Incidence Of Self-harm Research Articles

Trends in incidence of self-harm, neurodevelopmental and mental health conditions among university students compared to the general population: a nationwide electronic data linkage study in Wales.

Objective and ApproachThey are growing concerns that self-harm and mental health conditions are increasing in university students. This may reflect widening access to higher education, existing population trends or stressors associated with this setting. We linked real-world data from the Higher Education Statistics Agency between 2012-2018 with primary and secondary healthcare records. Students were undergraduates aged 18 to 24 years at university entry. Non-students were pseudo-randomly selected based on an equivalent age distribution. We used regression approach to examine characteristics of students and non-students and their risks of self-harm and mental health conditions before and during university. ResultsThis e-cohort study included 96,760 students and 151,795 non-students. Being male, self-harm and mental-health conditions recorded before university entry, and higher deprivation levels resulted in lower odds of entering university and higher odds of dropout. Risks of self-harm, Autistic Spectrum Disorder (ASD), depression, anxiety, drug misuse, and schizophrenia were lower for students. Risks of self-harm, ASD, ADHD, depression, alcohol misuse and schizophrenia were increasing more in students over time. Older students experienced higher risk of self-harm and mental-health conditions. Younger students were more at risk of alcohol misuse than non-students. ConclusionsMental health conditions in students are common, diverse and they influence their academic outcomes. University students have mental health needs and trajectories that differ from those of the general population. ImplicationsThe diversity and complexity of students’ needs require integrated person-centred stepped care approach within universities including triage, access to well-being support, counselling, and referral pathways to mental health services.

A profile of the mental health needs of children in out-of-home care in Wales between 2019-2020

Objective and approachYoung people who have experience of being in out-of-home care are more likely to have poorer mental health when compared to those in the general population. However, some of the most highly cited literature around prevalence rates of different mental health conditions are becoming outdated. Data held in the Secure Anonymised Information Linkage (SAIL) Databank was used to better understand the mental health needs of this group. Health data from General Practitioner records, emergency department, and inpatient admissions were linked to the 2019/20 data from children’s social services. ResultsMental health was considered in relation to two facets: indicators and conditions. Indicators included incidents of self-harm, drug or alcohol use, while conditions included symptoms or diagnoses of five different mental health conditions (anxiety, depression, eating disorder, conduct disorder, and severe mental illnesses). Prevalence was looked at across general demographic characteristics, as well as those specific to the care experience. Logistic regression models examined if a young person’s care experience could predict the likelihood of mental health need. Conclusions The findings from this piece of work will inform current understanding of the vulnerabilities of this group. Future work will compare the needs of this group to others, including Children Receiving Care and Support, as well as the general population. ImplicationsThis work will provide an update to existing literature. The findings have the potential to contribute to discussions about how we best support this group and will inform approaches to meeting the health needs of care-experienced young people.

ThP7.12 - Penetrating Neck Injuries as a form of deliberate self-harm: A Pre and Post COVID-19 Comparison

Abstract Introduction In March 2020, the UK government implemented the first national lockdown to contain the spread of COVID-19. Despite success at curbing infection rates, early studies suggested a rise mental health issues, including an increased incidence of violent self-harm. This included penetrating neck injuries. Limited research is available on the pandemic’s effect on self-harm in the UK. Methods Data was collected from self-harm major trauma activations to a regional trauma centre, between 01/01/17 to 31/12/22. All patients identified with neck-related self-harm injuries were included. Demographic information and injury data was grouped for analysis into pre-COVID-19 (2017-19), and post-COVID-19 outbreak (2020-22) groups. Results Penetrating neck injuries due to self-harm, post-2019, increased fourfold (12 vs 47). Men were the majority in both periods, but women had a larger proportional increase (men 10 vs 34, women 2 vs 13). Mean ages of Men presenting increased (Men 44 vs 53, Women 36 vs 35) Conclusions The frequency of self-harm related neck injuries increased following lock down. Older men were most likely to present, however there was an associated rise in the number of women. We must further investigate the impact the pandemic had on the population’s mental health and tendency towards violent self-harm, particularly in older men.

Economic impact of a vision-based patient monitoring system across five NHS mental health trusts.

A vision-based patient monitoring system (VBPMS), Oxevision, has been introduced in approximately half of National Health Service (NHS) mental health trusts in England. A VBPMS is an assistive tool that supports patient safety by enabling non-contact physiological and physical monitoring. The system aims to help staff deliver safer, higher-quality and more efficient care. This paper summarises the potential health economic impact of using a VBPMS to support clinical practice in two inpatient settings: acute mental health and older adult mental health services. The economic model used a cost calculator approach to evaluate the potential impact of introducing a VBPMS into clinical practice, compared with clinical practice without a VBPMS. The analysis captured the cost differences in night-time observations, one-to-one continuous observations, self-harm incidents, and bedroom falls at night, including those resulting in A&E visits and emergency service callouts. The analysis is based on before and after studies conducted at five mental health NHS trusts, including acute mental health and older adult mental health services. Our findings indicate that the use of a VBPMS results in more efficient night-time observations and reductions in one-to-one observations, self-harm incidents, bedroom falls at night, and A&E visits and emergency service callouts from night-time falls. Substantial staff time in acute mental health and older adult mental health services is spent performing night-time observations, one-to-one observations, and managing incidents. The use of a VBPMS could lead to cost savings and a positive return on investment for NHS mental health trusts. The results do not incorporate all of the potential benefits associated with the use of a VBPMS, such as reductions in medication and length of hospital stay, plus the potential to avoid adverse events which would otherwise have a detrimental impact on a patient's quality of life.

Psychometric Properties of Korean Version of Nonsuicidal Self-injury Inventory: Validation Study of Deliberate Self-harm Inventory.

This study aimed to develop a Korean version of the Nonsuicidal Self-injury Inventory (K-NSSI) through the Deliberate Self-harm Inventory (DSHI) developed by Gratz for the Korean context and confirm its reliability and validity for clinical application. A total of 188 participants were analyzed utilizing the DSHI, the Korean version of the Self-harm Inventory, the Personality Assessment Inventory-Borderline Features (PAI-BOR), and the DSM-5 Level-2-Depression scale (Level-2-Dep). Cronbach's α assessed their reliability, while frequency analysis examined the items of the K-NSSI scales. Validity of the K-NSSI was confirmed through correlation analyses between K-NSSI (tendency for and frequency of nonsuicidal self-injury [NSSI] behavior) and SHI, PAI-BOR total scale, four subscales of PAI-BOR, and Level-2-Dep scale. Polyserial correlations analyzed the correlation between the presence of NSSI behavior and other scales. Confirmatory factor analysis and structural equation modeling explored the relationship between borderline personality features and self-harm. Cronbach's α was 0.71, indicating an "acceptable" level of reliability. Statistically significant correlations were observed between the presence of NSSI behavior and the total scores of SHI and PAI-BOR, and the four subscales of PAI-BOR. The frequency of NSSI showed statistically significant correlations with the total score of SHI and PAI-BOR, and its four subscales. Notably, 13.8% of participants reported engaging in self-harm behaviors, 26.9% reported a single occurrence, and 73.1% reported two or more instances. Structural equation modeling demonstrated that self-harm adequately predicted borderline personality traits. This study successfully validated the adaptation of DSHI into K-NSSI. The K-NSSI can facilitate interventions for self-harm incidents.

Trends in incidence of self-harm, neurodevelopmental and mental health conditions among university students compared with the general population: nationwide electronic data linkage study in Wales.

Concern that self-harm and mental health conditions are increasing in university students may reflect widening access to higher education, existing population trends and/or stressors associated with this setting. To compare population-level data on self-harm, neurodevelopmental and mental health conditions between university students and non-students with similar characteristics before and during enrolment. This cohort study linked electronic records from the Higher Education Statistics Agency for 2012-2018 to primary and secondary healthcare records. Students were undergraduates aged 18 to 24 years at university entry. Non-students were pseudo-randomly selected based on an equivalent age distribution. Logistic regressions were used to calculate odds ratios. Poisson regressions were used to calculate incidence rate ratios (IRR). The study included 96 760 students and 151 795 non-students. Being male, self-harm and mental health conditions recorded before university entry, and higher deprivation levels, resulted in lower odds of becoming a student and higher odds of drop-out from university. IRRs for self-harm, depression, anxiety, autism spectrum disorder (ASD), drug use and schizophrenia were lower for students. IRRs for self-harm, depression, attention-deficit hyperactivity disorder, ASD, alcohol use and schizophrenia increased more in students than in non-students over time. Older students experienced greater risk of self-harm and mental health conditions, whereas younger students were more at risk of alcohol use than non-student counterparts. Mental health conditions in students are common and diverse. While at university, students require person-centred stepped care, integrated with local third-sector and healthcare services to address specific conditions.

Association of Medicaid coverage with emergency department utilization after self-harm in Korea: A nationwide registry-based study.

Self-harm presents an important public health challenge. It imposes a notable burden on the utilization of emergency department (ED) services and medical expenses from patients and family. The Medicaid system is vital in providing financial support for individuals who struggle with medical expenses. This study explored the association of Medicaid coverage with ED visits following incidents of self-harm, utilizing nationwide ED surveillance data in Korea. Data of all patients older than 14 years who presented to EDs following incidents of self-harm irrespective of intention to end their life, including cases of self-poisoning, were gathered from the National ED Information System (NEDIS). The annual self-harm visit rate (SHVR) per 100,000 people was calculated for each province and a generalized linear model analysis was conducted, with SHVR as a dependent variable and factors related to Medicaid coverage as independent variables. A 1% increase in Medicaid enrollment rate was linked to a significant decrease of 14% in SHVR. Each additional 1,000 Korean Won of Medicaid spending per enrollee was correlated with a 1% reduction in SHVR. However, an increase in Medicaid visits per enrollee and an extension of Medicaid coverage days were associated with an increase in SHVR. SHVR exhibited a stronger associated with parameters of Medicaid coverage in adolescents and young adults than in older adult population. Expansion of Medicaid coverage coupled with careful monitoring of shifts in Medicaid utilization patterns can mitigate ED overloading by reducing visits related to self-harm.

Neurocognitive Profile of Individuals having Depression with Suicidal Ideation

Depression is characterized by a persistent state of sadness and disinterest in activities that one would normally find enjoyable, as well as an inability to function on a daily basis for at least two weeks. Reducing the overall number of suicide deaths and intentional self-harm incidents requires early detection of depression. Depression is frequently caused by suicide. Depression and suicidal thoughts have been found to be highly correlated. The purpose of the current study is to comprehend the neurocognitive profile of depressed individuals who have considered suicide. This cross-sectional study included 30 participants of both genders who were between the ages of 20 and 50. Further assessments of cognitive flexibility were conducted using tests for domains such as working memory, inhibition, set shifting, processing speed, and attention. Overall, it can be concluded that while phonemic fluency, inhibition, and set shifting have been found to have an impact, processing speed, attention, working memory, and semantic fluency are all compromised in depression associated with suicidal ideation. We can draw the conclusion that depression is a significant health problem that must not be disregarded because it is a key indicator of suicide and has been shown to reduce engagement in day-to-day activities, both of which can result in a reduced quality of life.

요양병원 환자안전사고 분석

This study aimed to analyze the frequency, severity, and associated factors of patient safety incidents in long-term care hospitals in Korea, utilizing patient safety statistics. The objective was to provide foundational data for the development of system improvement strategies aimed at reducing the risk of harm occurrence in the future. From 2018 to 2022, a total of 10,117 patient safety incidents occurring in long-term care hospitals were analyzed. Cross-tabulation using chi-square tests was conducted to examine differences in the severity of patient safety incidents based on hospital-related characteristics and patient-related characteristics. Additionally, binary logistic regression analysis was performed to identify factors influencing the occurrence of harm in patient safety incidents. The risk of harm occurrence was approximately 1.2 times higher in hospitals with fewer than 200 beds and about 1.4 times higher in hospitals with 200-500 beds compared to those with over 500 beds. Furthermore, compared to medication errors, the risk of harm occurrence was approximately 74.8 times higher for injuries, 24.9 times higher for suicide·self-harm incidents, 10.7 times higher for meal-related incidents, and 7.6 times higher for falls. Given that long-term care hospitals with fewer than 200 beds are in a legal gray area and have a higher risk of harm occurrence in patient safety incidents, legislation for patient safety management is necessary. Additionally, since injuries pose a significantly higher risk of harm occurrence compared to medication errors, it is imperative to accurately identify the causes of injuries in long-term care hospitals and devise prevention measures.

COVID-19 pandemic amplified mortality rates among adolescents with bipolar disorder through family-related factors.

Recently, a growing number of adolescents have been afflicted with mental disorders, with annual morbidity rates on the rise. This trend has been exacerbated by the global coronavirus disease 2019 (COVID-19) pandemic, leading to a surge in suicide and self-harm rates among this demographic. To investigate the impact of the COVID-19 pandemic on adolescent bipolar disorder (BD), along with the underlying factors contributing to heightened rates of suicide and self-harm among adolescents. A comprehensive statistical analysis was conducted utilizing clinical interviews and self-reports obtained from patients or their guardians. Diagnostic criteria for BDs were based on the Diagnostic and statistical manual of mental disorders, international classification of diseases-11, and the National institute of mental health research domain criteria. Statistical analyses were performed using SPSS 26.0 software, with significance set at P < 0.05. A cohort of 171 adolescents diagnosed with BD between January 1, 2018, and December 31, 2022, was included in the analysis. The gender distribution was 2.8:1 (female to male), with ages ranging from 11 to 18 years old. Major factors contributing to adolescent BDs included familial influences, academic stress, genetic predisposition and exposure to school-related violence. Notably, a significant increase in suicide attempts and self-harm incidents was observed among adolescents with BD during the COVID-19 pandemic. Statistical analysis indicated that the pandemic exacerbated familial discord and heightened academic stress, thereby amplifying the prevalence of suicidal behavior and self-harm among adolescents. The COVID-19 pandemic has exacerbated familial tensions and intensified the incidence of suicide and self-harm among adolescents diagnosed with BD. This study underscores the urgent need for societal, familial and educational support systems to prioritize the well-being of adolescents and offers valuable insights and guidelines for the prevention, diagnosis and treatment of adolescent BDs.

What is a ‘good enough’ prison? An empirical analysis of key thresholds using prison moral quality data

Performance thresholds and minimum standards in prison have preoccupied policy makers and practitioners alike for some time. These standards are based on widely accepted statements of principle, but benchmarks are rarely set or explored empirically. Nor has there been any attempt to describe or define higher-end thresholds; the point at which outcomes become positive, or stated principles are achieved. In this study, we provide an empirical demonstration of how quality of life thresholds may be determined using data from 518 Measuring the Quality of Prison Life (MQPL) surveys conducted in prisons in England and Wales (2009–2020) and examine their relationship to five violence outcomes: serious prisoner on prisoner assaults, serious assaults on staff, self-harm incidents requiring hospital treatment, self-inflicted deaths, and homicides. The results suggested that thresholds exist for most of the MQPL dimensions. A set of lower ‘unsafe’ and higher ‘minimally safe’ thresholds were produced. We found that the scores of prisons below the lower threshold had a very strong relationship with each of our five serious forms of violence in prison. Similarly, prisons that did not manage to cross the ‘minimally safe’ threshold also had strong relationships with incidents of violence in their prison but were at slightly lower risk of those incidents occurring. Striking differences in mean incidents rates were found when comparing prisons below the lower threshold to prisons above the ‘minimally safe’ threshold. Our findings suggest that to operate a safe enough (and therefore legitimate) prison, a combination of harmony, security and professionalism dimensions above a certain threshold should be achieved.

RETRACTED: Reduced self-harm on acute mental health wards following the implementation of a vision-based patient monitoring system: Evidence from five NHS trusts.

WHAT IS KNOWN ON THE SUBJECT?: Inpatient mental health settings pose unique challenges for patient safety, in part because psychiatric disorders are well-known risk factors for self-harm and suicide. Ward staff follow protocols to try and keep patients safe including carrying out in-person safety checks, usually every 15 min, but patients unfortunately still find opportunities to harm themselves. A vision-based patient monitoring system (VBPMS) is a contact-free technology that can help mental health nurses to monitor patients in hospital more effectively. For example, the tool alerts staff to situations where a patient might need assistance, like when they spend a long period of time in their ensuite bathroom. Research has shown that the VBPMS can support staff to prevent safety incidents from occurring and a recent study found a decrease in self-harm after the tool was implemented at one NHS mental health trust. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: This paper presents data from five NHS mental health trusts and suggests that the VBPMS can consistently help staff to prevent self-harm on acute mental health wards. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Managing self-harm behaviours is a challenge for mental health nursing staff. Standard safety protocols are not effective enough - staff need new ways to monitor patients. In general hospitals, technology is used every day to support care. This research shows that the VBPMS can be used to improve patient safety in mental health hospitals. ABSTRACT: Introduction Self-harm is sadly relatively common in mental health inpatient settings, and the effectiveness and appropriateness of strategies used to prevent it have long been disputed. The use of vision-based patient monitoring systems (VBPMS) has been shown to improve various safety outcomes. Their potential to support staff in preventing inpatient self-harm warrants further exploration. Aim This research investigated whether implementing a VBPMS-as an adjunct to existing clinical practice-within acute inpatient services at five NHS England mental health trusts led to reductions in self-harm. Method Five quasi-experimental studies assessed the number of bedroom self-harm incidents, across 12 adult wards, before and 5-12 months after a VBPMS was deployed. Percentage changes were calculated. Four studies used control groups and were included in a fixed-effect meta-analysis. Results In the meta-analysis, a significant inverse-weighted average relative risk percentage change of -38.9% was recorded. For the study with no control groups, reductions in self-harm were seen across all wards (range: -9.1% to -29.8%). Discussion This research demonstrates that VBPMS can support clinicians to create safer ward environments by preventing incidents of self-harm from occurring. Implications for Practice The results provide preliminary support for wider rollout of the technology on acute mental health wards.

Risk of repeat self-harm among individuals presenting to healthcare services: development and validation of a clinical risk assessment model (OxSET)

BackgroundA self-harm episode is a major risk factor for repeat self-harm. Existing tools to assess and predict repeat self-harm have major methodological limitations, and few are externally validated.ObjectiveTo develop and...

Trait Emotional Intelligence, Social Desirability and Non-Suicidal Self-harm Behavior among Adolescents: A Cross-Sectional Study

Non-suicidal self-injury (NSSI) is the intentional and acute harm done to one's body without the intention of committing suicide. Suicidal behavior (SB) and non-suicidal self-injury (NSSI) are the two primary health issues affecting teenagers. Despite increasing attention to such issues, very little work is done regarding these issues in Pakistan. The objective of this research was to determine the incidence of non-suicidal self-harm in adolescents and to find an association between non-suicidal self-injury and traits of emotional intelligence and social desirability in Pakistani adolescents who made up a typical sample of the general community. For this purpose, 195 participants were selected from different hospitals and areas of Islamabad and Rawalpindi. The non-suicidal self-injury student questionnaire, the trait emotional intelligence questionnaire (TEIQue-SF), and the social desirability scale (SDS-17) were used to collect data. According to the findings, people who were more socially desirable and have lower emotional intelligence traits were more likely to engage in NSSI. The results of this research provide insight into the intricate interactions among these factors and how they affect NSSI. Mental health practitioners can improve their capacity to recognize and assist people who are experiencing NSSI, thereby, supporting their well-being and recovery, by developing a deeper understanding of these aspects.

Non-contact monitoring to support care in acute inpatient mental health

Background Averting incidents of patient self-harm is an ongoing challenge in acute inpatient mental health settings. Novel technologies that do not require continuous human visual monitoring and that maintain patient privacy may support staff in managing patient safety and intervening proactively to prevent self-harm incidents. Aim To assess the effect of implementing a contact-free vision-based patient monitoring and management (VBPMM) system on the rate of bedroom self-harm incidents. Methods A mixed methods non-randomized controlled before-and-after evaluation was conducted over 24 months on one female and one male acute inpatient mental health ward with the VBPMM system. The rates of bedroom self-harm, and of bedroom ligatures specifically, before and after implementation were investigated using quantitative methods. Qualitative methods were also used to explore the perceived effectiveness of the system and its acceptability. Results A −44% relative percentage change in bedroom self-harm incidents and a −48% relative percentage change in bedroom ligatures incidents were observed in the observational wards with the VBPMM system. Staff and patient responses gave insights into system acceptability and the ways in which these reductions may have been achieved. Conclusion The results indicate that using the VBPMM system helped staff to reduce self-harm incidents, including ligatures, in bedrooms.

Preliminary evaluation of a multidisciplinary pathway for people who self-harm in acute inpatient mental health care

Background/aims Inpatient mental health settings are required to provide biopsychosocial interventions to support service users who self-harm. This is important as self-harm has been associated with increased admissions and risk of suicide. A multidisciplinary self-harm pathway was developed in an acute inpatient mental health ward for adult women to help staff support patients who self-harm. The aim of this project was to evaluate the pathway in relation to service user distress, confidence in managing mental health, therapeutic alliances with the ward team and self-harm incidents on the ward. Methods Data were collected from the record-keeping systems and from questionnaires completed before and after the pathway was introduced. Results The pathway was well received by service users and contributed to improvements in distress, confidence and to more effective management of self-harm. Conclusions The self-harm pathway was found to be a useful framework within which to structure psychosocial interventions for self-harm and least restrictive practice.

Report: Trends in Eating Disorder and Self-harm Incidence Rates Since Covid-19

Published by The Lancet Child &amp; Adolescent Health

The burden of attempted hanging and drowning presenting to hospitals in Ireland between 2007 and 2019: a national registry-based study

PurposeTo measure the impact of hospital-treated self-harm by hanging and drowning in Ireland in 2007–2019 and identify risk factors for these methods of self-harm.MethodData on all self-harm presentations to Irish hospitals between 2007 and 2019 were obtained from the National Self-Harm Registry Ireland, a national self-harm surveillance system. Multinomial regression was used to explore factors associated with attempted hanging and drowning.ResultsThe age-standardised incidence rate of attempted hanging and drowning increased by 126% and 45%, respectively, between 2007 and 2019. The incidence of both methods was highest among young people aged 15–24 years. The odds of presenting to hospital for attempted hanging were highest in males (aOR 2.85, 95% CI 2.72–3.00), people experiencing homelessness (aOR 1.32, 95% CI 1.16–1.49) and individuals living in the capital, Dublin (aOR 1.23, 95% CI 1.17–1.29). The odds of presenting for attempted drowning were highest in males (aOR 1.68, 95% CI 1.58–1.78) and people experiencing homelessness (aOR 2.69, 95% CI 2.41–2.99).ConclusionThe incidence of hospital-treated self-harm by hanging and drowning is increasing in Ireland and is highest among adolescents and young adults. Males and people experiencing homelessness may be at highest risk and warrant targeted preventive interventions.

Effect of Electronic Rounding Board on Falls and Self-harm Among Psychiatric Inpatients: Quality Improvement Project.

More than 1 million falls are reported in US hospitals each year. Psychiatric inpatients are at high risk for self-harm behaviors with reported suicide rate of 6.5 per 1000 patients. Patient observation is the primary risk management intervention in preventing adverse patient safety incidents. This project aimed to examine the effectiveness of handheld electronic rounding board (ObservSMART) implementation on falls and self-harm incidents among psychiatric inpatients. A retrospective review of adverse patient safety incidents was conducted to compare the 6-month preimplementation period versus the 6-month postimplementation period with staff training and implementation in July 2019. The monthly fall rates per 1000 patient-days were 3.53 versus 3.80 during the pre- and postimplementation periods, respectively. About one-third of the falls resulted in mild or moderate injuries for both periods. The incidence of self-harm was 3 versus 7 during the pre- and postimplementation periods, with incidence of 1 versus 6, respectively, among adult patients, who are more likely to hide self-harm. Although there were no changes in falls, the implementation of ObservSMART markedly increased the detection of patient self-harm, including self-injury and suicide attempts. It also ensures staff accountability and provides an easy-to-use tool to perform timely, proximity-based patient observations.

Reduction of adverse events in a psychiatric inpatient eating disorder unit during the COVID-19 pandemic.

Globally, the COVID-19 pandemic had impacted the health care delivery including inpatient psychiatric facilities. Within psychiatric settings, life of inpatients was profoundly altered. This paper aimed to understand if pandemic-related changes within an inpatient Eating Disorder Unit in a specialized psychiatric hospital in Ontario, Canada impacted incidence of aggression and use of coercive methods among adolescents. An exploratory study design was used to examine incidence of aggression, self-harm, code whites, staff assist, restraints and seclusion, and nasogastric feeding (NGF) among adolescents with eating disorders before and after the modified service delivery within the inpatient unit. Descriptive analyses were conducted. Analyses revealed a complete reduction in episodes of self-harm, aggression, staff assists, use of restraint and seclusion as well as an 80.14% reduction on average use of NGF. Authors speculate that the change in environment and program delivery method, peer influence, and shift in power relations between patient and staff may have resulted in improved experiences. This report provides insights to adopt a recovery-oriented service delivery for adolescents with eating disorders in inpatient settings.