Search results

Prison institutional conditions affect risk for self-harm among detainees. In particular, prison overcrowding may increase the likelihood of self-harm by creating competition for resources, space, and enhancing a “deprivation state.” The purpose of this paper is to examine the association between overcrowding and prisoner acts of self-harm.

This cross-sectional study took place at Geneva’s pre-trial prison (capacity:376) between 2006 and 2014. Outcomes were acts of self-harm that required medical attention, and self-strangulation/hanging events (combined into one group, as these are difficult to differentiate). Dichotomous predictors were overcrowding index- annual mean daily population divided by capacity ( > 200 percent vs < 200 percent), and year group (2006-2009 vs 2011-2014).

Self-harm and self-strangulations/hangings increased in 2011-2014 compared to 2006-2010 (p < 0.001). Overcrowding in excess of 200 percent was associated with self-strangulation/hangings (p < 0.001) but not with all self-harm events. In terms of pertinent demographics that would affect self-harm, there was no prison change in gender, area of origin, foreign residency, religion, or psychiatric treatment.

The present study is limited by the definition and identification of self-harm. The distinction between self-strangulation and self-hanging, and the precise classification of an intent to die is difficult to make in practice, especially with limited prison data records available. The relevant literature addresses the complexity of the association between non-suicidal and suicidal behavior. Despite this, the combined category self-strangulations/hangings gives some indication of severe self-harm events, especially since the methodology of categorization employed was consistent throughout the entire period of the study. Other limitations include the small sample size and the lack of individual patient data and prison data to help control for confounding factors. Despite these drawbacks, pertinent data (socio-demographics and number of prisoners treated for mental health and drug abuse) remained stable over the years. Thus, there are no apparent changes in the inmate population that could be linked to an increase in self-harm. High-security placements and mean prisoner stay have increased over time, with a decrease in staff to prisoner ratio – and these must be looked into further as contributors. Additionally, qualitative methods such as semi-structured interviews and focus groups could delineate the impact of overcrowding on prisoner well-being and self-harm potential.

The authors observed a significant increase in self-harm and self-strangulation/hangings over time, and overcrowding was significantly associated with self-strangulation/hangings (but not with all self-harm events). Overcrowding can impose destructive effects on the psychological and behavioral well being of inmates in prison, influencing a myriad of emotional and livelihood factors that predispose to harmful behavior.

This report should alert public health and prison authorities to this issue, and garner resources to address such an alarming rise. The findings from this short report demonstrate the need for a further examination of the mechanisms affecting self-harm among prisoners in this population, particularly the relationship between self-strangulations/hangings and overcrowding.

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.

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.

The purpose of this paper is to examine the current state of the literature on the variables associated with self-harm and aggression in women who committed a criminal offence.

Studies were identified through online databases, namely, PsycINFO, PubMed, ERIC and EBSCOhost, as well as manual searches of reference lists of the selected studies. The target population included women who committed a criminal offence and have engaged in self-harm and aggressive behaviors during their incarceration, either in correctional institutions or in forensic psychiatric settings.

Of the 1,178 studies identified, nine met inclusion criteria. The studies were conducted in six different countries and included data from 6360 female participants. Few studies examine self-harm and aggression in women who committed a criminal offence which speaks to the still sparse literature on this topic. This review of the association between self-harm and aggression in women offenders highlights the finding that a small group of women is often involved in both self-harm and aggression. The authors have identified possible psychological factors associated with women engaging in both self-harm and aggression. The findings also reveal a possible connection between types of aggressive behaviors and specific time periods during sentences or stays in forensic psychiatry.

The findings of this scoping review have clinical implications which may be considered by both researchers and the case management teams of women involved in both self-harm and aggression.

Despite the limited number of studies examining self-harm and aggression in women, this scoping review highlights gaps in the literature as well as notable psychological correlates of women who engage in self-harm and aggression.

Previous research into health care professionals' perceptions of self‐harm has found that, although complex, in some cases their perceptions can be somewhat negative and unsympathetic towards individuals who harm themselves. However, it is presently unclear whether these perceptions reflect more general attitudes to self‐harm in broader social groups. The present study aims to represent a preliminary investigation into perceptions of self‐harm in the general public. First, since there is no universal agreement on which behaviours constitute self‐harm, this study aims to investigate public perceptions of this, including whether participants identified more controversial behaviours such as eating disorders and body modification as methods of self‐harm in addition to the more commonly identified behaviours such as cutting and burning. Secondly, it aims to identify whether attitudes towards individuals who self‐harm in a small sample of the general public were similar to the sometimes negative and unsympathetic perceptions of health care professionals demonstrated in some previous studies.

Semi‐structured interviews were conducted with seven participants, none of whom had any professional or academic experience or knowledge of self‐harm, who were recruited via second acquaintances of the first author. A matrix‐based thematic analysis method was used to analyse the data collected.

The main findings of this study were that eating disorders were generally perceived as forms of self‐harm while body modification was not, and that participants generally showed sympathy towards individuals who self‐harm, especially when they perceived the behaviour to be associated with mental illness.

Although, given the small size of the sample, this should be considered a preliminary study, the findings suggest that developing a greater understanding of public perceptions of self‐harm could have important implications for understanding mental health professionals' perceptions of the phenomenon. The authors suggest that stigma and negative perceptions of people who self‐harm may not be inevitable and that further research in this area could be of value in informing public and professional education campaigns in this area.

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 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.

Self-harm can affect people of all ages, yet the high prevalence rate in adolescents and the potential risk factor of suicide in adults 60 years and above has meant research has tended to focus within these areas. Therefore, the purpose of this exploratory study is to examine the experiences of self-harm in people from early adulthood to late middle age to gain greater insight and understanding in this underexplored area.

An online open-ended survey was used to collect the data from a UK user-led moderated online forum that supports people who self-harm.

Thematic data analysis indicates that feelings of shame and guilt were intensified, due to the double stigma participants face as adults that self-harm. Although most participants had seen a reduction in the frequency of their self-harm many experienced an increase in the severity of harm. In not fitting the assumed typical profile of someone that self-harm participants often struggled to gain formal support.

This was a small-scale online survey; hence, it is not possible to generalise the findings to all adults who self-harm.

The findings from this research provide evidence that greater recognition needs to be given to the reality that self-harm can affect people of all ages. As a result, access to support needs to be widened as a means of supporting those who do not fit the typical profile of someone who self-harms.

This exploratory online study provides insights around the tensions and challenges facing adults that self-harm, which remains an under-researched and largely ignored area.

The purpose of this paper is to present a qualitative analysis of the role of self-harm self-help groups from the perspective of group members.

A qualitative case study approach guided the research, which involved working with two self-harm self-help groups and all regularly attending members.

A thematic approach to the analysis of the findings indicates that self-harm self-help groups can provide a safe, non-judgemental space where those who self-harm can meet, listen and talk to others who share similar experiences for reciprocal peer support. Offering a different approach to that experienced in statutory services, the groups reduced members’ isolation and offered opportunities for learning and findings ways to lessen and better manage their self-harm.

This was a small-scale qualitative study, hence it is not possible to generalise the findings to all self-harm self-help groups.

The value of peers supporting one another, as a means of aiding recovery and improving well-being, has gained credence in recent years, but remains limited for those who self-harm. The findings from this research highlight the value of self-help groups in providing opportunities for peer support and the facilitative role practitioners can play in the development of self-harm self-help groups.

Self-harm self-help groups remain an underexplored area, despite such groups being identified as a valuable source of support by its members. This research provides empirical evidence, at an individual and group level, into the unique role of self-harm self-help groups.

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.