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Suicide is a tragic cause of death and causes considerable distress for families, carers and healthcare professionals. Thankfully, suicide rates in older people in the UK have steadily declined for both men and women since the mid‐1980s. An understanding of the clinical and demographic characteristics of both completed suicide and non‐fatal self‐harm in older people is important in informing the development of preventative strategies to sustain this decline. Non‐fatal self‐harm in older people is relatively uncommon compared with younger age groups, but research indicates that self‐harm among older people is frequently a failed attempt at suicide. Thus, the important factors associated with self‐harm in this age group are similar to those linked with completed suicide, particularly high rates of clinical depression, poor physical health and social isolation. Unfortunately, there is also a high rate of subsequent completed suicide. For this reason, self‐harm in later life needs to be taken very seriously and a careful assessment of risk and need by a specialist in older people's mental health should be conducted. The identification and appropriate management of older people with depression in the community and general hospitals is a key area for the prevention of self‐harm and suicide in this age group and requires further attention, particularly with targeted support programmes for those at high risk.

Discusses the results of a three‐month survey of all patients presenting to a local accident and emergency department, following an episode of deliberate self‐harm. Routine assessment was carried out by junior psychiatric staff. Results highlight important issues regarding service provision.

The purpose of this paper is to examine the predictors of self-harm in male inmates.

Male inmates with and without a background of self-harm (i.e. suicidal and non-suicidal) were compared across two distal (static and trait) and two proximal (environmental and current/state psychological) domains. The factors from the four domains which may accurately classify self-harm history were also examined.

The two groups were significantly different across the four domains, particularly on psychological characteristics. The self-harm group was associated with childhood trauma, violent offences, institutional misconducts and lower levels of social support significantly more than the non-self-harm group. Being single, childhood abuse, impulsivity, antisocial personality disorder and global psychopathology were the five key predictors that contributed to 87.4 per cent of all cases being correctly classified.

The high levels of psychiatric morbidity and childhood trauma in the self-harm group indicated a need for interventions that address emotional and interpersonal difficulties and optimization of adaptive coping skills. Also, interventions may require a focus on the behavioural functions.

A novel approach was taken to the grouping of the variables. A comprehensive range of variables, was assessed simultaneously, including some not previously considered indicators, and in an understudied population, Australian male inmates. The lower levels of agreeableness, conscientiousness and generalized anxiety disorder which distinguished the self-harm and non-self-harm group, were newly identified for self-harm.

Previous research has established that guidelines to facilitate a non‐judgemental, consistent approach to self‐harm management would be useful to staff working in a forensic psychiatric setting. In the preparation of these guidelines, a literature search was conducted to examine the evidence on clinical effectiveness for managing self‐harm. Overall, the evidence for defining a definitive treatment approach to self‐harm is extremely limited. However, a number of studies/reviews have identified aspects of treatment and care that are considered to be effective. Guidelines have been produced that capitalise on this information and provide front‐line staff (such as nurses) with advice that can be used on a daily basis when working with a service user who self‐harms.

This article reviews the international literature of the last two decades on self‐injurious behaviour in prisons and jails and introduces the risk factors associated with this behaviour. Studies from a variety of countries investigated different samples (e.g. in jails or prisons; female or male inmates). We only chose those studies using a control group of inmates without self‐injurious behaviour. The findings on potential risk factors for self‐injurious behaviour are largely contradictory because of the differences in sample selection and dependent variables (deliberate self‐harm without suicidal intent vs. suicide attempts). We also discuss some methodological problems in predicting self‐injurious behaviour.

The three aims of the study reported were to investigate the functions of self‐harm in a population of patients detained in the Peaks Unit at Rampton hospital, to investigate the context and nature of this behaviour and to examine how staff respond to incidents of self‐harm. The findings indicate that there may be some functions of self‐harm specific to this population in addition to those found in other settings, namely expression of aggression and revenge. The context and nature of incidents were similar to those found in other secure settings. A range of staff responses were observed, and indicated high demand on staff time and resources. Limitations of the methods are discussed, with proposals for future research.

There is a dearth of research exploring pathways to episodes of deliberate self‐harm (DSH) within mentally ill men in high‐secure hospitals. This study aims to explore pathway(s) to episodes of self‐harm experienced by this group over the course of their life.

A total of seven men with a history of repetitive DSH participated in audio‐taped semi‐structured interviews. Transcribed interviews were analysed using grounded theory methods.

Two pathways to episodes of DSH emerged and were termed: the relief, and the response to mental health problems pathways. Participation within a dyadic suicide pact emerged as an unexpected theme.

There were a number of limitations within this study. Participants did not describe DSH episodes, which occurred within the high‐secure hospital and it was unclear as to the stage of their illness or whether co‐morbid difficulties were present during the episodes of DSH. Further research is required to substantiate the two pathways to episodes of DSH found within this study.

The present study offers a theoretical framework for clinicians working with mentally ill men within high‐secure hospitals, who have a history of DSH and identifies the need to carefully assess each individual episode of DSH.

This study is the first to explore pathways to episodes of self‐harm as experienced by mentally ill men within a high‐secure hospital by interviewing patients directly.

Identified risk factors and clinical experience suggest that self‐harm is a common and very significant problem in forensic psychiatric settings. Sparse training on self‐harm given to staff throughout professional development is a concern for staff who can be left feeling dissatisfied and powerless as how to manage the patient who self‐harms. Consequently, staff often have to rely on idiosyncratic beliefs about self‐harm and its management to guide their practice. This survey investigated staff attitudes towards self‐harm in a forensic psychiatric service. The results highlight much variation in attitudes and a sub‐population of staff holding relatively more punitive/negative beliefs. In addition, the survey drew attention to the difficulty of managing self‐harm in forensic settings‐especially in relation to issues around facilitating safe self‐harm.

Although self‐harm is most common in younger people in Britain, the risk of suicide subsequent to an initial act of self‐harm is considerably greater in older age groups. Four characteristics have been shown to be associated with increased vulnerability in older people who self‐harm: increased suicidal intent, physical illness, mental illness and social isolation. This paper is part of a broader analysis of all self‐harm presentations to a British hospital accident and emergency department over a five‐year period. It examines the prevalence of these vulnerability indicators in patients aged 65 or over, and considers whether greater vulnerability in older patients is reflected in their clinical management within the hospital and in community support planning on discharge.At the first presentation older patients (n=91) exhibited greater vulnerability than did younger patients (n=2,326). Despite this, we found no evidence that older self‐harm patients were any more likely than younger patients to routinely receive either a psychosocial assessment from a member of staff with specialist mental health training, or community aftercare planning on discharge from the hospital. This study lends weight to recently published national guidelines recommending that all acts of self‐harm in older people be regarded as evidence of serious suicidal intent at the outset.

Deliberate self‐harm (DSH) is a serious public health problem and, although in the past research has focused mainly on the DSH patient, it is now recognised that parental involvement in the therapeutic process is beneficial. This study aimed to understand parents' concerns, expectations and experiences following an episode of deliberate self‐harm in young people in order to identify their support needs.

This was a qualitative study using a phenomenological approach. Data were generated primarily from face‐to‐face, in‐depth interviews with parents of young people who had self‐harmed and with health professionals directly concerned in the management of DSH patients.

The study suggests that an incident of DSH by their son or daughter is an extremely traumatic experience for parents. Parents reported being deeply distressed with feelings of helplessness, they had concerns regarding coping with their child on discharge from hospital and were worried about the possibility of future incidents. These anxieties were exacerbated by a perceived lack of information and support from some health professionals. These results suggest that parents need more support and if given this they might be enabled to better contribute to improving the long term prognosis for their child.

The information reported here may help health professionals to engage more fully with parents as they have a key part to play in the success of the therapeutic process. The findings could be used to increase awareness and understanding amongst health professionals and so facilitate the development of mutual trust and understanding between all parties involved in the therapeutic process.