Understanding the true economic impact of self-harming behaviour – authors' reply

Irina Kinchin and colleagues argue that the hospital costs of self-harm represent a small proportion of the overall economic impact of self-harming behaviour—we agree. Long-standing scientific literature indicates that most of the costs of self-harm and suicide lie outside of the health-care system. In fact, in our paper we refer to a review on these costs that includes previous work from one of Kinchin's co-authors, which was one of the few studies identified that included a detailed estimate of productivity losses associated with non-fatal self-harm.