Self-harm: patients’ experiences and perceptions of professional care and support

Conclusions

• There is a need for significant improvement in the attitudes of healthcare personnel to treating people who self-harm. Good communication between healthcare professionals and adults* with self-harming behaviour includes participation and continuity and can be crucial in motivating continued treatment.
• At present, many adults feel that healthcare professionals are judgmental, do not listen to them and lack sufficient knowledge, both of psychiatry and self-harm. They say that they are rarely offered the opportunity to participate in planning their care, that there is a lack of continuity in terms of treatment plans and staff, and that the care lacks meaningful content.
• In cases where boundaries are set or coercive measures are used, it is particularly important to act respectfully. Good contact with healthcare professionals, where explanations of implemented coercive measures/boundary-setting are commun­icated and understood, is crucial in order to avoid a situation where adults who self-harm experi­ence these set boundaries or coercive measures as punitive or disciplinary.
• It is important that young people with self-harming behaviour can confide in the people close to them and who can support them. Currently, many young people find it hard to confide in someone and seek help. Both health­care and school personnel are responsible for ensuring that young people are aware of where to seek help and for following up to ensure that the help is provided.
• There is a danger that responsibility for helping people who self-harm falls between the cracks. Some­times, society has unrealistic expectations of the ability of schools, parents and other relatives to help and support people who self-harm, although these people have neither the means nor the resources to assume such a responsibility. From an equality perspective, this is both problematic and unethical if it means that the conditions for helping these people are highly variable.

* The majority of the adult participants in the included studies were women.