It has been well established that self-harm is a key healthcare issue facing young people (Health and Social Information Centre, 2015). Consequently, many self-harmers preferentially seek support from friends (Evans, Hawton, & Rodham, 2005). Despite their unique position, friends’ experiences have been marginalised. Historically, friends have only been considered when they feature in the lives of the person who self-harms, when they are identified as “gate-keepers” to self-harming young people (Klingman & Hochdorf, 1993, p. 123), or when they themselves go on to self-harm (e.g. Hawton, Rodham, Evans, & Weatherall, 2002). Bearing in mind the friends’ unique, yet highly vulnerable status, there is a notable lack of research exploring how friends come to understand their experiences, and the subsequent impact this has on their friendships with the self-harmer. Through this qualitatively approached thesis I aimed to explore how the impact of self-harm on friendship is understood. Data was collected through a series of interviews and focus groups with friends of self-harmers, and those who supported them. Using a qualitative methodology, I conducted three studies. In Study One, I explored how counsellors made sense of the impact of self-harm on friendship. Studies Two and Three focussed on how friends, whilst maintaining a friendship with a self-harmer, came to understand themselves, their friendship with the self-harmer, and their relationships with others. The results indicated that friends struggled to integrate self-harm into their friendships and their understanding of themselves, took on excessive responsibility for the self-harmer, and felt constrained by secret-keeping. Additionally, as the friends in Study Three felt that information available to them was either absent, or lacking, I developed a prototype support tool tailored specifically to the needs of the friends.

Background: Self-injury is a serious behaviour undertaken by those in distress. Attitudes to self-injury both with and without intent to end life is often studied in terms of professionals working in Accident and Emergency (A&E), with little attention paid to other professionals or non-professionals. There are several potential aspects to one's stigmatising attitudes, such as willingness to help individuals, perceived causes for behaviour, optimism for prognosis and general empathy experienced. Moreover, some research suggests stigmatising attitudes may be different depending on the severity of the self-injury, including the presence or absence of suicidal intent. The aim of this study was to investigate the impact on these factors of the form of self-injury and professional background. Methods: Using an online survey methodology 436 respondents completed the survey. The attitudes of Mental Health Professionals, Primary Care Professionals and those not working in either of these settings ('Non-Professionals') were compared to explore their attitudes towards self-injury. Participants were randomly shown a vignette depicting either self-injury with or without intent to end life and reported their overall empathy, willingness to help, attributions for the behaviour and optimism for prognosis. Results: On all measures Non-Professionals reported more negative attitudes than either healthcare professional group, who had similar attitudes towards self-injury. Both professional groups differed in their attitudes towards self-injury with and without suicidal intent on all measures expect for optimism for prognosis. Across all professional groups a difference was seen between the optimism for personal and others' intervention. Conclusions: The study outlined the current attitudes of different healthcare professionals and the general public towards self-injury both with and without intent to end life. Differences in attitudes were seen, showing the potential to improve the stigmatising attitudes experienced by those who self-injure; methods were suggested by which to do this. Further research is needed in order to assess the clinical effectiveness of attempts to improve stigmatising attitudes.

Syfte: Syftet med studien var att beskriva hur ungdomar med självskadebeteende upplever bemötandet från vårdpersonalen. Metod: Studien genomfördes som en litteraturöversikt där sju kvalitativa vetenskapliga artiklar samt en kvantitativ vetenskaplig artikel användes. Datainsamlingen gjordes i databaserna PubMed, Psyc INFO och CINAHL Resultat: Resultatet av denna studie visade på att de flesta av ungdomarna med självskadebeteende inte sökte vård då de antingen var rädda för att förvärra sina problem eller för att de inte visste vart de skulle vända sig. De valde att i första hand söka hjälp hos sina vänner. Resultatet visade på tre kategorier. Dessa var: rädsla för vården, negativa upplevelser av bemötandet och positiva upplevelser av bemötandet. I resultatet framkom att av de som sökte hjälp inom sjukvården kände sig många missnöjda. Dessa ungdomar upplevde att det största problemet under vårdtiden var negativa attityder och dåligt bemötande från personalen. De ungdomar som tagit överdoser var övervägande positiva till det bemötande och den vård de fått till skillnad från de som inte tagit överdoser. Slutsats: Studien visade att ungdomar inte söker hjälp av sjukvården för sitt självskadebeteende då de är rädda för att deras problem ska förvärras eller att de inte ska bli förstådda eller tagna på allvar. De som ändå söker hjälp upplever att de får en annan hjälp än den de önskar.

Background: Self- harm among children is a growing problem in Sweden. The behavior means that persons deliberately hurt themselves. It´s not only the child who suffer from this behavior, it also affect the parents and siblings. It’s important that the nurse can give parents the support and information that they need. Research is limited when it comes to parents’ experience of having a child who deliberately harm her-/himself. Aim: The aim of this study was to illuminate parents’ experiences of living with a child with deliberate self-harm. Method: A literature-based study based on analysis of ten qualitative articles was performed. Results: The result are presented in three categories; "Feeling responsible", "Desire to be a better parent", "Feeling invisible and extradited" Conclusion: Nurses need more knowledge about self-harm and how parents perceive their situation. Parents need more support and information from the nurse.

Introduction: Deliberate self-harm is being increasingly recognised as a behaviour with significant clinical importance. Yet, there remains uncertainty regarding which forms of psychological therapy are most effective for its treatment. Schema Therapy is an integrative psychotherapy blending elements of cognitive behaviour therapy, object relations and gestalt therapy into a unified approach for the treatment of individuals with complex and chronic psychological conditions. The current thesis aimed to provide a better understanding of the Schema Therapy model and its association with deliberate self-harm. Systematic Review: Despite the increasing evidence base for the efficacy of Schema Therapy, less is known about the evidence for its theoretical underpinnings. To address this gap in the literature a systematic review was undertaken to explore the following question: How empirically supported is the theoretical underpinning of Schema Therapy? In a systematic search of the literature conducted until 01 June 2012, studies based on cross-sectional, longitudinal, intervention, meditational and experimental designs were considered. These studies underwent detailed quality analysis culminating in 19 articles being included in the current review. Overall these studies indicate that many of the key theoretical assumptions in Schema Therapy are supported by the literature. Empirical Study: Schema Therapy has recently been expanded to include the ‘schema mode’ concept, with a number of researchers highlighting an association between particular schema modes and a number of chronic psychological conditions. Although the schema mode model allows a method for understanding moment-to-moment emotional states it has not previously been explored in relation to deliberate self-harm. The current project aimed to explore the relationship between these variables and their association with early experiences of parental bonding and current levels of perceived stress. 70 psychiatric outpatients with a history of deliberate self-harm completed a number of measures including the Deliberate Self-Harm Inventory, Schema Mode Inventory, Parental Bonding Instrument and Perceived Stress Scale. Results revealed significant associations between deliberate self-harm, maladaptive schema modes, perceived stress and patterns of parental care. Maladaptive schema modes significantly mediated the relationship between parental care and deliberate self-harm. The Punitive Parent and Angry Child modes were significant mediators in this relationship. Conclusion: Results from the systematic review support the notion that Schema Therapy has a good theoretical underpinning. The empirical study also supports Schema Therapy by highlighting the meditational role of maladaptive schema modes in the relationship between low parental care in childhood and deliberate self-harm in adulthood. These findings provide further support for the Schema Therapy model and suggest that individuals with deliberate self-harm may benefit from this treatment.

No description available.

The aim of this diploma work is to explore tactics which would help serve as a preventive measure from inpatients inflicting self-harm. This work was conducted in selected psychiatric departments throughout the Czech Republic by using an anonymous questionnaire investigation. Only fifty percent of the departments have internal guidelines for detection of at risk patients. Eighty-eight percent of departments have an internal system for reporting extraordinary events. Many of these departments have advanced technical equipment, but there are still some departments with technical equipment at lower levels, probably due to the high costs associated. Only two departments are using scales for evaluation of admitting patients. Fifty percent of the departments evaluate risks of self-harm for admitting patients. Self-harm was present in all departments in this study; seventeen percent of departments did not report any number of suicide attempts and forty two percent of the departments did not report any number of the self-harm attempts. The results are showing a positive trend in the role of prevention, as well as increasing the safety level within individual departments. The data are also showing that not all of departments are taking sufficient measures to ensure prevention. Clear evidence of self-harm and suicide...

Self-harm and suicide is more prevalent within the prison environment than in community samples, with those in the first weeks of imprisonment at greatest risk. Descriptions and evaluations of static risk factors (e.g. mental health diagnosis) dominate the empirical literature with few dynamic (e.g. defeat) and protective factors (e.g. resilience) evaluated. Additionally, current research is largely atheoretical and the integration of existing knowledge into a unifying model may improve the predictability of assessment. In the current research Williams and Pollock’s cry of pain model provided the template for assessing predictors of self-harm or suicide. For three months, all new arrivals at a local prison were invited to complete baseline questionnaires to assess factors derived from the cry of pain model. It was hypothesised that the factors derived from the model (perceived stress, defeat, entrapment and absence of rescue factors) would be predictive of self-harm and suicide risk and would distinguish prior self-harmers from non self-harmers. Two hundred and seventy prisoners participated in the study. Prisoners with active psychosis and non-English speakers were excluded. All participants were followed up for four months for instances of self-harm. Eighteen participants engaged in self-harm during this period. The hypotheses derived from the model were supported in the prediction of future engagement in self-harm in prison and had some support in identifying those who engaged in previous self-harm and those at risk of suicide. Additional research is needed to confirm the factor structure of defeat and entrapment and the presence of ‘scripts’ as relevant factors in the cry of pain model. The 3 implications for practice are discussed including the identification of patterns of risk linked with self-harm and suicide. The measures utilised in the study were shown to be largely valid within this population. Methodological limitations are discussed together with their implications for future research.

Background: Suicide is the second leading cause of death among 15 to 29 year olds and 79% of global suicides occur in low- to-middle income countries. South Africa has the eight highest rate of suicide in the world, evidence that suicide is a serious public health concern. Identifying socio-demographic and clinical factors associated with high risk of serious self-harm or suicide, may be useful for improving patient care and strengthening appropriate referral pathways. Aim: To determine the sociodemographic and clinical factors associated with elevated levels of suicidal intent among self-harm patients who presented for treatment in the emergency room of an urban hospital in Cape Town, South Africa. Setting: A retrospective folder review of all patients who presented for treatment of deliberate self-harm to Groote Schuur Hospital. Methods: During the time period, 238 consecutive presentations for deliberate self-harm were identified and recorded on a data capture form.which obtained information about demographics, clinical characteristics and suicidal intent. The data was analysed using bivariate and multivariate analyses. Results: In our sample of 238 patients, 128 (54%) self-reported an elevated level of suicidal intent. Being of male gender, higher levels of education and having multiple reasons for selfharm were significant predictors of an elevated level of suicidal intent. Conclusion: Suicide is increasingly recognised as a serious public health problem globally, and in South Africa. Determining the socio demographic and clinical correlates for those at increased risk of suicidal behaviours, provides useful information on identifying vulnerable patients. This allows clinicians to improve patient risk assessment and public health awareness interventions may be closer targeted to at risk groups

Yes / The aim of this study is to determine emergency nurses’ knowledge about, and perceived ability to support, people who are suicidal. A questionnaire consisting of 34 questions was sent out to 113 adult emergency nurses employed in two emergency departments. A total of 38 responded. Findings highlight differences in attitudes and show a correlation between suicide prevention training and nurses’ perceived competence to triage people who are suicidal. The article makes recommendations for future research, as well as nurse education and training on suicide prevention, to improve attitudes and increase emergency nurses’ ability to respond effectively to people who are suicidal.