Attitudes towards clinical and non-clinical services among individuals who self-harm or attempt suicide: A systematic review

Abstract

The prevalence of self-harm has increased substantially in recent decades. Despite the development of guidelines for better management and prevention of self-harm, service users report that quality of care remains variable. A previous systematic review of research published to June 2006 documented largely negative experiences of clinical services among patients who self-harm. We reviewed research papers published since then until July 2022 to examine contemporary attitudes towards clinical and non-clinical services among individuals who self-harm and their relatives. We identified 29 studies meeting inclusion criteria, all of which were from high- or middle-income countries and were generally of high methodological quality. Our narrative synthesis identified negative attitudes towards clinical management and organisational barriers across services. Generally, more positive attitudes were found towards non-clinical services providing therapeutic contact, such as voluntary sector organisations and social services, than clinical services, such as emergency departments and inpatient units. Views suggested that negative experiences of service provision may perpetuate a cycle of self-harm. Our review suggests that in recent years there has been little improvement in experiences of services for patients who self-harm. These findings should be used to reform clinical guidelines and staff training across clinical services to promote patient-centred and compassionate care and deliver more effective, acceptable and accessible services.

‘Am I really the priority here?’: help-seeking experiences of university students who self-harmed

“…In the current sample, all students had sought professional help for their mental health when at university; therefore, help-seeking was more prevalent in this sample than in the larger population of students who have self-harmed. 7–10 Students who do not seek help may experience more pronounced barriers to their help-seeking, coupled with fewer facilitators, or may face additional barriers not identified by this study. Future research could benefit from purposively sampling those who have not sought help for their difficulties.…”

“…27,28 As half of students who self-harm do not receive any kind of professional help, it may be beneficial to provide entire student populations with interventions that teach stress management skills, with built-in systems to assist people in seeking treatment when needed. 7–10 Universities could also take a holistic approach to stress, thinking about which aspects of university culture foster meaningful and challenging activities, and which aspects create unhelpful levels of stress that weaken students’ sense of confidence and competence. 21…”

“…Mirroring previous research, we found that students were selective about who they spoke to about self-harm, for fear of being misunderstood or judged. 11,13–15 This applied to informal support, NHS and university staff, whose responses appeared to influence students’ negative perceptions of their own difficulties. To address this issue, some universities have implemented stigma interventions to educate the student body about mental health stigma.…”

“…This study explored the reasons for low levels of help-seeking in students who had self-harmed when at university. 7–10 This could generate new means of service delivery, which may be more accessible than services designed solely by professionals. 21,24 Students called for more scaffolding, particularly at the start of university, to establish social and professional networks of support, including holistic mental health education integrated into the university curriculum.…”

“…6–9 A recent study found prevalent negative views toward clinical services among those who self-harm, and noted minimal changes in the clinical management of self-harm over the past 16 years. 10 Nevertheless, university students represent a distinct group with different social and professional connections and access to mental health services compared with the wider population. Therefore, it is crucial to understand the experiences of university students who have self-harmed, to understand if they report a similar pattern of dissatisfaction in mental health support.…”