Background This paper details the experiences of nine people with mild ⁄ moderate intellectual disability who self injure; looking beyond the clinical presentations in an attempt to capture the perceptions these people have of their care in a medium secure unit. Methods A phenomenological approach was used, and during in-depth interviews, the participants gave rich descriptions of their experiences of self-injury. Results The analysis of the interviews revealed four main themes; coping strategies, staff and the organizational response -therapeutic communication, close observation and looking to the future. As a coping strategy, self-injury was seen as an effective means of reducing distress -there were unique and common reasons for this distress. Common themes relating to the actions and reactions of health professionals and the organizational response were evident within all accounts. Conclusions The theoretical and clinical implications for service users are discussed.

Accessible summary• Clients and staff at a service called Calderstones talked to the authors about self injury. • Clients said that staff do not understand why they self-injure. Some clients feel punished when staff stop them self-injuring. All clients like talking to staff and said that telling their problems to staff helps them. Clients said that they should be allowed self-injure without staff being blamed. • Staff said they feel upset and worried when a client self-injures. They told the authors they would like more training about self-injury. Some staff would like clients to be allowed to self-injure, but don't want to be blamed for a client's injuries. SummaryThis paper is the synthesis of two pre-existing studies. It details the experiences of nine people with mild/moderate learning disabilities who self injure, and those who work with them. At the time of this study the participants were living and working in a medium secure unit at Calderstones NHS Trust in Lancashire. A phenomenological approach was used, and during in-depth interviews, the participants gave rich descriptions of their experiences of self injury. The descriptions that emerged from the interviews detailed four main themes: understanding, communication, control and blame.

PurposeThe Department of Health advocates the involvement of service users in the risk assessment and management process. Studies suggest that this is not routine practice and is dependent on individual professionals. The “Keeping me Safe and Well” screen was developed by Mersey Care NHS as part of a human rights healthcare project and this paper aims to analyse it.Design/methodology/approachThe screen was piloted to adopt a more participative holistic approach to risk whilst working in partnership with service users. This took place in a 16‐bed, medium secure unit for people with a diagnosis of intellectual disabilities and personality disorder; five service users took part in the pilot. Personal records were audited to assess the level of involvement in the risk assessment process and individual and focus group interviews provided narrative on the use and usefulness of the tool.FindingsAll participating service users experienced an increased awareness and knowledge of the risk assessment process and human rights issues. The screen helped them focus on their own risk issues and the rights of others. Their views of personal risk matched those of the professionals, effectively validating existing assessment methods, promoting trust between service users and professionals, giving service users an opportunity to work collaboratively with professionals on individual risk management.Originality/valueThe screen added value to the risk assessment process by engaging service users in the risk process and supporting the adoption of a more participative, holistic approach to risk by maximising autonomy and empowerment and working in partnership with the service user.

Ward managers working in a medium secure learning disability service were asked to identify members of staff who they believed to be superior in the management of violent and aggressive individuals. A grounded theory approach was used to interview staff about their management of imminent aggression. The participants explained their strategies in terms of the following eight themes, which were common to all interviews: safety and de-escalation, attribution and control, relationships, understanding and empowerment, anticipating reactions, creating a façade, communication, and humour. The participants described the importance of building up trusting relationships with clients when trying to understand the reasons for the client's behaviour. They also explained how they offer a ;get-out clause' to the client, a way for the client to decide to calm down without losing face. The participants also reported that creating the appearance of being in control can help, as does the use of humour to aid communication.

Accessible summary Staff were asked for their views on using harm minimisation with people with a learning disability who self‐harm.Staff felt that this policy could benefit some but not all of the clients.They felt that staff and clients should be able to choose whether to be involved in using harm minimisation.Staff were mostly in favour of harm minimisation but were worried about the level of their responsibility. Summary Recent local research about personal experiences of self‐injury and discussions about the use of harm minimisation with service users who self‐injure were the motivation behind this study to glean staff opinions and advice about the introduction of a harm minimisation policy. An online survey was designed, and all staff were invited by email to take part. The survey used multiple‐choice questions as well as providing room for open comments. Eighty‐five per cent of the seventy‐one staff that responded were in favour of the introduction of a harm minimisation policy. Common requests for inclusion were: clear, individualised guidelines that include roles and responsibilities, staff and client support systems, client education and staff training and advice about duty of care issues. This exercise has been invaluable in the production of a harm minimisation policy. Services should consider implementing this type of policy on an individual basis.