Abstract
Although UK clinical guidelines make tentative recommendations for “harm minimization” strategies for repeated self-harm, this is in the absence of empirical evidence supporting their acceptability or effectiveness. We explore young people’s views of harm minimization strategies (e.g., snapping elastic bands on skin, drawing on skin with red ink), as a proxy for self-harm. In this mixed methods study we examine data (secondary analysis) from: (1) an online questionnaire (N = 758) observing the frequency of these strategies being used as a form of self-harm, and as a form of alternative coping (viewed as distinct from self-harming), and (2) semi-structured interviews (N = 45), using thematic analysis to identify themes related to harm minimization. Predominant themes suggest that many young people viewed harm minimization strategies as a proxy for self-harm as ineffective. Where such strategies were reported as helpful, their utility was reported to be short-lived or situation-specific. Findings from both studies indicate that some young people described using harm minimization (e.g., elastic band snapping) as a form of self-harm (e.g., to break the skin). Harm minimization strategies should not be recommended in isolation and their use must be monitored. Further research is urgently needed to develop an evidence base that informs practice.
Highlights
“These Things Don’t Work.” Young People’s Views on Harm Minimization Strategies as a Proxy for Self-Harm: A Mixed Methods Approach
In this mixed methods study we examine data from: (1) an online questionnaire (N 1⁄4 758) observing the frequency of these strategies being used as a form of self-harm, and as a form of alternative coping, and (2) semi-structured interviews (N 1⁄4 45), using thematic analysis to identify themes related to harm minimization
Of the seven participants who reported harm minimizations strategies in their coping responses, only four (0.5% of the study sample) did not consider this to be a form of self-harm
Summary
Self-harm (any act of self-poisoning or self-injury irrespective of motivation or intent) affects approximately one in every five to ten adolescents and is indicative of psychological distress, often repetitive, and strongly associated with future suicide risk (Burns, Dudley, Hazell, & Patton, 2005; Chan et al, 2016; Doyle, Treacy, & Sheridan, 2015; Madge et al, 2008). The focus of this study is harm minimization strategies as sensation or process proxies for self-harm (e.g., snapping elastic bands on skin, drawing on skin with red ink – see Table 1). Such strategies are often advocated as an alternative to selfharm, but there are concerns that they are potentially risky (Livesey, 2009; Pengelly et al, 2008). In Study 2, secondary thematic analysis was used to explore young people’s perceptions of harm minimization strategies reported in qualitative interviews focused broadly on the experience of self-harm and stopping self-harm This exploratory mixed methods approach (convergent design) is a suitable first step in a greatly under-researched area (Creswell & Plano Clark, 2011). Study 1 explored whether young people with a history of self-harm reported harm minimization used: (1) as a form of selfharm, or (2) as a form of coping, which was not considered to be self-harm, when not explicitly prompted
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