The effects of COVID-19 on self-harm in a high-secure psychiatry hospital

Abstract

Purpose Self-harm, including death from suicide, remains a significant public health challenge. The prison population is known to be a high-risk group for self-harm and suicide. The purpose of this study is to explore the trends in the frequency of self-harm over the course of the COVID-19 pandemic within a high-secure hospital. The authors hypothesised that the pandemic could adversely affect the mental health of patients, which could increase the rates of self-harm. Reasons for changes in the frequency of self-harm and the strategies used in response to the pandemic were also investigated. Design/methodology/approach This paper encompasses findings from a quality improvement project that investigated self-harming behaviours from February 2020 to February 2021 in a high-secure psychiatric hospital. Incidents of self-harm were recorded based on the hospital’s ward structure. Data was collected on the incidence of self-harm rates over the COVID-19 pandemic, with a focus on how the pandemic may have had an effect on self-harm. Findings This paper found an increase in the incidents of self-harm during the initial stages of the pandemic. The first national lockdown period yielded a rise in self-harm incidents from pre-COVID levels. The frequency of self-harm reduced following the first lockdown and returned to pre-COVID levels. The authors explored the psychological effects of COVID, isolation, interpersonal dynamics and changes in the delivery of care as reasons for these trends. Practical implications This study demonstrates the substantial challenges of the COVID-19 pandemic to secure psychiatric services. Having an awareness of how the pandemic can impact on self-harm is important, as it allows the correct balance of restriction of our patients’ liberty to a degree deemed necessary to control the pandemic and the delivery of effective patient care. The key clinical implications include the importance of direct face-to-face patient contact, effective communication, therapeutic interventions and activities, the psychological impact of quarantine and the influence the pandemic can have on an individual’s function of self-harm. Originality/value This paper is the first, to the authors’ knowledge, to explore the impact of COVID-19 in a high-security psychiatric hospital. The authors also explore possible explanations for the changes in the trends of self-harm and include the consideration of strategies for improving the prevention and management of self-harm in high-secure settings during a pandemic.

Suicide prevention during disasters and public health emergencies: a systematic review

“…The examined intervention types included psychiatric hospital treatment, disaster related mental health support, video-enabled tablets, CBT-skills training, and varied universal measures (including national gun laws and buy back scheme, a suicide prevention act, economic security measures, as well as urban parks). Interventions were either ongoing existing measures ( 30 , 31 , 34 , 37 , 40 ) or specifically deployed in disaster contexts ( 32 , 33 , 35 , 36 , 38 ). Some interventions included an explicit focus on suicide prevention ( 31 , 33 , 34 , 37 ), whereas other generic interventions did not ( 30 , 32 , 35 , 36 , 38 , 40 ).…”

“…Interventions were either ongoing existing measures ( 30 , 31 , 34 , 37 , 40 ) or specifically deployed in disaster contexts ( 32 , 33 , 35 , 36 , 38 ). Some interventions included an explicit focus on suicide prevention ( 31 , 33 , 34 , 37 ), whereas other generic interventions did not ( 30 , 32 , 35 , 36 , 38 , 40 ). Target groups for interventions were whole populations ( 30 , 34 , 36 , 38 ), people in disaster affected areas ( 33 , 35 ), rural veterans ( 31 ), psychiatric hospital patients ( 40 ), school students ( 37 ), and bereaved tsunami survivors ( 32 ).…”

Risk and protective factors for self-harm in secure mental health hospitals: a systematic review

“…For example, waiting for things (Selenius and Strand, 2017), use of restraints and penal measures (Šendula-Jengić et al , 2004; Webb et al , 2022) and not having access to preferred items or substances, such as nicotine (Zhong et al , 2019). Further factors included being locked in (Liebling et al , 1997) and isolation (Challinor et al , 2021). It was proposed by staff and patients that self-harm was used to regain a sense of control in a restrictive environment where they had little autonomy (Baker et al , 2013; Brown and Beail, 2009; Sandy, 2013; Shaw and Sandy, 2016).…”

Forensic psychiatry in times of COVID-19: a qualitative study into the concerns and needs of patients

“…It was hypothesized that this was due to rapid changes in delivery of patient care, the impact of dealing with a pandemic and the effects of isolation. After the initial lockdown, delivery of care was restored close to treatment as usual as possible, likely explaining the reduction in self-harm levels (Challinor et al , 2021). Within prisons in the UK, a decrease in self-harm was found during the first period of the pandemic.…”