Self‐harm and attempted suicide within inpatient psychiatric services: A review of the Literature

Abstract

Self harm is a major public health concern, yet there are considerable challenges in providing support for those who self harm within psychiatric inpatient services. This paper presents the first review of research into self harm within inpatient settings. Searches of the main electronic databases were conducted using key words for self harm and inpatient care. There was substantial variation in the rates of self-harm and attempted suicide between studies, but rates were highest on forensic wards. There was no evidence of differences in prevalence of self-harm between men and women; women, however, were at increased risk of attempting suicide. People were more likely to self-harm in private areas of the ward and in the evening hours, and often self-harmed in response to psychological distress, or elements of nursing care that restricted their freedom. Wards used a variety of strategies to prevent self-harm; however, there is little research into their effectiveness.

Predictive validity of the HCR-20 for inpatient self-harm

“…Overall, rates of self-harm were somewhat lower than have been observed in previous studies [3]; the relatively short follow-up period may have provided less opportunity for events to occur. Further, self-harm might be stopped by restrictive management such as seclusion; hence its occurrence in inpatient settings is likely underestimated compared with what would have happened without intervention, and this may account for differences in observed base rates.…”

“…Further, self-harm might be stopped by restrictive management such as seclusion; hence its occurrence in inpatient settings is likely underestimated compared with what would have happened without intervention, and this may account for differences in observed base rates. However, the proportion of incidents classified as severe self-harm seemed roughly equivalent [3] and it is likely that more of these incidents will be prevented due to intervention. As expected, and consistent with previous research [4], rates of self-harm were higher in women compared with men, those with a personality disorder compared with all other examined diagnoses, and those aged b40 years compared to those aged ≥40 years.…”

“…However, adequate care of mental health inpatients requires the consideration of a range of risk behaviours including self-harm [2]. A recent review found that between 1 and 69% (mean 17.4%) of psychiatric inpatients had selfharmed during their stay; rates were especially high (mean 42.9%) among patients resident on forensic wards [3]. Patients at increased risk for self-harm are younger, female, and those diagnosed with EUPD [4].…”

“…It is important to accurately predict patients' engagement in self-injurious behaviour because it has obvious deleterious sequelae for themselves; 12-20% of incidents are classified as severe, resulting in deep cuts, fractures, or internal injuries [3]. In addition, it affects the emotional wellbeing of carers, and contributes to therapeutic nihilism [3] and staff absence [5]; Nijman et al [5] reported that, in 1 year, 84% of psychiatric nurses witnessed self-harm, 68% a suicide attempt, and 28% a completed suicide. Witnessing such incidents was significantly correlated with number of days absent from work due to illness.…”

Patients’ Experiences After Attempted Suicide: A Literature Review

“…One commonly used intervention is constant observation, which requires nursing staff to maintain a presence near the patient. This involves observing the individual's suicidal behaviour and being at hand and listening to the patient when he or she might be at risk of attempting suicide (James, Stewart, & Bowers, 2012;O'Donovan, 2007;Rooney, 2009). Another intervention for preventing suicide is to make the care environment secure and reduce access to material that can be used as a tool for suicide (Bowers et al, 2005;Sun, Long, Boore, & Tsao, 2005).…”