- and gender-matched non-court cohort using Cox regression.

Adjusted self-harm rates were higher in court-involved children than the non-court cohort (incident rate ratios (IRRs) (95% CI), private: GP 1.8 (1.6–2.1); emergency department 1.4 (1.2–1.7); admissions 1.8 (1.5–2.1); public: GP 4.6 (4.1–5.3); emergency department 5.0 (4.3–5.8); admissions 5.0 (4.3–5.8)). Compared with matched comparison children, risk of self-harm was higher following private (adjusted hazard ratios 2.0 (1.7–2.2)) and public court proceedings (hazard ratio 2.3 (2.7–3.8)). Hazard ratios were greater for those from less deprived areas and those with no history of self-harm.

The elevated risk of self-harm in children involved in public law proceedings is well recognised. Our study highlights risk in children in private family justice proceedings. Elevated risk among those from less deprived areas and those with no history of self-harm may reflect circumstances associated with family justice involvement, resulting in rates comparable to children with other pre-existing vulnerabilities. Contact with family justice is an opportunity to offer preventative support.