Guidelines for managing self‐harm in a forensic setting

Abstract

Previous research has established that guidelines to facilitate a non‐judgemental, consistent approach to self‐harm management would be useful to staff working in a forensic psychiatric setting. In the preparation of these guidelines, a literature search was conducted to examine the evidence on clinical effectiveness for managing self‐harm. Overall, the evidence for defining a definitive treatment approach to self‐harm is extremely limited. However, a number of studies/reviews have identified aspects of treatment and care that are considered to be effective. Guidelines have been produced that capitalise on this information and provide front‐line staff (such as nurses) with advice that can be used on a daily basis when working with a service user who self‐harms.

Psychiatric Nurses Explanations of Self-Harming Behaviour in Secure Forensic Settings: A Multi-Method Phenomenological Investigation

“…It is becoming a common knowledge among practitioners that secure environments are hotbeds for self-harming behaviours [3]. Similar outcomes are reflected in this study as participants reported that some users only commence acts of harm when detained in forensic mental health settings.…”

“…Secure hospitals are places with the highest incidence of self-injury in both female and male service users [3]. Most psychiatric nurses in these hospitals have little understanding of self-harm [4].…”

Non-Suicidal Self-Injury Within Offender Populations: A Systematic Review

“…Staff rated their understanding of NSSI as 44%. Understanding increased with training Gough (2005) United Kingdom Results from Gough & Hawkins (2000) 12 Guidelines were suggested for forensic psychiatric service staff for dealing with NSSI Heney (2007) Canada N = 85; n = 44 female inmates, n = 41 members of security 97% of inmates that engaged in NSSI said segregation was an inappropriate response after NSSI, they perceived it as a punishment; 78% of inmates said females who engage in NSSI need to talk to someone after. The majority said they want to self-injure in situations of helplessness, powerlessness, or isolation Ireland & Quinn (2007) United Kingdom N = 162 prison officers in training (38.27%…”

“…Although the majority of staff surveyed reported having support in the treatment of NSSI, only half of the staff characterized the quality of support as representing "best practice" (Marzano & Adler, 2007). Further, despite the development of guidelines (e.g., Gough, 2005) and handbooks (e.g., Pengelly, Ford, Blenkiron, & Reilly, 2008) to help staff understand and manage NSSI, it is unknown whether these are frequently implemented.…”

Motives for self‐harm: views of nurses in a secure unit

“…). Secure environments have the highest incidence of self‐harm (Gough ; Tantam & Huband ). But the statistics indicating this are likely to be an underestimate, as the majority of cases of self‐harm usually remain a secretive act that can go on for a long time without being discovered (Mental Health Foundation ).…”