Skip to main content
×
×
Home

Harm minimisation after repeated self-harm: development of a trust handbook

  • Nicky Pengelly (a1), Barry Ford (a2), Paul Blenkiron (a3) and Steve Reilly (a2)
Extract

Repeated self-harm without suicidal intent occurs in approximately 2% of adults (Meltzer et al, 2002). Service users report that professionals can respond to self-harm with unhelpful attitudes and ineffective care. Although evidence for effective treatments is poor (Hawton et al, 1999), this therapeutic pessimism is not found in the self-help approaches promoted by voluntary organisations such as Mind: ‘If you feel the need to self-harm, focus on staying within safe limits' (Harrison & Sharman, 2005). User websites frequently offer advice on harm minimisation: ‘Support the person in beginning to take steps to keep herself safe and to reduce her self-injury – if she wishes to. Examples of very valuable steps might be: taking fewer risks (e.g. washing implements used to cut, avoiding drinking if she thinks she is likely to self-injure)’ (Bristol Crisis Service for Women, 1997).

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Harm minimisation after repeated self-harm: development of a trust handbook
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Harm minimisation after repeated self-harm: development of a trust handbook
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Harm minimisation after repeated self-harm: development of a trust handbook
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
Hide All
Beck, A.T. (1976) Cognitive Therapy and the Emotional Disorders. International Universities Press.
Blenkiron, P. & Milnes, D. (2003) Do we manage deliberate self harm appropriately? Characteristics of general hospital patients who are offered psychiatric aftercare. International Journal of Psychiatry in Clinical Practice, 7, 2732.
Bristol Crisis Service for Women (1997) Helpful responses to self-injury. Bristol Crisis Services for Women. http://www.users.zetnet.co.uk/locsw/pdfleafs/Helpful%20responses.pdf.
British Medical Association (2002) The role and responsibilities of doctors in doping in sport. In: Drugs in Sport: the Pressure to Perform. BMJ Books.
Fagin, L. (2006) Repeated self-injury: perspectives from general psychiatry. Advances in Psychiatric Treatment, 12, 193201.
Ferreira de Castro, E., Cunha, M. & Pimenta, F. (1998) Parasuicide and mental disorders. Acta Psychiatrica Scandinavica, 97, 2531.
Harrison, D. & Sharman, J. (2005) Understanding Self-harm. Mind Publications. http://www.mind.org.uk/Information/Booklets/Understanding/Understanding+self-harm.htm.
Hawton, K., Townsend, E., Arensman, E., et al (1999) Psychosocial and pharmacological treatments for deliberate self harm. Cochrane Database of Systematic Reviews, Issue 4.
Meltzer, H., Lader, D. & Corbin, T. (2002). Non-fatal suicidal behaviour among adults aged 16 to 74. TSO (The Stationery Office).
National Institute for Health and Clinical Excellence (2004) Self-Harm: the Short-term Physical and Psychological Management and Secondary Prevention of Self-harm in Primary and Secondary Care. Clinical Guideline 16. NICE.
National Treatment Agency for Substance Misuse (2003) Injectable Heroin (and Injectable Methadone): Potential Roles in Drug Treatment. NTA.
Pengelly, N. & Ford, B. (2005) Alternatives to Self Harm: Service User Handbook and Guidelines. Selby and York Primary Care Trust.
Royal College of Psychiatrists (2004) Assessment Following Self-harm in Adults (Council Report CR122). Royal College of Psychiatrists.
Bolam v. Friern Hospital Management Committee [1957] 1WLR 583, 587. Gillick v. West Norfolk and Wisbech Area Health Authority [1985] 3 AllER 423.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 1
Total number of PDF views: 86 *
Loading metrics...

Abstract views

Total abstract views: 159 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 21st July 2018. This data will be updated every 24 hours.

Harm minimisation after repeated self-harm: development of a trust handbook

  • Nicky Pengelly (a1), Barry Ford (a2), Paul Blenkiron (a3) and Steve Reilly (a2)
Submit a response

eLetters

The struggle between a human and a professional!

Vishweshwari Bhadravathi, Specialist Registrar in Child and Adolescent Psychiatry
28 February 2008

I was impressed with the brave step that the authors of the article 'Harm minimisation after repeated self-harm: development of a trust handbook: Psychiatric Bulletin (2008):32:60-63, have taken, despite the opposing and challenging views presented to them. It is known that the majority of people who self-harm repeatedly demonstrate an impulsive element in them and as unfortunate as it is, many completed suicides following recurrent acts of self-harm result from an underestimation of lethality of what was intended to be a non-fatal self injury.

I can't agree more with the view that " Unconscious determinants of self-injuring behaviour might not respond in predictable ways to simple advice on alternatives to self-harm and damage limitation": however, clinical practice is often juggling between risk elimination and risk reduction and interventions are often symptom targeted rather than diagnosis targeted.

When harm minimisation can be advocated as a reasonable intervention in intra venous drug abusing, by supporting needle-exchange programmes, for general public, it would seem prudent that this can be employed for people who self-harm.

Current clinical practice is highly driven by legal principles and it would appear that growing pressures on clinicians to be ‘Right’ limits their willingness to research what they might genuinely believe would help the client. One might have the clinical experience of an intervention being effective but lacks the paper-based evidence and unfortunately, the latter wins the battle against the former. It is vital to remind ourselves that hypotheses do not become guidelines until someone has the conviction to examine them, in a clinically safe way.

I am of the opinion that a parent’s view, if included in the article,along with patients and professionals, would have provided a different outlook. If their son or daughter who is refusing to or struggling to refrain from self-harming completely, a parent might prefer them to use cleaner blades rather than be in septicaemic shock.

Although we are in a professionally accountable role as clinicians, if we find the courage and willingness to ask some of these questions to the human in us, we might find an answer that no Randomised Controlled Trial would provide and that might just be what matters to our patients.
... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *