Standard clinical measures are promising as indicators of change in low security hospital patients. Risk ratings may be conservative, but at this stage of a secure hospital admission, higher scores may be as likely to indicate progress in identifying and quantifying risks as apparent increase in risk. Copyright © 2017 John Wiley & Sons, Ltd.

Purpose The purpose of this paper is to describe the Eye movement desensitisation and reprocessing (EMDR) treatment of an adult female patient detained within a high secure hospital with complex mental health difficulties, including complex trauma, factitious disorder, self-injury and a history of offending. The EMDR treatment addressed the patient’s urges to engage in severe and sometimes life-threatening self-injury, a primary motive of which was to access physical healthcare interventions within a general hospital. The paper describes the wide-ranging benefits of the treatment and incorporates feedback from the patient and clinicians within her multi-disciplinary team (MDT). Design/methodology/approach Four triggers for self-injury were processed during the therapy using the DeTUR Protocol (Popky, 2005, 2009) and the Constant Installation of Present Orientation and Safety (CIPOS, Knipe, 2009a) method. In total, 18 one hour therapy sessions were delivered plus three follow-up sessions to continue to offer support and complete the post-treatment evaluation. Findings The level of urge for each trigger was reduced to 0 which the patient defined as “no urge to self-injure”. Benefits went well beyond self-injury with reported positive impacts on mood, thinking, sleep, concentration, memory and experience of flashbacks. Practical implications This case report demonstrates that the EMDR DeTUR Protocol together with the CIPOS method can be extremely valuable in the treatment of patients who self-injure. Originality/value The case report offers an important contribution to an area that requires much further research.

No abstract