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Daytime night attire as a therapeutic intervention in an acute adult psychiatric in-patient unit
- Authors:
- LANGAN Camila, MCDONALD Colm
- Journal article citation:
- Psychiatric Bulletin, 32(6), June 2008, pp.221-224.
- Publisher:
- Royal College of Psychiatrists
Dressing in-patients in night attire during daytime is currently practised in many in-patient psychiatric units, despite the lack of evidence to support its benefit in reducing absconding or self-harm. Using a triangulation design, we investigated the prevalence of, attitudes towards and associations of this practice in an acute psychiatric in-patient setting in the Republic of Ireland. Case-note review revealed a high prevalence of this practice (57%) and its significant association with involuntary admission. Nursing staff believed that using night attire was effective at reducing absconding and self-harm, and that only voluntary patients should retain the right to choose their clothes. Most patients interviewed were uncomfortable in night clothes and indicated that they should be entitled to choose what to wear. Night attire is regularly used for risk-management, despite lack of evidence supporting its efficacy and negative attitudes towards it in many patients. This practice and the reasons for its implementation deserve medical documentation.
Self-harm among people with intellectual disabilities living in secure service provision: a qualitative exploration
- Authors:
- BROWN Jessica, BEAIL Nigel
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 22(6), November 2009, pp.503-513.
- Publisher:
- Wiley
This study explored the experiences and understanding of self-harm among people with intellectual disabilities living in secure accommodation. Interventions associated with this behaviour were also explored. Semi-structured interviews were carried out with nine people who self harm, had intellectual disabilities and had been placed in secure accommodation. Interpretative Phenomenological Analysis yielded three master themes. The first related to the interpersonal context of self-harm and included sub themes relating to past experiences of abuse and loss, and current issues of control and protection. The second master theme related to the emotional experience of self-harm, which varied throughout the process of self-harm and was characterized by anger, frustration, hopelessness, relief, guilt and regret. The third master theme related to the management of self-harm. Participants had experience of helpful individual and collaborative strategies, as well as interventions that were experienced as controlling, unhelpful or ridiculing. The emerging themes are considered in relation to the wider-self-harm literature and current psychotherapeutic models. A number of limitations to the study are noted and the use of this methodology with people with intellectual disabilities was discussed.
A study of the relationship between the patterns of planned activity and incidents of deliberate self-harm within a Regional Secure Unit
- Authors:
- GARNER Ruth, BULTER Graham, HUTCHINGS Deborah
- Journal article citation:
- British Journal of Occupational Therapy, 59(4), April 1996, pp.156-160.
- Publisher:
- Sage
Looks at the increase in the number of patients admitted to a Regional Secure Unit who deliberately do themselves harm. Whilst there is a perception among rehabilitation staff that activity has a role in reducing the incidence of deliberate self-harm, this study identifies no correlation between the patterns of structured activity and the patterns of deliberate self-harm. This does not suggest, however, that occupational therapy is ineffective with this client group, particularly given the potentially addictive nature of deliberate self-harm behaviour even after problem resolution. The study identifies areas for further research, focusing on qualitative rather than quantitative study.
Women who use secure services: applying the literature to women with learning disabilities
- Author:
- FISH Rebecca
- Journal article citation:
- Journal of Forensic Practice, 15(3), 2013, pp.192-205.
- Publisher:
- Emerald
Purpose: This paper aims to review research of relevance to women with learning disabilities, focusing in particular on literature which is applicable to women with learning disabilities who use forensic services. Design/methodology/approach: Research involving women with learning disabilities over the past 30 years was sought out and reviewed, and literature relating to women living in locked wards (including those without learning disabilities) was focused upon. Related themes such as the BPD diagnosis, self injury, and aggression are explored. Findings: The author found very little research relating to women with learning disabilities who use secure services, particularly which included quotes from the women themselves. Research limitations/implications: The author recommends that more research in this area is needed, primarily research which includes the voices of women service users themselves. Originality/value – This paper will be relevant to all staff who work with women in secure services. (Publisher abstract)
Self-harm and the positive risk taking approach. Can being able to think about the possibility of harm reduce the frequency of actual harm?
- Authors:
- BIRCH Sarah, et al
- Journal article citation:
- Journal of Mental Health, 20(3), 2011, pp.293-303.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Self-harm is a common problem in mental health care, and the UK has one of the highest rates in Europe. This is particularly true in psychiatric and prison services, and especially with women. This paper presents findings from an assessment of self-harming across three women's units in England over a period of 6 years. The units used a positive approach to self-harm where the risk that this behaviour presents is considered in an effort to reduce actual harm. Episodes of self-harm were collected from incident forms collected from 2004 to 2009. Results indicated a reduction of self-harm over the course of admission, and analyses revealed that there was a significant difference in the frequency of self-harm during the first and last 3 months of admission. The authors conclude with a discussion within a psychoanalytical framework, with reference to the value of positive risk-taking in a secure setting.
Managing self harm: psychological perspectives
- Editors:
- MOTZ Anna, (ed.)
- Publisher:
- Routledge
- Publication year:
- 2009
- Pagination:
- 232p.
- Place of publication:
- London
The book aims to help clinicians, people who self harm, and their families and carers understand its causes, meaning and treatment, with each chapter integrating theory with clinical illustration. Part one looks at the causes of self harm, arguing that its prime motivation is self preservation rather than destruction. Part two considers self harm in the wider context of society, suggesting that those who self harm are themselves victims of societal violence. It also discusses difficulties for staff and young people in foster and residential care. Part three devotes three chapters to examining the experience of women in secure settings from different angles, and one on the association between eating disorders and self harm. The conclusion pulls together the various strands of the arguments and perspectives.
Risk and responding to self injury: is harm minimisation a step too far?
- Author:
- SULLIVAN Patrick Joseph
- Journal article citation:
- Journal of Mental Health Training Education and Practice, 14(1), 2019, pp.1-11.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to consider some of the legal implications of adopting a harm minimisation approach in supporting people who self-injure within inpatient mental health units. It is argued that a focus on risk and the increasing influence of the law and legal styles of thinking often associated with the allocation of blame have produced a more risk adverse clinical environment. As a result health professionals are more likely to err on the side of caution rather than engage in practices that although potentially therapeutic are not without their risks. Design/methodology/approach: The analysis draws on the clinical, philosophical and legal literature to help understand how harm minimisation may support people who self-injure. It considers some of the complex medico-legal issues that arise in a clinical environment dominated by risk. Findings: A focus on risk and accountability has produced an environment where the law and legal styles of thinking have come to influence practice. This is often associated with blame in the minds of the health professional. Given the legal obligation to prevent suicide, health professionals may take a conservative approach when working with people who self-injure. This makes the adoption of harm minimisation difficult. Originality/value: This paper provides a legally informed analysis of some of the challenges associated with using harm minimisation techniques with people who self-injure. It adds to the literature regarding this area of clinical practice. (Edited publisher abstract)
The PARALLEL Study (imPAct of expeRiencing Another’s seLf harm and suicidaL bEhaviour in hospitaL)
- Authors:
- HARGATE Rebecca, et al
- Journal article citation:
- Journal of Forensic Practice, 19(4), 2017, pp.258-268.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore the experiences of both staff and patients in a medium-secure mental health unit of the self-harm and/or suicidal behaviour of others. Suicide and self-harm is highly prevalent in forensic settings and evidence suggests that experiencing other people’s self-harm and suicidal behaviour can lead to negative outcomes, both for staff and patients. This is particularly important in hospitals where patients are highly dependent on staff for support. Design/methodology/approach: Semi-structured interviews were conducted with five staff members and six patients in a medium-secure male mental health unit in the North of England. Data were analysed following interpretative phenomenological analysis guidelines. Findings: Three dominant themes were identified during analysis: the impact of suicide and self-harm; the role of others; and the importance of understanding and experience. Various impacts were discussed including desensitization, negative emotions and the desire to help. Other people played an important role in protecting against negative impacts, with shared experiences and peer support reported as the biggest benefits. Experiences of self-harm and suicide were found to increase understanding resulting in more positive attitudes. Additionally, the importance of training and education was highlighted. Originality/value: This paper provides an insight into the experiences of staff and patients in medium-secure male mental health unit, which has benefits to practitioners when considering support mechanisms. (Publisher abstract)
One hundred girls in care referred to an adolescent forensic mental health service
- Authors:
- JASPER Anne, SMITH Carly, BAILEY Susan
- Journal article citation:
- Journal of Adolescence, 21(5), October 1998, pp.555-568.
- Publisher:
- Academic Press
Presents the results of a retrospective study of 100 consecutive referrals of girls aged 11-17 in care to an Adolescent Forensic Mental Health Service. Sixty-eight girls had assaulted at least one person; a further 10 had caused damage to objects; 76 had deliberately harmed themselves; 90 had behaved in a way which was against the law in the 6 months prior to assessment, although only 42 had been charged with an offence. Outlines the findings and discusses areas for future research.