Appropriate interventions for the prevention and management of self-harm: a qualitative exploration of service-users' views.

Megan Hume,Stephen Platt

doi:10.1186/1471-2458-7-9

Megan Hume, Stephen Platt

Open Access

https://doi.org/10.1186/1471-2458-7-9

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Abstract

BackgroundThe engagement of service-users in exploring appropriate interventions for self-harm has been relatively neglected in comparison with clinical studies focusing on the management and prevention of self-harm. The purpose of this study was to investigate perceptions of interventions for self-harm (formal and informal, prevention and treatment) among people who have first-hand experience as a result of their own behaviour.MethodsSemi-structured interviews were undertaken with 14 patients admitted to hospital following a repeat act of self-harm. Data analysis was undertaken thematically, drawing broadly on some of the principles and techniques of grounded theoryResultsThe patients were a heterogeneous group with respect to their personal characteristics and the nature of their self-harm. Thirteen of the 14 patient accounts could be assigned to one or more of three overlapping experiential themes: the experience of psychiatric illness, the experience of alcohol dependency, and the experience of traumatic life events and chronic life problems. These themes were related to the nature of patients' self-harm and their experiences of, and attitudes towards, interventions for self-harm and their attitudes towards these. There was a clear preference for specialist community-based interventions, which focus on the provision of immediate aftercare and acknowledge that the management of self-harm may not necessarily involve its prevention. The findings generate the preliminary hypothesis that personal circumstances and life history are major influences on the choice of interventions for self-harm.ConclusionThis study attests to the importance of recognising differences within the self-harming population, and acknowledging patients' personal circumstances and life history. These may provide clues to the antecedents of their self-harm, and lead to more acceptable and appropriate treatments.

Highlights

The engagement of service-users in exploring appropriate interventions for selfharm has been relatively neglected in comparison with clinical studies focusing on the management and prevention of self-harm
Clinical guidelines for the management of self-harm [1] highlight the need for primary and secondary care services to provide a thorough assessment of mental health and social needs, precipitating factors and the risk of further self-harm or suicide among self-harming patients with whom they come into contact
The characteristics of the sample as a whole did not differ significantly from those of repetitive self-harmers reported in the literature [5]

Summary

Introduction

The engagement of service-users in exploring appropriate interventions for selfharm has been relatively neglected in comparison with clinical studies focusing on the management and prevention of self-harm. The purpose of this study was to investigate perceptions of interventions for self-harm (formal and informal, prevention and treatment) among people who have first-hand experience as a result of their own behaviour. With user-led evidence increasingly recognised in research and policy-making [3], it is to be expected that serviceuser perspectives of the treatments received following selfharm would have been thoroughly investigated. The current evidence base is heavily reliant on studies that have been carried out 'on' self-harm patients, with a focus on managing and preventing self-harm from a medical perspective. Providing a valuable insight into users' experiences, these testimonies are not part of the formal evidence base. The NICE guidelines [1] recommended that " [a] study using an appropriate and rigorously applied qualitative methodology should be undertaken to explore user experiences of services."

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