Research that explores the relationship between suicide and self-injury is limited, and the lack of clarity surrounding this topic can present challenges for professional counselors. Although persons who self-injure are at an increased risk for suicide (e.g., Toprak, Cetin, Guven, Can, & Demircan, 2011; Chapman & Dixon-Gordon, 2007), not all individuals who engage in self-injurious behaviors attempt or complete suicide (e.g., Hawton & Harriss, 2008; Howson, Yates, & Hatcher, 2008). Research on common and distinct risk factors for suicide and self-injury (e.g., Andover, Primack, Gibb, & Pepper, 2010; Brausch & Gutierrez, 2010; Greydanus & Apple, 2011; Hawton & James, 2005; Lloyd-Richardson, Perrine, Dierker, & Kelley, 2007; Toprak et al., 2011; Wichstrom, 2009), as well as emotional antecedents and consequences for suicide and self-injury (e.g., Chapman & Dixon-Gordon, 2007), has contributed to our understanding of this complex relationship. However, the specific nature of the relationship remains unclear. This study serves to help fill the gap in the literature by examining advanced professional counselors’, as measured by the Supervisee Levels Questionnaire-Revised, conceptualizations of the relationship between suicide and self-injury and by exploring how the presence of self-injury impacts clinical assessment and interventions. Data was collected by means of an online survey. Analysis was conducted by a research team using qualitative content analysis. Seven categories emerged, including: relationship between suicide and self-injury, functions of self-injury, associated risk, suicide risk assessment, treatment planning and goals, intervention, and identification of self-injury.

The thesis will examine the harm principle, as originally described by John Stuart Mill. In doing so, it will defend that, though unintended, the harm principle may justify several principles of distributive justice. To augment this analysis, the paper will examine several secondary authors’ interpretations of the harm principle, including potential critiques of the thesis itself.

Place is not a static backdrop for social relationships; rather, it is a dynamic product of the interactions among the people, practices, objects, and representations contained within it. Often, street-involved people who use drugs are excluded from interactions that would otherwise allow them to participate in community dynamics. In Vancouver, British Columbia, peer-based outreach groups redress these barriers by providing low-threshold positions to individuals living with active or past addiction. The overall question of this thesis is: what is the role of place in the health of an individual and of a community? Objectives include: (1) applying existing models of social exclusion to outline barriers preventing Peer Members from engaging in placemaking; (2) mapping the ideological positionality of the Peer Members and the rest of the community with regard to citizenship; and (3) exploring how Peer Members utilize their biosocial role as outreach workers to establish social capital and situate themselves as participants in a healthy community. By providing a platform where various social identities can interact with one another, ties of familiarity are established between these groups, thus enabling the transfer of resources, knowledge, and shared norms of respect. The first half of the discussion focuses on how social and geographic displacement legitimizes the process of social abandonment. Consequently, this relegated the Peer Members and their peers into the role of anti-citizen, rationalized their marginalization, and reinforced the wider community’s stigma toward people who use drugs. The latter half of the discussion illustrates how the Peer Members utilize their biosocial role of outreach and support workers to navigate boundaries and establish social connections to circulate knowledge and information within and among different social fields. This enabled the expression of mutual reciprocity, thereby negotiating the place of people who use drugs and harm reduction among the wider community. Place is therefore a concept that shapes, and is shaped by, the social networks that determine social legitimacy or illegitimacy. Although marginality and oppression cannot be transformed immediately, creating a social environment where Peer Members can be supported and support one another helps mitigate the marginalization that characterizes their lives.

This thesis in an invistigation into the concept of "harm" and its moral relevance. A common view is that an analysis of harm should include a counterfactual condition: an act harms a person iff it makes that person worse off. A common objection to the moral relevance of harm, thus understood, is the non-identity problem. This thesis criticises the counterfactual condition, argues for an alternative analysis and that harm plays two important normative roles. The main ground for rejecting the counterfactual condition is that it has unacceptable consequences in cases of overdetermination and pre-emption. Several modifications to the condition are considered but all fail to solve this problem. According to the alternative analysis to do harm is to perform an act which (1) is responsible for the obtaining of a state of affairs which (2) makes a person’s life go worse. It is argued that (1) should be understood in terms of counterfactual dependence. This claim is defended against counterexamples based on redundant causation. An analysis of (2) is also provided using the notion of a well-being function. It is argued that by introducing this notion it is possible to analyse contributive value without making use of counterfactual comparisons and to solve the non-identity problem. Regarding the normative importance of harm, a popular intuition is that there is an asymmetry in our obligations to future people: that a person would have a life worth living were she to exist is not a reason in favour of creating that person while that a person would have a life not worth living is a reason against creating that person. It is argued that the asymmetry can be classified as a moral option grounded in autonomy. Central to this defence is the suggestion that harm is relevant to understanding autonomy. Autonomy involves partly the freedom to pursue one’s own aims as long as one does no harm.

This is a qualitative study aiming to illuminate and gain better understanding of deliberate self-harm. The study has a narrative perspective and is based on three women’s life stories, focusing on a period when they had an active self-harming behaviour. The study examines what the participants experienced as important to the initiation and the cessation of the deliberate self-harm. It is also examining identity performances and turning points which can be discerned in the life stories. The analysis is based on theories of the narrative perspective and on Erving Goffman's dramaturgical perspective. Our conclusions are that the participants of the study at the time prior to the self-harming behaviour felt as outsiders, and that they lacked strategies for dealing with emotions. We also found that functional relationships had an important role for the participants to enable the cessation of the deliberate self-harming behaviour. At the time when the participants managed to end the self-harming behaviour, they all had developed more functional relationships and did not feel the same alienation. They also feel that they have a different identity now than they had during the period of deliberate self-harm.         Keywords: Deliberate self-harm, identity performances, turning points, narrative   Nyckelord: Självskadebeteende, identitetsuttryck, vändpunkter, narrativ

Ett lågtröskelboende vänder sig till individer med missbruks- och boendeproblematik där intentionen är att erbjuda individen stöd i dennes alkoholproblematik samt en trygghet i boendet utan att ställa krav på nykterhet. Studiens syfte var att undersöka fenomenet: upplevelsen av att bo på ett lågtröskelboende utifrån ett brukarperspektiv, samt vad flytten till lågtröskelboendet har inneburit för de boendes livskvalitet. I analysen användes ett fenomenologiskt perspektiv med livsvärldsteorin som utgångspunkt. Resultatet visar studiens fenomen som existentiell samhörighet i alkoholmissbruk. Den delade alkohol- och boendeproblematiken gör att de boende upplever sig som jämlika med varandra, vilket också skapar en känsla av gemenskap och tillhörighet. Studien visar att alkoholkonsumtion, trots acceptans av alkoholbruk inom boendet, upplevs av de boende som om den minskar. Resultatet har betydelse för hur lågtröskelboenden kan utvecklas för att göra en än bättre anpassning till de boendes behov. / A low-threshold-home is a home for individuals that are struggling with alcohol addiction problems and finding it hard to find a place to stay. The intention of the home is to offer the residents support in their struggle with alcohol, and a safe place to stay, without putting pressure on the person to stay sober. The purpose of the study was to see how the individuals are coping with living at the low-threshold home and still struggling their addiction, and how the move there has changed their quality of life. A phenomenological perspective of theory of life has been used in the analysis and the results show an existential connection between the men in their alcohol-addiction. Because of their shared alcohol- and accommodation problems with addiction, the individuals feel a unity between them that creates understanding. The study shows by experiences by the residents that the acceptance of alcohol within this low-threshold-home in many cases leads to less consumption of alcohol. That is important and useful when trying to improve these low-threshold-homes even more in the future for the individuals living there.

In this study the aim is to examine how employees in treatment programmes relate to girls that self-harm. To achieve this four questions were formulated: (1) What experiences does the empolyees have of meeting girls that self-harm? (2) Based on the employees’ experiences, what has been the background to why the girls self-harm? (3) Based on the employees’ experience, what increases or decreases the risk of self-harm? (4) How do the employees’ work with girls that self-harm? The method being used was qualitative interviews with vignettes. The theoretical framework is Becker’s Labeling Theory and Bronfenbrenner’s Ecology of Human Development. The result shows that according to the employees issues in the family is a common factor among girls that self-harm. It also shows that the employees’ opinions on how to work with the girls’ physical wounds are divided. Some think that paying attention to the wounds can increase the risk of self-harm while others think that paying attention to the wounds can be helpful for the girls.

The aim of this literature review was to elucidate how suicidal and self-harming patients should be treated and cared for, mainly in the acute phase in somatic care. Searches were conducted in databases with relevant keywords. Qualitative and quantitative articles were included, would not be more than 20 years, be written in Swedish or English, and match the aim of the study. Results showed that nurses and patients felt that the treatment would be respectful, non-judgmental and characterized by active listening and clear communication. Poor care was described as disrespect and lack of understanding. Staff and relatives experienced a lack of knowledge in the subject. Difficulties staff experienced in taking care of these patients were aggressive patients, a feeling of loss of control and unclear guidelines. Staff attitudes towards patients were generally positive, and various factors of the staff affected their attitudes. The most prominent factors were age and education. Conclusion was that good treatment is emphasized by respect, confidence, knowledge, openness, and a clear communication. Bad treatment was characterized by uncertainty, stress and disrespect. It´s important that staff receive appropriate training in the subject, as this alters their attitudes from negativity, stigmatization and uncertainty to understanding, empathy and safety.

This study is of a qualitative phenomenological approach. Its background lies in recent reports that show the problem of self-harm increasing among adolescents. The intent of the study was to highlight school counselors’ view of self-harm, and their experiences of meeting self-harm through their work. Six school counselors, all employed in secondary school, have participated in semi-structured interviews. Data from these interviews have been categorized into themes named Girl Cutters, Waves, Meeting Self-harm, and Responsibility. These where analyzed according to a social constructionist approach and have been compared to previously known research. Results show that several of the school counselors defined self-harm as girls who cut themselves. It is also described that self-harm occurs in time-periods for groups of pupils, described as waves. A number of school counselors divided girls who self-harm in to two categories, depending on how severe it is considered to be. Several of the school counselors described that school take on a high responsibility for mental health among adolescents, more then they are legally responsible for. School counselors described signals for development of self-harm problems as over all changes in the pupils general behavior.

SAMMANFATTNING Vårdpersonal möter patienter med självskadebeteende på olika avdelningar inom sjukvården. Vårdpersonalen har ofta svårt att bemöta denne patientgrupp eftersom de trots allt vårdar patienterna efter bästa förmåga ändå skadar sig igen. Detta väcker frustration och negativa känslor som vrede och mindre sympati för dessa patienter. Oftast är det unga kvinnor som lindrar sin ångest med att skada sig själva medan unga män oftare väljer att vara våldsamma eller aggressiva. Syftet med studien var att belysa vårdpersonalens uppfattning och bemötande av patienter med självskadebeteende. Metoden är en artikelgranskning. Resultatet visade att det är viktigt att vårdpersonal ser, förstår och bemöter patienterna med respekt för att de skall få ett bättre självförtroende. Varje person är unik och en egen individ. Det är därför viktigt att se bakom självskadande för att se till varje persons behov och förstå att det oftast är andra problem som ligger bakom självskadandet. Vårdpersonal med utbildning till att vårda patienter med självskadebeteende är bättre på att ta hand om dessa patienter än personal utan utbildning. Mera kunskap och utbildning om självskadandet skulle hjälpa personal till att upptäcka problemet tidigare. Vården skulle då bli bättre och kanske kortare för patienter med självskadebeteende.