Unhelpful Responses Research Articles

How schools can respond to pupils who self-harm: a qualitative study with young people and school staff

ABSTRACT Schools are well-placed to offer support to young people who self-harm. However, research shows that pupils who disclose self-harm behaviour to school staff are often faced with negative reactions and unhelpful responses. There is a clear need for an increased level of knowledge and understanding for staff to respond more appropriately. This study explored the expectations of young people and the needs of staff when responding to self-harm. Twenty semi-structured interviews were conducted with nine young people and 11 school staff. Interviews were analysed using reflexive thematic analysis. Three key themes were identified: (1) Lack of knowledge and confidence to appropriately respond to self-harm (2) Systemic barriers and facilitators to help-seeking in schools and (3) Positive relationships facilitate help-seeking. Young people and staff believe there is an unmet need for training to help staff confidently address self-harm. Future research should involve stakeholders to develop interventions to improve the school response to self-harm.

Communities of Inquiry for Offenders: Learning Malware Development on Asynchronous Platforms

ABSTRACT Malware as a service (MaaS) has become a profitable profession, allowing individuals who are not technologically competent, and criminal organizations, to purchase such malicious software to conduct a variety of attacks. This has created space for those with the technological abilities to make a business off the malware that they write, and it is therefore important to understand where these developers are learning the skills needed. The current study was carried out to assess how malware developers use an encrypted messaging platform for knowledge acquisition, more specifically knowledge about malware development. This was carried out through a qualitative analysis of questions and answers posted within Telegram channels that are related to malware, and malware development and distribution. Further to this, latent class analysis was conducted to aid in determining whether there are subsets of individuals posting this information. A total of 467 user questions and 518 user responses were captured from eight channels. Results from this study revealed that posters are usually responsive to questions posed within these communities, with seven different response themes identified: Criticized question, offered answer or advice, offered help or service, probing for further information, provided resource, and unhelpful response. Therefore, while not many people are seeking Telegram channels to learn, when they do pose questions, respondents are likely to offer helpful advice to aid in their learning of malware development.

How do professionals and non-professionals respond to non-suicidal self-injury? Lived experiences of psychiatric outpatients in Singapore

BackgroundFor young people who engage in non-suicidal self-injury (NSSI), receiving negative responses to their NSSI can pose a barrier to future help-seeking. This qualitative study aimed to explore helpful and unhelpful ways in which professionals and non-professionals respond to NSSI, from the perspectives of individuals with lived experiences of NSSI.MethodsSemi-structured interviews were conducted with 20 outpatients (6 males, 14 females) aged 17 to 29 years from a tertiary psychiatric hospital in Singapore, who had reported engaging in NSSI behavior in an earlier study. The interviews were audio recorded and transcribed verbatim. Thematic analysis was used to identify themes and subthemes in the data.ResultsProfessionals’ responses were organized into three main themes: ‘prescribing solutions without understanding needs’, ‘disapproval or judgment’, and ‘helpful responses’. Non-professionals’ responses were organized into four main themes: ‘emotionally charged responses’, ‘avoidance and inaction’, ‘poor understanding of reasons for NSSI’, and ‘providing tangible support and acknowledging NSSI’. Participants also described how unhelpful responses negatively impacted their willingness to seek help.ConclusionsOur findings provide a better understanding of responses to NSSI that are considered helpful and unhelpful, and can be used to improve existing guidelines on responding to NSSI.

Reaching out for help

PurposeThe purpose of this paper is to illustrate how often survivors are dismissed and unsupported in response to actively reaching out for help with distress. The author hopes the vignettes written about in this piece will serve to support and contribute to a body of work, which will educate professionals how to better support. The author shares various experiences when opportunities to help were denied and the impact this had on recovery. It is also noted that the responses of some health professionals mirror the original trauma suffered and therefore add to distress unnecessarily.Design/methodology/approachThe author has written about various experiences in different settings in which the support offered fell below professional standards and contributed to further unnecessary distress. The writing is evocative and rich in descriptive detail of the event and then implications of the event on recovery.FindingsThe author concludes that it is helpful to use experiences of being dismissed and unsupported by various professionals to contribute to a body of work, which will hopefully educate and support those in caring professions to support survivors better. The author notes that responses to requests for help can unintentionally and intentionally further exacerbate the distress already experienced by those living with traumatic early life experiences and relational abruptions.Originality/valueThis is the author’s unique and first-hand lived experience of reaching out for help in relation to the distress experienced as a result of early life traumatic and adversarial experiences. The author notes that it is helpful to write about these difficult experiences with the hope that they will inform educational programmes to support health professionals in how they respond to people experiencing trauma. This has helped the author regain a sense of agency in contributing to the prevention of further unhelpful responses from various health professionals to those in distress. The vignettes are rich, deeply evocative and moving. The writing process also helped the author make sense of these further difficulties and how they impacted the recovery process.

Disclosure and Help-Seeking Experiences of Sexual and Gender Minority Victims of Intimate Partner Violence: A Mixed-Methods Study.

Sexual and gender minorities assigned female at birth (SGM-AFAB) experience high rates of intimate partner violence (IPV), with negative effects on health and well-being. Disclosure of and help-seeking for IPV can support the well-being of IPV survivors, yet are understudied among SGM-AFAB people. To better understand the IPV disclosure and help-seeking experiences in this population, we conducted semi-structured interviews with 41 SGM-AFAB young adults who experienced physical, sexual, or severe psychological IPV. Qualitative analyses explored to whom SGM-AFAB disclosed IPV, barriers to disclosure/help-seeking, the types of responses received, and perceived helpfulness of responses. Exploratory mixed methods analyses assessed frequency of code endorsement, demographic differences, and associations among codes. Three-quarters of participants disclosed IPV, though rates were lower for sexual and physical than psychological IPV and very few sought help from formal sources. The most common barriers to disclosure were not viewing the IPV as abuse and anticipation of negative responses, often due to stigma; other participants described inability to access formal help and concerns about SGM incompetence in those services. Most actual responses received were considered helpful, including emotional support, labeling the IPV as unhealthy, nonjudgmental listening, actions to stop the IPV, and practical support. Minimizing IPV or criticizing the victim was common unhelpful response; advice to end the relationship was considered helpful and unhelpful. Whereas 92% of friend responses were described as helpful, around half of family (56%) and therapist (62%) responses were helpful. Findings suggest that efforts to increase access to culturally affirmative services and educate SGM youth to recognize IPV in their relationships may help promote help-seeking and well-being among SGM-AFAB IPV survivors.

Changes in cognitive processes and coping strategies precede changes in symptoms during cognitive therapy for posttraumatic stress disorder

Theories of posttraumatic stress disorder (PTSD) highlight the role of cognitive and behavioral factors in its development, maintenance, and treatment. This study investigated the relationship between changes in factors specified in Ehlers and Clark's (2000) model of PTSD and PTSD symptom change in 217 patients with PTSD who were treated with cognitive therapy for PTSD (CT-PTSD) in routine clinical care. Bivariate latent change score models (LCSM) of session-by-session changes in self-report measures showed that changes in PTSD symptoms were preceded by changes in negative appraisals, flashback characteristics of unwanted memories, safety behaviours, and unhelpful responses to intrusions, but not vice versa. For changes in trauma memory disorganization and PTSD symptoms we found a bidirectional association. This study provides evidence that cognitive and behavioral processes proposed in theoretical models of PTSD play a key role in driving symptom improvement during CT-PTSD.

Engaging young people and their caregivers in support services following harmful sexual behaviors: Qualitative analysis

BackgroundHarmful sexual behavior (HSB) displayed by children and young people under the age of 18 has been described as developmentally inappropriate, may be harmful towards self or others, or be abusive towards another child, young person, or adult. Early intervention and treatment completion are crucial to cease HSB, reduce impacts and address underlying issues for the child who has displayed HSB. Considerable shame attaches to seeking help for this stigmatized behavior which may result in dropout from support services. Understanding young people and caregivers' experiences of what facilitates or hinders their engagement with support services is therefore critical to preventing re-occurrence of HSB and keeping children safe. ObjectiveThis article draws on the first-hand experience of young people and caregivers to address the question: What have they found helpful and unhelpful when engaging with services for harmful sexual behavior? Participants and settingParticipants were recruited from public health and youth justice services in the state of New South Wales, Australia. The 31 participants included 11 young people (aged 14 to 17) and 20 caregivers (parents, foster or kinship carers). MethodsQualitative data were collected through individual semi-structured interviews, following which thematic analysis was conducted. ResultsData analysis identified three helpful responses: (1) non-judgmental recognition of crisis; (2) child-centred and family-focused orientation; and (3) multi-dimensional interventions. Unhelpful responses included: (1) closed doors (an inability to access a service) (2) stigmatization of HSB; and (3) reduced caregivers' autonomy. ConclusionsGreater involvement of caregivers, non-stigmatizing language and coordinated responses between generalist and specialist services are needed to facilitate service engagement.

Responsive E-government in China: A way of gaining public support

A growing body of research suggests that officials in China are highly responsive to citizens' requests on e-government platforms. However, our understanding of the effects of such responsiveness in China remains limited due to the lack of research from a citizen perspective. By conducting two online survey experiments involving 205 residents of Hubei Province, China, we examined the features of government responses in the e-government context that affect citizens' perceptions of government performance. The findings show that even a delayed and unhelpful response can have a positive impact on citizens' satisfaction with the government. This effect is mediated by the level of perceived government responsiveness. Moreover, citizens are affected more by the usefulness than by the timeliness of the government's responses. These results suggest that by combining the broad implementation of e-government with a higher response quality, the Chinese government can establish a new means of gaining public support.

Perceptions of Helpful and Unhelpful Responses to Disclosures of Suicidality in a Sample of Mobile App Users

Objective Assessment and management of suicide risk is dependent on the individual at risk disclosing their suicidal thoughts. This study analyzed self-reported data collected via Youper, a mental-health app, to explore user experiences with suicide-related disclosure. Method 2,952 international users who endorsed suicidal ideation reported on experiences with suicide-related disclosure. Differences in experiences were examined according to age, gender, and symptoms of psychopathology. Results Just over half of users (56.17%) shared their suicidal thoughts. The primary reason for not sharing was thinking others would not understand. Of those who had disclosed their suicidal thoughts, 56.31% perceived the listener’s response to be helpful, with listening and expressing care identified as most helpful. More severe depression and generalized anxiety symptoms were associated with higher disclosure likelihood, whereas higher borderline-personality and social-anxiety symptoms were associated with lower disclosure likelihood. Perceptions of what users found helpful when they disclosed suicidality varied by gender. Lack of understanding was the most frequently reported unhelpful response universally. Conclusion Findings suggest that listening and expressing care should be prioritized to maximize suicidal individuals’ experiences of feeling supported. That said, gender and symptoms impact likelihoods of and experiences with disclosure, which should be considered when receiving suicide-related disclosure. HIGHLIGHTS Nearly half of users shared suicidal thoughts and found listener responses helpful. Users most often endorsed listening as helpful and not understanding as unhelpful. Symptom severity and gender informed suicide-related disclosure experiences.

Views of people living with dementia and their families/care partners: helpful and unhelpful responses to behavioral changes.

This study investigated the views of people living with dementia and their families/care partners on (i) what they find helpful or unhelpful regarding behavioral changes, i.e. which coping strategies they used for themselves and/or which responses from others, and (ii) what they consider to be appropriate terminology to describe behavioral changes. One-on-one semi-structured interviews were conducted with people living with dementia and families/care partners face to face, online, or over the telephone. Data from open-ended questions were analyzed inductively. Common themes were derived from the data using an iterative approach. Twenty-one people living with dementia and 20 family members/care partners were interviewed. Four main themes were derived for helpful responses, and three main themes for unhelpful responses. Helpful responses included providing clear professional support pathways and supportive environments where people living with dementia can engage in physical, cognitive, social, and spiritual activities. Unhelpful responses included discriminatory treatment from others and use of medicalized terminology. Views toward terminology varied; people with lived experience most favored using "changed behaviors" over other terminology. Areas for improvement included targeting dementia stigma, societal education on dementia, and building confidence in people living with dementia by focusing on living well with dementia. Knowledge of the views of people living with dementia may assist healthcare professionals to provide more appropriate care for people living with dementia.

Adolescents’ lived experience of panic disorder: an interpretative phenomenological analysis

BackgroundPanic disorder is a debilitating anxiety disorder that has a serious impact on adolescents’ social and academic functioning and general wellbeing. Panic disorder is experienced by around 1 to 3% of the adolescent population. The aim of this study was to examine adolescents’ experiences of having panic disorder.MethodsSemi-structured interviews were conducted with eight adolescents with a primary diagnosis of panic disorder. Interpretative Phenomenological Analysis was used to gain an understanding of adolescents’ lived experience of panic disorder.ResultsTwo superordinate themes were identified: (1) Drowning in sensations, and (2) An unacceptable self. The findings show that adolescents experience panic disorder as extremely overwhelming and unpleasant, with debilitating feelings of drowning in sensations. Adolescents’ experiences largely fit with the cognitive model of panic, in which catastrophic misinterpretation of bodily sensations is associated with anxiety, avoidance, and safety behaviours, creating a vicious cycle. Attempts to avoid or prevent the attacks appear to inadvertently make them worse. Social worries, feeling broadly misunderstood, and unhelpful responses from others, contributed to feelings of being different or abnormal and were connected to a negative self-concept. Negative social interactions with teachers and peers in the school environment were particularly damaging.ConclusionsThese findings offer new insight into these adolescents’ lived experience of panic disorder and highlight the need for adolescents to access timely, evidence-based treatment, as well as the need for increased awareness and understanding of panic disorder in schools.

Experiences and Support Needs of Bereaved Students in Higher Education.

Bereavement is commonly experienced by students in higher education and is associated with negative health and academic consequences. We conducted a systematic review of the literature to identify how grief affects students in higher education and the types of support they seek and/or find beneficial. A search of Health Collection, Medline, CINAHL Plus, Web of Science, Taylor and Francis online, ProQuest, and Open Grey resulted in 30 articles that met inclusion criteria. A narrative synthesis resulted in 11 themes focused on the university experience following bereavement (six themes) and supports following bereavement (five themes). Our review highlights how grief symptoms can have a negative impact on bereaved students' academic and social experiences. These difficulties are exacerbated by barriers to accessing grief supports, and unhelpful responses from staff and peers. Students' grief is often disenfranchised and so students learn to avoid grief related emotions, communications, and support-seeking.

“It doesn’t get taken seriously until it gets bad”: experiences of risk management from people diagnosed with a borderline personality disorder

PurposePeople with a borderline personality disorder (BPD) diagnosis can require support from mental health services for managing risk behaviour. Current routine inpatient and community treatment can be unhelpful for this group. Positive risk taking has been developed to help community teams manage risk with people with a BPD. This study aims to explore experiences of risk management in an NHS Trust where positive risk taking is being implemented with people with a BPD.Design/methodology/approachInterpretative phenomenological analysis is the methodology of transcripts from semi-structured interviews. Nine adults with a diagnosis of BPD and current or previous experiences of risk management approaches were sampled from one NHS Trust.FindingsLimited resources and interpersonal barriers had a negative impact on experiences of Positive risk taking. Participants experienced one-off risk assessments and short-term interventions such as medication which they described as “meaningless”. Traumatic experiences could make it difficult to establish therapeutic relationships and elicit unhelpful responses from professionals. Participants could only feel “taken seriously” when in crisis which contributed towards an increase in risky behaviour. Positive risk taking was contingent upon collaborative and consistent professional relationships which created a “safety net”, enabling open communication and responsibility taking which challenged recovery-relapse patterns of service use.Research limitations/implicationsPositive risk taking approaches to risk management may benefit people with a BPD. Findings complement those from other studies emphasising the importance of compassion and empathy when working with personality disorder. Training and increased resources are required to implement effective risk management with this group.Originality/valueFindings expand upon the sparse existing research in the area of risk management using the Positive risk taking approach with people with a BPD diagnosis, and provide idiographic understanding which is clinically meaningful. Participants’ experiences suggest Positive risk taking may provide a framework for improving quality of life and decreasing service use for people diagnosed with BPD engaging in risk management with Community Mental Health Teams, which facilitates recovery and other benefits.

Social Network Changes and Disclosure Responses after Sexual Assault.

Social support after sexual assault is important for recovery, but violence and recovery may also challenge relationships. We examined functional and structural social support changes following sexual assault and their association with mental health. College women (N=544) with and without a sexual assault history completed a cross-sectional survey assessing current and past egocentric social networks. Functional support (perceived global support, assault disclosure, perceived helpfulness of responses) and structural support (network density, size, retention) were examined. Multilevel models revealed that, relative to non-survivors, survivors reported smaller, less dense past networks, but similarly sized current networks. Survivors retained less of their networks than non-survivors, and network members who provided unhelpful responses to disclosure were less likely to be retained. Structural equation modeling revealed that, among survivors, perceived unhelpful responses to disclosure and a greater loss of network members were associated with worse mental health. Findings suggest that survivors may experience a restructuring of social networks following sexual assault, especially when network members respond in unhelpful ways to disclosure. Although survivors appeared to build new relationships, this restructuring was associated with more mental health problems. It is possible that interventions to improve post-assault social network retention may facilitate recovery.

Staff attitudes, beliefs and responses towards self-harm: a systematised literature review

Introduction/AimsSelf-harm is a growing issue and remains a complex phenomenon in contemporary society. Understanding this behaviour may present challenges to staff providing care and support to patients who self-harm. There is an absence of a detailed review on staff attitudes, beliefs and responses towards self-harm. The aim of this review was to explore and critically appraise research on how staff attitudes impact on care provision.MethodsElectronic databases were searched and relevant literature were critically analysed to gather evidence to address this review.ResultsThis review identified lack of training, staff support and limited resources as contributory factors to negative attitudes and hostility towards self-harm patients.ConclusionsReasons for self-harm may be misconstrued, resulting to unhelpful responses and patients being ascribed stigmatising labels. Understanding factors that contribute to these unhelpful responses allows for the development of core strategies that enhances effective care.

How to Handle Dogmatic Union Supporters

In some union campaigns, one or more employees may become excessively vocal in their support of a petitioning labor organization—sometimes to the point of being obnoxious. These are the employees that can easily get under the skin of a supervisor and elicit unhelpful (and sometimes unlawful) responses. Handling such individuals in a proper manner is of paramount importance.

An exploration of the Personal Relationship Advisory Group in a community learning disability service: A service development project

Accessible summary The project aimed to explore discussions from the Personal Relationship Advisory Group (PRAG) meetings in a community adult learning disability team to influence the development of new relationship resources. All meeting minutes within a 12‐month period were analysed to find themes. The themes suggest the importance of the service looking at the whole person, such as their physical, emotional and social well‐being, when there are relationship concerns. New resources that focus on personal sexuality, different types of relationships and Internet safety may be of benefit to the service. Resources for carers may also be useful, such as helping carers to support people with learning disabilities to safely access relationships online. AbstractBackgroundAdults with learning disabilities often face barriers when accessing relationships and can require additional support. The Personal Relationship Advisory Group (PRAG) is a provision in a community learning disability service in North England, which offers multidisciplinary advice regarding relationship concerns. The current project aimed to identify common themes within PRAG to influence the development of new resources in the service.Materials and MethodsAll meeting minutes within a 12‐month period were analysed using thematic analysis. There were a total of 16 minutes, which discussed 11 people with learning disabilities. This included six females and five males with a mean age of 30 (SD = 14.97).ResultsIndividuals often had limited opportunity to develop relationships. There was a lack of understanding of sex and of how to behave appropriately in different types of relationships, with a need for individualised, accessible education. The Internet was commonly used to seek relationships, with many concerns regarding safety from carers or family. There were some unhelpful responses from others, such as the implementing of restrictions. Factors that may have an impact on the person's overall well‐being, such as their health, social issues and trauma, were often discussed.ConclusionsThe identified themes suggest the need for the service to take a holistic, biopsychosocial and individualised approach when supporting individuals with any relationship concerns. A multidisciplinary approach and collaboration with the individual and family/carers is key. It may be useful for the service to develop resources on topics such as personal sexuality, different types of relationships and Internet safety. Carer‐specific resources would also be beneficial, such as advice on how to safely support individuals to seek relationships on the Internet.

Sexual health issues postpartum–A mixed methods study of women's help-seeking behavior after the birth of their first baby

ObjectiveTo identify women's help-seeking behavior in relation to sexual health issues after the birth of their first baby. DesignA mixed methods sequential explanatory study design was utilized. Phase one of the study consisted of a prospective cohort study to identify the help-seeking behavior of women experiencing sexual health issues at 3, 6, and 12 months postpartum. Phase two consisted of a qualitative descriptive design to explore women's help-seeking behavior for sexual health issues postpartum. Setting & ParticipantsThe setting was a large urban tertiary referral maternity unit (greater than 8000 births per year) in the Republic of Ireland. Nulliparous women aged 18 years and over were invited to participate in phase one. Phase two consisted of a subsample of women who consented to being contacted for further research on admission to the study. FindingsFew women consulted a clinician for postpartum sexual health issues at each of the study's three, six and twelve month time-points. For example, only 2.9% (n=18) of women experiencing dyspareunia, and 3.6% (n=16) of those experiencing a lack of vaginal lubrication spoke to their General Practitioner (GP) about these issues at three months postpartum. The qualitative data supported the quantitative findings and suggested that even when women proactively sought help from healthcare professionals they were met with unhelpful responses. In the absence of support from practitioners, women became active agents and sought information from other women or the internet. In an effort to improve practice women recommended a greater focus on their physical and emotional recovery from birth. Key conclusions and implications for practiceVery few women consulted with a clinician about their experience of sexual health issues after birth. Findings will contribute to and assist policy makers in planning future postnatal services for women to include extending the final postnatal assessment beyond six weeks after birth.

The experiences of palliative care professionals and their responses to work-related stress: A qualitative study.

Previous qualitative research has demonstrated that palliative care professionals (PCPs) deal with a wide array of emotionally challenging issues associated with the care they provide. Although previous research has identified self-care strategies PCPs engage in, there is a lack of focus on what responses are helpful and/or unhelpful. The aim of the current study is to understand and describe the experiences of PCPs and to explore the helpful and unhelpful responses to work-related stress they employ. This was a qualitative study of the experiences of working PCPs in a hospice setting. Nine semi-structured interviews were conducted and subsequently analysed using the framework method. The current study revealed five overarching themes: (1) Sources of Meaning and Purpose (making a difference, personal growth), (2) Sources of Stress (emotional challenges, patient family dynamics, work environment factors, public perception, uncontrollability of symptoms), (3) Personal Impact (life engagement, perceptions of death), (4) Unhelpful Responses (self-doubt, emotional suppression, rumination, overidentifying, lack of self-care), and (5) Helpful Responses (acceptance, being present, perspective taking, being able to switch off, social support, active self-care). The experiences of PCPs can be interpreted from or directly mapped onto the psychological (in)flexibility model in Acceptance and Commitment Therapy (ACT). It is suggested that ACT training for professionals may encourage more reliable and explicit helpful responses and reduce the impact of unhelpful responses. Thus, an ACT training intervention may enhance wellbeing and effectiveness in PCPs.

Engaging or Disengaging: Understanding the Differences between Actionists and Unhelpful Bystanders among Youth Reacting to Peer Sexual Violence

ABSTRACT A growing body of research examines variables that may improve or impede helpful bystander action to prevent peer sexual assault among adolescents. The current study examines how individual and relational variables distinguish youth who respond to sexual violence in unhelpful versus helpful ways. Students were given a survey to assess frequency of actions taken in response to four peer sexual violence situations. Helpful actions were more likely among students who endorsed positive bystander attitudes and who reported more proactive prevention behaviors and less likely among students who self-reported peer violence perpetration. The findings support bystander prevention efforts that change social norms, increase proactive behaviors, and promote responsibility for intervening. Effectiveness may be enhanced through tailored approaches for youth most at risk for unhelpful bystander responses.