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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 associated with psychological disorders and suicidal thoughts and behaviours; disclosure of NSSI can serve as a catalyst for help-seeking and self-advocacy amongst people who have self-injured. This study aims to identify the socio-demographic, NSSI-related, socio-cognitive and socio-emotional correlates of NSSI disclosure. Given elevated rates of NSSI amongst university students, this study aimed to investigate these factors amongst this population.

Australian university students (n = 573) completed online surveys; 80.2% had previously disclosed self-injury.

NSSI disclosure was associated with having a mental illness diagnosis, intrapersonal NSSI functions, specifically marking distress and anti-dissociation, having physical scars from NSSI, greater perceived impact of NSSI, less expectation that NSSI would result in communication and greater social support from friends and significant others.

Expanding on previous works in the area, this study incorporated cognitions about NSSI. The ways in which individuals think about the noticeability and impact of their NSSI, and the potential to gain support, are associated with the decision to disclose self-injury. Addressing the way individuals with lived experience consolidate these considerations could facilitate their agency in whether to disclose their NSSI and highlight considerations for health-care professionals working with clients who have lived experience of NSSI.

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 consider some of the legal implications of adopting a harm minimisation approach in supporting people who self-injure within inpatient mental health units. It is argued that a focus on risk and the increasing influence of the law and legal styles of thinking often associated with the allocation of blame have produced a more risk adverse clinical environment. As a result health professionals are more likely to err on the side of caution rather than engage in practices that although potentially therapeutic are not without their risks.

The analysis draws on the clinical, philosophical and legal literature to help understand how harm minimisation may support people who self-injure. It considers some of the complex medico-legal issues that arise in a clinical environment dominated by risk.

A focus on risk and accountability has produced an environment where the law and legal styles of thinking have come to influence practice. This is often associated with blame in the minds of the health professional. Given the legal obligation to prevent suicide, health professionals may take a conservative approach when working with people who self-injure. This makes the adoption of harm minimisation difficult.

This paper provides a legally informed analysis of some of the challenges associated with using harm minimisation techniques with people who self-injure. It adds to the literature regarding this area of clinical practice.

Research has consistently shown that staff working with people who self‐harm tend to experience a range of anxieties and negative emotions. Very little has been written on the particular issues and needs of staff in prisons, where rates of self‐harm are high. The current study gathered information about existing sources of support for staff dealing with prisoners who self‐harm, and identified positive practice examples. A postal survey was sent out to the Suicide Prevention Team Leaders from every HM Prison Service Establishment in England and Wales (139 in total). Fifty‐four surveys (38.8%) were completed and returned. Findings indicate that staff support services were reportedly in place in virtually all 54 establishments. However, the data suggest that even when present, provisions may not have adequately met the needs of staff working with prisoners who self‐harm, particularly when dealing with ‘repetitive’ self‐harming behaviours. These findings are discussed in relation to organizational health literature. Their practical and theoretical implications are considered, together with directions for further studies in this under‐researched area.

Despite evidence that violent daydreaming is a correlate of suicidal ideation, no research has examined the mechanisms underlying this association. The interpersonal theory of suicide may provide insight. This theory postulates that individuals with high suicidal desire experience intractable feelings of perceived burdensomeness (PB) and thwarted belongingness (TB). Violent daydreaming may fuel negative attitudes toward others and oneself and turn attention away from loved ones, thereby increasing feelings that one is a burden on others (PB) and socially disconnected (TB). However, no studies have tested TB and PB as explanatory mechanisms. The purpose of this paper is to examine the relationships between violent daydreaming, PB, TB, suicidal ideation, and depression in two samples (n=818).

Study 1 was comprised of general undergraduates, and Study 2 selected for undergraduates with a history of ideation. Self-report measures were administered and indirect effects analyses were conducted.

In both studies, violent daydreaming was associated with increased feelings of PB, TB, and ideation severity. Consistent with the interpersonal theory, TB and PB were significant parallel mediators of the relationship between violent daydreaming and suicidal ideation, beyond sex and age. In contrast to Study 1, results were no longer significant in Study 2 after accounting for depression.

This was the first study to test TB and PB as mechanisms underlying the relationship between violent daydreaming and suicide risk. Findings highlight the importance of monitoring and addressing violent daydreams and interpersonal functioning throughout treatment to mitigate risk.

The purpose of this paper is to explore the experiences of both staff and patients in a medium-secure mental health unit of the self-harm and/or suicidal behaviour of others. Suicide and self-harm is highly prevalent in forensic settings and evidence suggests that experiencing other people’s self-harm and suicidal behaviour can lead to negative outcomes, both for staff and patients. This is particularly important in hospitals where patients are highly dependent on staff for support.

Semi-structured interviews were conducted with five staff members and six patients in a medium-secure male mental health unit in the North of England. Data were analysed following interpretative phenomenological analysis guidelines.

Three dominant themes were identified during analysis: the impact of suicide and self-harm; the role of others; and the importance of understanding and experience. Various impacts were discussed including desensitization, negative emotions and the desire to help. Other people played an important role in protecting against negative impacts, with shared experiences and peer support reported as the biggest benefits. Experiences of self-harm and suicide were found to increase understanding resulting in more positive attitudes. Additionally, the importance of training and education was highlighted.

This paper provides an insight into the experiences of staff and patients in medium-secure male mental health unit, which has benefits to practitioners when considering support mechanisms.

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.

Borderline personality disorder (BPD) is a debilitating illness characterised by a pervasive pattern of emotional instability, interpersonal difficulties and impulsive behaviour in association with repeated self-injury and chronic suicidal ideation. People diagnosed with BPD also have high rates of co-occurring psychopathology, including disorders associated with disturbed impulse control, such as substance use disorder (SUD) and disordered eating behaviours. The co-occurrence of BPD and impulse control disorders contributes to the severity and complexity of clinical presentations and negatively impacts the course of treatment and recovery. This study qualitatively documents aspects of the lived experience and recovery journeys of people diagnosed with BPD and co-occurring SUD and/or disordered eating. This study aims to identify similarities with respect to themes reported at different stages of the recovery process, as well as highlight important factors that may hinder and/or foster recovery.

In-person, in-depth, semi-structured interviews were conducted with 12 specialist service consumers within a clinical setting. Ten women and two men (22–58 years; mean: 35.5 years) were recruited. Interview transcripts were analysed using thematic analysis principles.

As expected, participants with co-occurring disorders experienced severe forms of psychopathology. The lived experience descriptions aligned with the proposition that people with BPD engage in impulsive behaviours as a response to extreme emotional states. Key emergent themes and sub-themes relating to recovery comprised three domains: factors hindering adaptive change; factors assisting adaptive change and factors that constitute change. An inability to regulate negative affect appears to be an important underlying mechanism that links the three disorders.

This study highlights the potential shortcomings in the traditional approach of treating co-occurring disorders of BPD, SUD and eating disorders as separate diagnoses. The current findings strongly support the adoption of an integrative approach to treating complex mental health issues while concurrently emphasising social connection, support and general health and lifestyle changes.

The findings of this study contribute to the burgeoning BPD recovery literature. A feature of the current study was its use of in-depth face-to-face interviews, which provided rich, many layered, detailed and nuanced data, which is a major goal of qualitative research (Fusch and Ness, 2015). Furthermore, the interviews were conducted within a safe clinical setting with engagement facilitated by a clinically trained professional. There was also a genuine willingness among participants to share their stories in the belief that doing so would inform effective future clinical practice. Their willingness and engagement as participants may reflect their progress along the path to recovery in comparison to others with similar diagnoses. Finally, most of the interviewees were engaging in dialectical behavioural therapy (DBT)-style therapies; two were receiving mentalisation-based therapy treatment, and most had previously engaged in cognitive behavioural therapy or acceptance and commitment therapy-based approaches. The predominance of DBT-style therapy may have influenced the ways that themes were articulated. Future studies could supplement this area of research by interviewing participants receiving therapeutic interventions other than DBT for the treatment of BPD and heightened impulsivity.

This paper aims to explore service-user perspectives of sensory approaches introduced and promoted by the trauma and self-injury service within the National High Secure Healthcare Service for Women (NHSHSW) at Rampton Hospital.

This cross-sectional descriptive study used a semi-structured questionnaire, which was devised for this evaluation and included both open and closed questions. The data collected were then analysed using descriptive statistics and thematic analysis.

The paper evaluates the current use of sensory approaches within the NHSHSW. Sensory approaches were widely used across the service, with essential oils being the most commonly used sensory approach. The use of sensory approaches can be understood according to the following three themes: independence, accessibility and self-regulation. The self-regulation theme contained three sub-themes as follows: safety-seeking, relaxation and reducing distress. The evaluation also highlighted barriers to using sensory approaches and sought service-user feedback as to how these may be overcome.

Participants’ feedback informed changes to practice, such as introducing sensory approaches to service-users earlier in their care pathway and increasing the accessibility of sensory items. These approaches may be of relevance to service provision in other forensic or inpatient settings.

This paper offers a unique contribution to the current literature with its focus on using sensory approaches to ameliorate trauma symptoms, in the context of a forensic setting.