Nonsuicidal Self-Injury: Management on the Inpatient Psychiatric Unit

Abstract

BACKGROUND. Between 4% to 70% of inpatients engage in self-harming behaviors and effective interventions are needed to address this population. AIM. This article reviews literature from 2007 to 2017 to address treatment and management strategies specific for the treatment of nonsuicidal self-injury in the inpatient psychiatric setting. METHODS. Cochrane, PsycINFO, PubMed, and CINAHL were searched for relevant articles with 34 studies reviewed for applicability to the question, and 9 parsed into a summary of Findings table. RESULTS. Therapeutic approaches that show promise include cognitive behavioral therapy, dialectical behavior therapy, and mentalization as well as medications that act on the serotonergic, dopaminergic, and opioid systems. Effective models of care aim toward enhancing therapeutic relationships with staff, providers, and most important, encouraging the internal shift toward recovery within the patient. CONCLUSIONS. More research with controlled designs in the inpatient setting is needed, however, regardless of which approach is used, the impact of the individual caregiver on the patient’s recovery is key.

Environmental changes to reduce self-harm on an adolescent inpatient psychiatric ward: an interrupted time series analysis

“…The current study evaluated an intervention that made immediate changes to an adolescent psychiatric inpatient environment to reduce self-harming behaviours with and without suicidal intent. Evenings were identified as a peak time for self-harm incidents occurring on the ward, and similar rates have been reported on adult psychiatric settings [32][33][34]. An evening-focused intervention was designed with two main components; introducing a regular nursing shift between 3 and 11 pm, and implementing a structured activity programme for weekday evenings.…”

“…Another component of the intervention was introducing a structured activity programme in the evenings. Since evenings are generally unstructured times of the day on psychiatric wards, some patients may find themselves feeling vulnerable and emotionally distressed during this time and using self-harm as a coping mechanism to regulate negative emotions such as feelings of pain and anger [3,4,33,34,48,66]. Meaningful activities in the evening have been suggested as a positive way to distract patients who have negative thoughts and feelings [33,47,48,67], and may help to replace the positive functions associated with self-harm with or without suicidal intent such as sensation-seeking and feelings of gratification [4].…”

“…This is likely due to an increase in negative emotions in an individual, as well as the positive functions of self-harm which can provide comfort and excitement during this period [4]. This is apparent on adult psychiatric wards, where self-harming behaviours commonly occur when patients are alone in the evening [32][33][34] and on private areas like the bedroom and bathroom [32,33]. Young people in the community also report more self-harming thoughts when they are alone [35] and usually consider selfharm a private act, to be done in secrecy [36].…”

Interventions to reduce self-harm on in-patient wards: systematic review

“… 43 There are a number of ways that ward-based interventions could have an impact on patient self-harm. These include, increasing the presence of staff available for patients to seek help and feel supported, 22 , 73 providing positive and safe ways to distract patients and help them to bond with their peers to replace the positive functions associated with self-harm. 74 – 76 In addition, ward-based activities and interventions may help to reduce the sense of isolation, restriction and loneliness that patients often feel on psychiatric wards that may trigger self-harming behaviours.…”

An Analysis of Nonsuicidal Self-Injury Among Children and Adolescents in Inpatient Psychiatric Hospitals and Units in Pennsylvania

“…Psychotherapy may be an effective treatment choice for adolescents engaging in NSSI, and the most common methods include dialectical behavioral therapy, cognitive behavioral therapy, and mentalization. 2,14 Specific strategies for prevention of NSSI include recreational therapy, video gaming, puzzles, relaxation techniques, displacement strategies, journaling, identification of triggers, and conflict resolution. 2,14 At present, there is insufficient evidence that psychiatric medication is beneficial in the treatment of NSSI in adolescents, although medications with sedating properties may be useful in some situations, as we saw with the use of as-needed medications for agitation or anxiety in our own analysis.…”