Self‐cutting and harm reduction: Evidence trumps values but both point forward

Dickens, Geoffrey L.; Hosie, Leah

doi:10.1111/jpm.12508

Cited by 5 publications

(8 citation statements)

References 4 publications

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“…Coping and distraction-strategies that aim to delay behavior engagement, support alternative coping strategies, self-soothing, or distraction (such as listening to a favorite song or taking a bath)-may also be viewed, by some, to fall under the umbrella of "harm minimization" for self-harm. Recently, it has been suggested that sensation and process proxies of self-harm may be viewed as-or termed-"substitution" methods, as opposed to the more commonly used phrases of "harmreduction" or "harm minimization" strategies (Dickens and Hosie, 2018).…”

Section: Damage Limitationmentioning

confidence: 99%

“These Things Don’t Work.” Young People’s Views on Harm Minimization Strategies as a Proxy for Self-Harm: A Mixed Methods Approach

Wadman¹,

Nielsen²,

O’Raw

et al. 2019

Archives of Suicide Research

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Although UK clinical guidelines make tentative recommendations for "harm minimization" strategies for repeated self-harm, this is in the absence of empirical evidence supporting their acceptability or effectiveness. We explore young people's views of harm minimization strategies (e.g., snapping elastic bands on skin, drawing on skin with red ink), as a proxy for self-harm. In this mixed methods study we examine data (secondary analysis) from: (1) an online questionnaire (N ¼ 758) observing the frequency of these strategies being used as a form of self-harm, and as a form of alternative coping (viewed as distinct from self-harming), and (2) semi-structured interviews (N ¼ 45), using thematic analysis to identify themes related to harm minimization. Predominant themes suggest that many young people viewed harm minimization strategies as a proxy for self-harm as ineffective. Where such strategies were reported as helpful, their utility was reported to be short-lived or situation-specific. Findings from both studies indicate that some young people described using harm minimization (e.g., elastic band snapping) as a form of self-harm (e.g., to break the skin). Harm minimization strategies should not be recommended in isolation and their use must be monitored. Further research is urgently needed to develop an evidence base that informs practice.

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Section: Damage Limitationmentioning

confidence: 99%

“These Things Don’t Work.” Young People’s Views on Harm Minimization Strategies as a Proxy for Self-Harm: A Mixed Methods Approach

Wadman¹,

Nielsen²,

O’Raw

et al. 2019

Archives of Suicide Research

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“…One area that has received research attention is the attitudes of nurses and other mental health professionals to the use of coercive measures (Bowers et al . 2007; Dickens & Hosie 2018; Jalil et al . 2017; Vandamme et al .…”

Section: Introductionmentioning

confidence: 99%

“…2012a, 2012b) noted a mean of 17.4% of mental health inpatients self‐harming within the ward setting. Nursing reactions to self‐harm vary from proactive and therapeutic to reactive and coercive (Dickens & Hosie 2018). Research on the epidemiology of the use of coercive measures like seclusion and restraint for self‐harm are less prominent in the literature than for aggression and disturbed behaviour in general but there are numerous indications that they are indeed used for this purpose.…”

Section: Introductionmentioning

confidence: 99%

Coercive containment measures for the management of self‐cutting versus general disturbed behaviour: Differences in use and attitudes among mental health nursing staff

Dickens

Hosie

2022

Int J Mental Health Nurs

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Self-harm is common in mental health facilities, and coercive containment measures are sometimes used to manage it. Nurses' attitudes towards these measures have been investigated in relation to disturbed behaviour in general, but rarely to self-harm specifically. We therefore investigated mental health nurses' use of and attitudes towards coercive measures (seclusion, restraint, intermittent and constant observations, forced intramuscular medication, and PRN medication) for self-cutting management compared with for disturbed behaviours in general using a cross-sectional, repeated measures survey design. Participants were N = 164 mental health nursing staff. Data collection was via a questionnaire comprising validated attitudinal measures. The study is reported in line with STROBE guidelines. Physical restraint (36.6%), forced intramuscular medication (32.3%) and seclusion (48.2%) had reportedly been used by individuals for self-cutting management. Respondents disapproved of using each coercive measure for self-cutting more than they did for disturbed behaviour in general with the exception of PRN medication. Attitudes to coercive measures differed across target behaviours. Hence, nurses who had used each measure for managing self-cutting disapproved of it less for that purpose than those who had not. Nurses who had used coercive techniques for self-cutting management had less desirable attitudes to their use. We cannot say whether prior use of these techniques led to increased approval or whether greater approval led to an increased willingness to use them. Reducing the use of coercive techniques for self-harm will require attitudes that support its use to be challenged. Less coercive techniques should be encouraged. Harm reduction techniques offer one such alternative.

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“…Previous studies examining the acceptability of harm minimisation for self-harm suggest inpatients preferred harm minimisation strategies to preventative and controlling methods. 20 21 Meta-analyses of randomised controlled trials exploring interventions for self-harm found that abstinence approaches used by mental health professionals are ineffective 22 23 and may reduce patient trust and lead to more lethal methods of self-harm or indeed suicide. 21 Recently, there has been a push to reconceptualise self-harm recovery beyond cessation, to recognise a more non-linear process that is reported by people with lived experience of self-harm.…”

Section: Introductionmentioning

confidence: 99%

“…No trials have been conducted to evaluate the effectiveness of harm minimisation for self-harm. Previous studies examining the acceptability of harm minimisation for self-harm suggest inpatients preferred harm minimisation strategies to preventative and controlling methods 20 21. Meta-analyses of randomised controlled trials exploring interventions for self-harm found that abstinence approaches used by mental health professionals are ineffective22 23 and may reduce patient trust and lead to more lethal methods of self-harm or indeed suicide 21.…”

Section: Introductionmentioning

confidence: 99%

Harm minimisation for self-harm: a cross-sectional survey of British clinicians’ perspectives and practices

et al. 2022

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ObjectiveHarm minimisation for self-harm is an alternative to preventive strategies and focuses on maximising safety when self-harming. We explored the views of clinicians on harm minimisation for self-harm to describe reported use and acceptability in clinical practice.DesignA cross-sectional study using an online survey consisting of fixed-choice and open-ended questions.SettingPrimary and secondary care practices in England, Scotland and Wales.ParticipantsSnowball sampling of UK-based clinicians (n=90; 67% female) working with people who self-harm and who have or have not previously recommended harm minimisation methods to patients.ResultsOf the 90 clinicians sampled, 76 (84%) reported having recommended harm minimisation techniques to people in their care who self-harm. Commonly recommended techniques were snapping rubber bands on one’s wrist and squeezing ice. Other techniques, such as teaching use of clean instruments when self-harming, were less likely to be recommended. Perceived client benefits included harm reduction and promotion of the therapeutic relationship. Perceived potential limitations of a harm minimisation approach for self-harm were (a) potential worsening of self-harm outcomes; (b) ethical reservations; (c) doubts about its effectiveness and appropriateness; and (d) lack of training and clear policies within the workplace.ConclusionsIn our sample of UK-based clinicians in various settings, harm minimisation for self-harm was broadly recommended for clients who self-harm due to perceived client benefits. However, future policies on harm minimisation must address clinicians’ perceived needs for training, well-defined guidelines, and clear evidence of effectiveness and safety to mitigate some clinician concerns about the potential for further harm.

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Self‐cutting and harm reduction: Evidence trumps values but both point forward

Cited by 5 publications

References 4 publications

“These Things Don’t Work.” Young People’s Views on Harm Minimization Strategies as a Proxy for Self-Harm: A Mixed Methods Approach

“These Things Don’t Work.” Young People’s Views on Harm Minimization Strategies as a Proxy for Self-Harm: A Mixed Methods Approach

Coercive containment measures for the management of self‐cutting versus general disturbed behaviour: Differences in use and attitudes among mental health nursing staff

Harm minimisation for self-harm: a cross-sectional survey of British clinicians’ perspectives and practices

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