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79, p 0.001). There was a significant association between female gender and ingestion (X2 = 12.73, df = 1, p 0.05) and between male gender and ligature as a method of self-harm (X2 = 5.54, df = 1, p 0.05). Over half (53%) of children presented with suicidal thoughts and 22% presented with suicidal behaviours. The reported use of ligature as a method of self-harm emerged only from 2012 among cases studied. Children aged 12 years and under are presenting in increasing numbers with acute mental health difficulties, including