CARE: A framework for responding therapeutically to the client who self-harms

Repeated self-injury: perspectives from general psychiatry

Patients who repeatedly injure themselves present particular management problems for general psychiatric teams. This article, the first of a series of four, examines the characteristics of those that present to adult mental health services, and the possible underlying background and trigger factors that lead to these anxiety-raising events. Suggestions are made on preventive and assessment procedures, staff reactions and management strategies aimed at helping patients deal with the overwhelming feelings that underlie self-injury.

The healing journey: help seeking for self-injury among a community population

Help seeking is known to be a complex and difficult journey for people who self-injure. In this article, we explore the process of help seeking from the perspective of a group of people living in Northern Ireland with a history of self-injury. We conducted 10 semistructured interviews and employed a grounded theory approach to data analysis. We created two major categories from the interview transcript data: (a) "involution of feeling," which depicts participants' perspectives on barriers to help seeking; and (b) "to be treated like a person," in which participants communicate their experiences of help seeking. The findings pose important implications for policy, practice, theory, and future research, including the need to increase the uptake of follow-up care among people who arrive at hospitals as a result of self-injury, self-harm, or suicidal behaviors.

Motives for self-harm: views of nurses in a secure unit

BACKGROUND

Self-harm is a widespread behaviour among people with mental health problems. Although guidance on how to manage self-harm is offered, it is still a behaviour that is misunderstood by many nurses. Such misunderstanding is generally attributed to the perceived motives for self-harm and lack of specialized education to manage the behaviour. As a consequence, the care provided is usually inadequate and inappropriate. Yet, research concerning nurses' reasons of users' self-harming behaviours is limited.

AIM

This paper reports on a study that explores nurses' explanations of the motives for self-harm in a secure adolescent unit in England.

METHODS

The study utilized a phenomenological methodology with semi-structured individual interviews (n = 25). The data were analysed thematically using interpretative phenomenological analysis.

RESULTS

The findings indicate that the behaviour of self-harm has multiple motives. Examples of these include affect regulation, coping with distress, averting death, regaining control and attention seeking.

DISCUSSION

Self-harm is a complex behaviour commonly experienced in secure environments. Nurses assume that users who self-harm are motivated by a desire to seek attention and manipulate others. Users may find these beliefs humiliating. Such feelings may increase users' risks for further self-harm. Most adolescents who self-harm experience unbearable emotions because of their past sexual abusive encounters. They self-harm to regulate these emotions. These affect regulatory functions may act as reinforcers of self-harming behaviours.

CONCLUSIONS

Improved understanding of self-harm and its motives may result in improved nurse-user relationships and thus safer and more effective care provision.

We are all in this together: working towards a holistic understanding of self-harm

Self-harm is a widespread and controversial issue in contemporary society. Statistics are based on reported incidents and therefore do not accurately reveal prevalence, as self-harm is often a hidden behaviour. This highlights the essential need for practitioners and society to work towards reducing the stigma surrounding self-harm. This paper goes some way towards understanding the impact of self-harm on individuals and communities. It begins by exploring terminologies and definitions of self-harm and discusses the importance of sensitivity in language use relating to self-harm. It continues by examining types of self-harm and subsequently presents life experiences that may contribute to the onset of self-harm. The paper elucidates the cultural, historical and religious origins of self-harm, indicating the ways in which self-harm has evolved with us as part of our humanity. Moreover, literature relating to the significance of stigma and attitudes is examined, followed by issues around psychiatric diagnoses pertaining to self-harm. The paper concludes by synthesizing literature relevant to the relationship between self-harm and suicide.

Can supervising self-harm be part of ethical nursing practice?

It was reported in 2006 that a regime of 'supervised self harm' had been implemented at St George's Hospital, Stafford. This involves patients with a history of self-harming behaviour being offered both emotional and practical support to enable them to do so. This support can extend to the provision of knives or razors to enable them to self-harm while they are being supervised by a nurse. This article discusses, and evaluates from an ethical perspective, three competing responses to self-harming behaviours: to prevent it; to allow it; and to make provision for supervised self-harm. It is argued that of these three options the prevention strategy is the least plausible. A tentative conclusion is offered in support of supervised self-harm.