A study of service providers' understanding of self-harm (original) (raw)
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Caring for self-harming patients in general practice
Journal of Primary Health Care
INTRODUCTION Intentional self-harm is an international public health issue with high personal, social and financial costs to society. Poor relationship dynamics are known to have a negative influence on the psyche of people who self-harm, and this can increase anxiety and decrease self-esteem, both shown to be significant contributors to self-harm behaviours. Positive and functional social supports have been proposed as a cost-effective and constructive approach in diminishing self-harming behaviours. AIM This qualitative study investigated the aspects of professional, social, familial and romantic relationships that people who have self-harmed identified as having a positive and constructive effect on their self-harm behaviour. METHODS Twelve participants with a history of self-harming behaviours were recruited through free press advertising in primary care and interviewed. The participants ranged in age from 19 to 70 years, and represented New Zealand (NZ) European and Māori from ...
BMC Psychiatry, 2014
Differing perspectives of self-harm may result in a struggle between patients and treatment staff. As a consequence, both sides have difficulty communicating effectively about the underlying problems and feelings surrounding self-harm. Between 2009 and 2011, a programme was developed and implemented to train mental health care staff (nurses, social workers, psychologists, psychiatrists, and occupational therapists) in how to communicate effectively with and care for patients who self-harm. An art exhibition focusing on self-harm supported the programme. Lay experts in self-harm, i.e. people who currently harm themselves, or who have harmed themselves in the past and have the skills to disseminate their knowledge and experience, played an important role throughout the programme. Methods: Paired sample t-tests were conducted to measure the effects of the training programme using the Attitude Towards Deliberate Self-Harm Questionnaire, the Self-Perceived Efficacy in Dealing with Self-Harm Questionnaire, and the Patient Contact Questionnaire. Effect sizes were calculated using r. Participants evaluated the training programme with the help of a survey. The questionnaires used in the survey were analysed descriptively.
Working with self-harm: accounts of two staff groups
Journal of Learning Disabilities and Offending Behaviour, 2011
This study explores the content analysis of two qualitative studies. Both groups of staff interviewed in this study worked with people with learning disabilities who selfharm. The sample was taken from nurses from both medium security and low security.
Patients with deliberate self-harm seen by a consultation-liaison service
OBJECTIVE: To examine Australian trends in deliberate self-harm in order to explore aetiological factors and improve clinical practice. METHOD: A database recording 5 years of activity of a consultation-liaison service from a large tertiary referral hospital in Sydney was analysed to discover trends in types of self-harm, sex, age, marital status, repetition rates, diagnoses and follow up. RESULTS: 1295 patients with deliberate self-harm were referred to the Service over the 5 years. Of these patients, women exceeded men (ratio of 1.48:1). Self-poisoning constituted 79.5% of the referrals. Rates of self-harm referrals increased from 1999 to 2001, but appeared to plateau in 2002 and 2003. Eighty-eight per cent of referrals were first presentations of self-harm. Most referrals received the diagnosis of adjustment disorder with depressed mood, but a significant proportion was diagnosed with major depressive disorder and schizophrenia, particularly in those that violently self-harmed. There was a significant decline in the rate of admission to hospital over the study period. CONCLUSIONS: While patient characteristics did not change significantly, there was a decline in admission rates to hospital. Many patients had serious mental illnesses, highlighting the importance of a thorough psychiatric assessment of people who self-harm.
Archives of Suicide Research, 2017
Background Self-harm is an increasing phenomenon among young people, with potentially fatal outcomes. Patient's perceptions of treatment and support are poorly documented. 2 Aim The aim was to synthesise the experiences of those who self-harm, with special reference to professional care and support by family, friends and the school system. Method A systematic review of the literature was conducted. Results Following retrieval of 1,623 abstracts, 14 studies were included in the final analysis, 11 of which are reported here. Two quantitative studies as well as one mixed method study on self-care could not be reported on here due to word limitations. Adult people who self-harm described the importance of quality in the caring relationship and a tailored care designed for each individual. There is a need for more studies into adolescents who self-harm but of importance is the adolescents need for support from the adult world. Conclusions A positive relationship between patient and healthcare professional can be crucial in motivating continued treatment of people who self-harm. A major priority is radical improvement in the attitudes of healthcare personnel.
A national survey of the hospital services for the management of adult deliberate self-harm
Psychiatric Bulletin, 2001
Aims and Method Services were compared for the management of deliberate self-harm with existing national guidance. A postal survey was sent to all clinical directors of adult psychiatry at all NHS trusts assessing adult patients admitted to general hospital following deliberate self-harm in England. Results Responses were received from 129 (65%) trusts.Thirty per cent of trusts do not use secondary psychiatric services for psycho-social assessment following deliberate self-harm; 52% have designated self-harm liaison staff and 69% of general hospitals have a ward to which most cases of deliberate selfharm are admitted. However, only 18% have staff with psychiatric experience. In 82% of trusts training is provided for junior psychiatrists at induction but in only 56% are observed-assessments undertaken. Forty-two per cent of the trusts have a deliberate self-harm services planning group. Clinical Implications Standards for deliberate self-harm services fall substantially below existin...
Services for assessment, aftercare, and psychological treatment following self-harm
Psychiatry, 2009
effective intervention following self-harm is vital because of the strong link between self-harm and suicide. Unfortunately, services for people who self-harm have been poor in the UK and elsewhere. in 2004, the national institute for Health and clinical excellence issued a guideline setting out clear standards for care following self-harm, many of which are included in this article. Whether this guideline has led to much needed improvements in care is not clear; there are few published experiences concerning implementation of the guidance but some studies suggest that care continues to be unsatisfactory. the barriers to implementation of self-harm guidelines are not clear, but the lack of definitive research evidence for effective treatments is a potential candidate. several systematic reviews have failed to demonstrate a statistically significant reduction in fatal or non-fatal repetition following intervention after self-harm. recent studies have, however, shown clear benefits for some psychological therapies -in particular for cognitive behavioural therapy with a problem-solving element. Promising results have also been demonstrated for some brief interventions designed to encourage uptake of aftercare following self-harm. this article sets out a little of the evidence for these potentially beneficial interventions, including recent developments in research evidence and implications for future research.
A study of individuals with intentional self-harm referred to psychiatry in a tertiary care center
Industrial psychiatry journal
Intentional self- harm (ISH) is one of the commonest yet neglected entities of Consultation liaison Psychiatry. More researches in the field of ISH are needed to effectively manage this problem. To study the socio-demographic and clinical profile of subjects of ISH referred to Psychiatry in a tertiary care hospital. All subjects of ISH referred to department of Psychiatry, of a tertiary centre, on specified days were recruited in to the study after obtaining an informed consent. Socio-demographic details, details of psychiatric assessment were documented using a semi structured proforma. Appropriate management was done. Forty one subjects were included in the study. About two third of them belonged to the age group of 18 to 35 years. 56% of them were males, and 71% were married. House wives and students formed a significant proportion of sample. Most common method of ISH was self-poisoning. About two third of the patients had no diagnosable psychiatric illness. Interpersonal conflic...
Staff knowledge and attitudes towards deliberate self-harm in adolescents
Journal of adolescence, 2003
This study investigates knowledge, attitudes and training needs concerning deliberate self-harm (DSH) in adolescents, amongst a variety of professionals involved in the assessment and management of adolescence who self-harm. A questionnaire survey was completed by 126 health professionals working with adolescents who harm themselves. The main outcome measures were a knowledge measure and three attitude measures (generated using factor analysis). The mean percentage of correctly answered knowledge questions, across all professional groups, was 60%. With regard to knowledge, over three-quarters of participants were unaware that homosexual young men and those who had been sexually abused are at greater risk of DSH, whilst one third of staff were unaware that adolescents who self-harm are at increased risk of suicide. Staff who felt more effective felt less negative towards this group of patients (B=-0.21, p=0.03). Forty-two per cent of the participants wanted further training in DSH am...
General Practitioners’ Accounts of Patients Who Have Self-Harmed A Qualitative, Observational Study
Background: The relationship between self-harm and suicide is contested. Self-harm is simultaneously understood to be largely nonsuicidal but to increase risk of future suicide. Little is known about how self-harm is conceptualized by general practitioners (GPs) and particularly how they assess the suicide risk of patients who have self-harmed. Aims: The study aimed to explore how GPs respond to patients who had self-harmed. In this paper we analyze GPs’ accounts of the relationship between self-harm, suicide, and suicide risk assessment. Method: Thirty semi-structured interviews were held with GPs working in different areas of Scotland. Verbatim transcripts were analyzed thematically. Results: GPs provided diverse accounts of the relationship between self-harm and suicide. Some maintained that self-harm and suicide were distinct and that risk assessment was a matter of asking the right questions. Others suggested a complex inter-relationship between self-harm and suicide; for these GPs, assessment was seen as more subjective. In part, these differences appeared to reflect the socioeconomic contexts in which the GPs worked. Conclusion: There are different conceptualizations of the relationship between self-harm, suicide, and the assessment of suicide risk among GPs. These need to be taken into account when planning training and service development.