‘Change can only be a good thing:’ staff views on the introduction of a harm minimisation policy in a Forensic Learning Disability service

Fish, Rebecca; Woodward, Sarah; Duperouzel, Helen

doi:10.1111/j.1468-3156.2011.00681.x

Cited by 8 publications

(10 citation statements)

References 12 publications

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“…1 Of note, these estimates vary dependent on age (12-14 years versus 15-17 years) and gender (male versus female) A Mixed Methods Approach Thus, recommendations were based on the weight of empirical support for harm minimization approaches in other fields. There remains a paucity of evidence assessing the effectiveness and application of these strategies or identifying individual characteristics which might contribute to any success of the approach (National Collaborating Centre for Mental Health, 2011;Fish, Woodward, & Duperouzel, 2012). The guidelines suggest the need for studies to investigate different approaches to harm reduction following self-harm in clinical settings, including service users' experiences (National Collaborating Centre for Mental Health, 2011).…”

mentioning

confidence: 99%

“These Things Don’t Work.” Young People’s Views on Harm Minimization Strategies as a Proxy for Self-Harm: A Mixed Methods Approach

Wadman¹,

Nielsen²,

O’Raw

et al. 2019

Archives of Suicide Research

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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 ¼ 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 ¼ 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.

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confidence: 99%

“These Things Don’t Work.” Young People’s Views on Harm Minimization Strategies as a Proxy for Self-Harm: A Mixed Methods Approach

Wadman¹,

Nielsen²,

O’Raw

et al. 2019

Archives of Suicide Research

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“…Our finding that clinicians perceived a need for clear guidelines, staff training, ensuring individualised harm minimisation advice and a well-supported workforce is consistent with previous studies in specialised settings (a forensic learning disability service and prison service). 26 36 As our study included respondents from a wide range of services, this finding may be resonant across a range of clinical settings.…”

Section: Discussionmentioning

confidence: 99%

Harm minimisation for self-harm: a cross-sectional survey of British clinicians’ perspectives and practices

et al. 2022

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ObjectiveHarm minimisation for self-harm is an alternative to preventive strategies and focuses on maximising safety when self-harming. We explored the views of clinicians on harm minimisation for self-harm to describe reported use and acceptability in clinical practice.DesignA cross-sectional study using an online survey consisting of fixed-choice and open-ended questions.SettingPrimary and secondary care practices in England, Scotland and Wales.ParticipantsSnowball sampling of UK-based clinicians (n=90; 67% female) working with people who self-harm and who have or have not previously recommended harm minimisation methods to patients.ResultsOf the 90 clinicians sampled, 76 (84%) reported having recommended harm minimisation techniques to people in their care who self-harm. Commonly recommended techniques were snapping rubber bands on one’s wrist and squeezing ice. Other techniques, such as teaching use of clean instruments when self-harming, were less likely to be recommended. Perceived client benefits included harm reduction and promotion of the therapeutic relationship. Perceived potential limitations of a harm minimisation approach for self-harm were (a) potential worsening of self-harm outcomes; (b) ethical reservations; (c) doubts about its effectiveness and appropriateness; and (d) lack of training and clear policies within the workplace.ConclusionsIn our sample of UK-based clinicians in various settings, harm minimisation for self-harm was broadly recommended for clients who self-harm due to perceived client benefits. However, future policies on harm minimisation must address clinicians’ perceived needs for training, well-defined guidelines, and clear evidence of effectiveness and safety to mitigate some clinician concerns about the potential for further harm.

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“… 20 , 22 However, other practitioners felt that harm minimisation was able to empower patients and increase autonomy, albeit with caveats around the need for careful monitoring. 20 , 39 …”

Section: Discussionmentioning

confidence: 99%

Harm minimisation for the management of self-harm: a mixed-methods analysis of electronic health records in secondary mental healthcare

et al. 2021

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Background Prevalence of self-harm in the UK was reported as 6.4% in 2014. Despite sparse evidence for effectiveness, guidelines recommend harm minimisation; a strategy in which people who self-harm are supported to do so safely. Aims To determine the prevalence, sociodemographic and clinical characteristics of those who self-harm and practise harm minimisation within a London mental health trust. Method We included electronic health records for patients treated by South London and Maudsley NHS Trust. Using an iterative search strategy, we identified patients who practise harm minimisation, then classified the approaches using a content analysis. We compared the sociodemographic characteristics with that of a control group of patients who self-harm and do not use harm minimisation. Results In total 22 736 patients reported self-harm, of these 693 (3%) had records reporting the use of harm-minimisation techniques. We coded the approaches into categories: (a) ‘substitution’ (>50% of those using harm minimisation), such as using rubber bands or using ice; (b) ‘simulation’ (9%) such as using red pens; (c) ‘defer or avoid’ (7%) such as an alternative self-injury location; (d) ‘damage limitation’ (9%) such as using antiseptic techniques; the remainder were unclassifiable (24%). The majority of people using harm minimisation described it as helpful (>90%). Those practising harm minimisation were younger, female, of White ethnicity, had previous admissions and were less likely to have self-harmed with suicidal intent. Conclusions A small minority of patients who self-harm report using harm minimisation, primarily substitution techniques, and the large majority find harm minimisation helpful. More research is required to determine the acceptability and effectiveness of harm-minimisation techniques and update national clinical guidelines.

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‘Change can only be a good thing:’ staff views on the introduction of a harm minimisation policy in a Forensic Learning Disability service

Cited by 8 publications

References 12 publications

“These Things Don’t Work.” Young People’s Views on Harm Minimization Strategies as a Proxy for Self-Harm: A Mixed Methods Approach

“These Things Don’t Work.” Young People’s Views on Harm Minimization Strategies as a Proxy for Self-Harm: A Mixed Methods Approach

Harm minimisation for self-harm: a cross-sectional survey of British clinicians’ perspectives and practices

Harm minimisation for the management of self-harm: a mixed-methods analysis of electronic health records in secondary mental healthcare

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