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The purpose of this paper is to examine the discourses that shape nurses’ understanding of self-harm and explore strategies for working with people who self-harm in a relational and a recovery-oriented manner.

Self-harm is a relatively common experience for a cohort of people who present to the mental health services and is, therefore, a phenomenon that mental health nurses will be familiar with. Traditionally, however, mental health nurses’ responses to people who self-harm have been largely framed by a risk adverse and biomedical discourse which positions self-harm as a “symptom” of a diagnosed mental illness, most often borderline personality disorder.

This has led to the development of largely unhelpful strategies to eliminate self-harm, often in the absence of real therapeutic engagement, which can have negative outcomes for the person. Attitudes towards those who self-harm amongst mental health nurses can also be problematic, particularly when those who hurt themselves are perceived to be attention seeking and beyond help. This, in turn, has a negative impact on treatment outcomes and future help-seeking intentions.

Despite some deficiencies in how mental health nurses respond to people who self-harm, it is widely recognised that they have an important role to play in self-harm prevention reduction and harm minimisation.

By moving the focus of practice away from the traditional concept of “risk” towards co-constructed collaborative safety planning, mental health nurses can respond in a more embodied individualised and sensitive manner to those who self-harm.

This paper adds further knowledge and understanding to assist nurses’ understanding and working with people who self-harm in a relational and a recovery-oriented manner.

Non-suicidal self-injury (NSSI) is distinguishable from suicide attempts (SAs) on a number of psychological and motivational factors. However, in corrective services settings, NSSI and SA are not clearly distinguished in assessment impacting on intervention. The purpose of this paper is to examine if any attributes differentiate lifetime history of SA+NSSI, NSSI and SA presentations in inmates who had recently been assessed in custody by a risk intervention team.

A comprehensive clinical assessment and file review was conducted with 87 male inmates (including a no self-injury control group) in two large correctional centres in New South Wales, Australia, to determine if three self-injury groups differ from the control group and if the three self-injury groups differ from each other across a range of static, trait, environmental and clinical characteristics.

The SA+NSSI group was most different from the control group (27/59 variables), and from the SA group (10/59 variables), predominantly across trait and clinical correlates. The SA group was least different from the control group (2/59 variables: suicide ideation, childhood physical abuse).

It was found that the presence of SA+NSSI history is an indicator of increased psychopathology. A history of SA only appears not readily associated with psychopathology. The self-injury subgroups reflected different clinical profiles with implications for risk assessment and treatment planning.

Non-suicidal self-injury (NSSI) is a growing public health concern. Continued NSSI is often associated with negative outcomes, yet the behaviour usually serves a purpose for individuals who self-injure (e.g. emotional relief). As such, individuals who self-injure often experience ambivalence about the behaviour. The purpose of this paper is to highlight the importance of recognising ambivalence as a natural and expected part of the recovery process.

This paper draws on literature regarding NSSI recovery, ambivalence towards stopping the behaviour and challenges for both clients and health professionals.

This paper argues that ambivalence towards self-injury can be challenging for both clients and health professionals. Clients may feel shame and sense of failure if they experience a setback; health professionals may experience frustration towards clients who continue to self-injure despite treatment.

Validation of the clients’ experience can have significant positive outcomes in treatment and help-seeking behaviours. Acknowledgement of client ambivalence during the recovery process will serve to validate clients’ experience and facilitate rapport. Health professionals who accept ambivalence as a natural part of the recovery process may experience less frustration with clients who continue to self-injure.

The purpose of this paper is to understand the needs and motivations of incarcerated men who self-harm with no apparent suicidal intent. These have received little attention in research and policy, despite men accounting for a high and increasing proportion of self-harm in prisons.

Semi-structured interviews were conducted with 20 adult male prisoners with a recent history or thoughts of non-suicidal self-harm. The interviews were analysed drawing on principles of thematic analysis and discourse analysis.

Against a backdrop of early traumatic experiences and more recent adverse events (including prison-related ones), self-harm was described by many as a desperate – but meaningful – coping strategy; both a means of releasing tension, sadness and frustration, and of being heard in an unresponsive system.

These findings echo those of research conducted with women (including women prisoners) who self-harm, but challenge some of the more negative ways in which non-suicidal male prisoner self-harm has been portrayed in the (scant) previous literature. As well as pointing to the need for greater awareness of the complex needs of men in prisons, they underscore the importance of (also) exploring – and perhaps addressing – the issue of self-harm separately from suicide, and of striving to make prisons, as well as prisoners, “healthier” and better able to cope with pressure.

The aim of this paper is to explore how the role of low intensity cognitive behavioural therapy (CBT) could be incorporated as a treatment option for individuals who engage in non‐suicidal self‐injury. Primary Care Mental Health Workers (PCMHWs) and Psychological Wellbeing Practitioners (PWPs) are employed to assist patients experiencing common mental health problems through CBT‐based self‐help materials; this is commonly referred to as low intensity CBT.

This article reviews the literature in order to investigate how these workers could incorporate their skills to offer support to those who self‐harm as means of coping with psychological distress.

The findings from this review identify a call for research into the efficacy of low intensity CBT, to enable the dissemination of clear guidance into the treatment of non‐suicidal self‐injury, considering the role of PWPs and PCMHWs.

At present, there is a lack of guidance into the treatment options for people who participate in non‐suicidal self‐injury. There is ambiguity into how PWPs and PCMHWs should manage this client base and training courses designed for these workers do not address the issues of self‐harm. It is hoped that this article may promote the development of such protocols.

The purpose of this paper is to call on researchers and clinicians to carefully consider the terminology used when discussing non-suicidal self-injury (NSSI), and specifically the use of the term “maladaptive” coping.

Drawing on literature regarding stigma, language and self-injury to support the argument that the term maladaptive is inappropriate to describe self-injury.

Use of the term maladaptive conflates short-term effectiveness with long-term outcomes and ignores context in which the behaviour occurs.

Use of the term maladaptive to describe self-injury can invalidate the person with a history of NSSI, impacting stigma and potentially help-seeking. An alternate framing focussed on specific coping strategies is offered.

Language is a powerful medium of communication that has significant influence in how society shapes ideas around mental health. In proposing a change in the way the authors’ talk about self-injury there is potential to significantly improve the wellbeing of people with lived experience of self-injury.

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.

The purpose of this paper is to describe the Eye movement desensitisation and reprocessing (EMDR) treatment of an adult female patient detained within a high secure hospital with complex mental health difficulties, including complex trauma, factitious disorder, self-injury and a history of offending. The EMDR treatment addressed the patient’s urges to engage in severe and sometimes life-threatening self-injury, a primary motive of which was to access physical healthcare interventions within a general hospital. The paper describes the wide-ranging benefits of the treatment and incorporates feedback from the patient and clinicians within her multi-disciplinary team (MDT).

Four triggers for self-injury were processed during the therapy using the DeTUR Protocol (Popky, 2005, 2009) and the Constant Installation of Present Orientation and Safety (CIPOS, Knipe, 2009a) method. In total, 18 one hour therapy sessions were delivered plus three follow-up sessions to continue to offer support and complete the post-treatment evaluation.

The level of urge for each trigger was reduced to 0 which the patient defined as “no urge to self-injure”. Benefits went well beyond self-injury with reported positive impacts on mood, thinking, sleep, concentration, memory and experience of flashbacks.

This case report demonstrates that the EMDR DeTUR Protocol together with the CIPOS method can be extremely valuable in the treatment of patients who self-injure.

The case report offers an important contribution to an area that requires much further research.

Non-suicidal self-injury (NSSI) is reasonably common, particularly among young people with prevalence rates of up to 25 per cent reported. Many factors contribute towards NSSI, including depression, anxiety and history of abuse and NSSI is a risk factor for suicide. Many people who engage in NSSI do not seek help, potentially due to concern about sigmatising attitudes. The purpose of this paper is to investigate the impact of gender and disclosure on stigmatising attitudes towards individuals who engage in NSSI.

Participants were 384 first-year university students (77.4 per cent female; mean age 19.50 years (SD=3.53)) who completed measures of stigmatising attitudes in response to vignettes featuring individuals who engaged in self-harming behaviour. Vignettes varied in the gender of the individual as well as whether the NSSI was disclosed or not.

The results support the attribution model of public discrimination in relation to NSSI stigma. Perceptions of higher personal responsibility for NSSI behaviour and higher levels of danger and manipulation were positively associated with stigmatizing attitudes and behaviours. Male research participants reported significantly higher levels of stigmatizing attitudes and behaviours than females.

The level of stigmatising attitudes towards individuals who engage in NSSI is significant and may impact on help-seeking behaviour.

Between 10 and 25 per cent of adolescents engage in some form of NSSI, but only a minority seek help to address this behaviour. This study suggests that attitudes by peers may influence help-seeking. Further research is required outside of tertiary education settings.

The purpose of this paper is to examine the association of bullying perpetration and victimization to non-suicidal self-harm and suicidal ideation among 93 boys from residential programs. Parental warmth was also examined as a moderator in these associations.

Participants completed questionnaires on their bullying involvement, parental warmth, non-suicidal self-harm, and suicidal ideation.

The findings revealed that bullying perpetration and victimization were both associated positively with non-suicidal self-harm and suicidal ideation, while parental warmth was related negatively to non-suicidal self-harm and suicidal ideation. In addition, the association between victimization and non-suicidal self-harm was stronger at lower levels of parental warmth, while these patterns were weaker at higher levels of parental warmth. Similar patterns were found for victimization and suicidal ideation.

The results indicate the significance of examining non-suicidal self-harm and suicidal ideation in relation to bullying involvement among adolescents from residential programs as well as the important role of parents in mitigating the negative effects associated with bullying perpetration and victimization.