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The aim of the thesis is to establish whether "assisted self-harm" is ethical or moral, when used in adult acute inpatient environments; in other words, whether it is consistent with how people should live their lives and treat others. "Assisted self-harm" refers to management strategies for self-harm which strive to reduce/limit, rather than stop, the behaviour. Strategies include offering advice on safer places to injure or allowing/providing sharp implements. In the project I used an "empirical ethics" approach, combining philosophical analysis with empirical studies to produce normative, not descriptive, conclusions. I conducted individual qualitative interviews with 5 patients and 20 inpatient or home intervention mental health professionals. Two focus groups were conducted: (I) with people from adult community services (n=4); and (2) with people from a specialist service for personality disorder (n=12). The interviews provided descriptive data about people's motivations, reasons and intentions when they self-injure, as well as predictive data about the possible consequences of allowing injury and participant-driven arguments for or against the approach. This data was used to complement theoretical analysis of the key concepts "autonomy", "responsibility" and "harm" and was integrated into my own arguments, to provide recommendations for action. Based on the combined analysis, I argue that "assisted self-harm" is justifiable in the shortterm as a means to reduce long-term harm, provided that five conditions are met. Thus, where the patient: is using self-injury primarily to manage distress; is injuring in a way which is associated with a low probability of physical damage (given the presence of appropriate support, such as advice on technique); possesses sufficient mental acuity after injury to engage with therapy; has an honest and open relationship with staff who are familiar with their history; and is capable of injuring in private, then "assisted self-harm" m.ay be an appropriate and effective approach.

This study aimed to investigate the qualitative nature of two different self-harm internet websites (professionally-led and user-led websites) using thematic content analysis (TCA). The second phase of the study posted questionnaires onto both websites to explore participants’ experiences of using self-harm websites and to investigate any relationships between the cultures of the websites and participants’ reports from the questionnaires. The second part of the questionnaire investigated individuals’ views regarding the type of professional support they would ideally like to receive for help with their self-harm. Particular interest was placed on respondents’ views on internet-based ‘professional’ help and whether they regarded it more or less beneficial than traditional face-to-face support (e.g. community mental health teams). The TCA revealed similar cultures between the professionally-led and user led self-harm websites and some subtle thematic differences. The majority of participants’ responses to the questionnaire revealed that they would favour internet based support for self-harm, moderated by both professionals and trained service-uses over face-to-face support. The limitations of the study were noted, with suggestions for future research. Finally, important implications of the research findings for service delivery were provided.

Increasing rates of self-injury in the United Kingdom coupled with the apparent lack of understanding, highlights a need for research to be conducted in this area. A dearth of research illuminating the experiences of self-cutting, together with increased awareness of the differences in perspective between people who self injure and professionals, also provides a rationale for this study. This study aims to explore the experiences of people who self-injure in order to identify and understand the processes involved in self-cutting, and develop a theory which aids this understanding. A grounded theory approach is used to meet the aim of the study, generating data through in-depth interviews with 10 people who engage in self-cutting. Participants shared their experiences of self-injury emphasising both the meaning and function of cutting for them, and the struggle they face living with the behaviour. Although the experiences of participants were unique to each individual, clear commonalities in experience emerged during data analysis and were explored with subsequent participants,in keeping with the grounded theory method. As data generation and analysis developed, the aim of the study became more focused, resulting in an exploration of the urge to self-injure and how people who engage in self-cutting respond to this urge. Findings relate to the core category, living with the urge and main categories of experience namely underlying urge, triggering the urge, satisfying the urge and resisting the urge. Discussion of the findings offers a substantive theory, asserting that people who self-injure face a paradox of finding it very difficult to live with self-cutting, while simultaneously facing the challenge of living without the behaviour. This paradox can be understood within the context of the core category, living with the urge, a process which begins before the participants start self injuring, continues while they are cutting, through to when they are trying to live without cutting. The discussion contributes knowledge relating to commonalties between self-cutting and the experience of addiction; issues for prevention; repetitive nature of cutting; the relationship between people who cut and their cutting tools; and ultimately highlights how difficult it is for the participants to break-free from the world of cutting. Implications of the findings for health and social care practitioners, and education and training are discussed, and recommendations for research are made.