Harm minimisation for self-harm: a cross-sectional survey of British clinicians’ perspectives and practises

Haris, Aishah Madinah; Pitman, Alexandra; Morant, Nicola; Rowe, Sarah L.; Mughal, Faraz; Bakanaite, Evelina

Abstract

Objective Harm minimisation for self-harm is an alternative to preventive strategies and focuses on maximising safety when self-harming. We explored the views of clinicians on harm minimisation for self-harm to describe reported use and acceptability in clinical practice. Design A cross-sectional study using an online survey consisting of fixed-choice and open-ended questions. Setting Primary and secondary care practices in England, Scotland and Wales. Participants Snowball sampling of UK-based clinicians (n=90; 67% female) working with people who self-harm and who have or have not previously recommended harm minimisation methods to patients. Results Of the 90 clinicians sampled, 76 (84%) reported having recommended harm minimisation techniques to people in their care who self-harm. Commonly recommended techniques were snapping rubber bands on one's wrist and squeezing ice. Other techniques, such as teaching use of clean instruments when self-harming, were less likely to be recommended. Perceived client benefits included harm reduction and promotion of the therapeutic relationship. Perceived potential limitations of a harm minimisation approach for self-harm were (a) potential worsening of self-harm outcomes; (b) ethical reservations; (c) doubts about its effectiveness and appropriateness; and (d) lack of training and clear policies within the workplace. Conclusions In our sample of UK-based clinicians in various settings, harm minimisation for self-harm was broadly recommended for clients who self-harm due to perceived client benefits. However, future policies on harm minimisation must address clinicians' perceived needs for training, well-defined guidelines, and clear evidence of effectiveness and safety to mitigate some clinician concerns about the potential for further harm.

Citation

Haris, A. M., Pitman, A., Morant, N., Rowe, S. L., Mughal, F., & Bakanaite, E. (2022). Harm minimisation for self-harm: a cross-sectional survey of British clinicians’ perspectives and practises. BMJ Open, 12(6), Article ARTN e056199. https://doi.org/10.1136/bmjopen-2021-056199

• Journal Article Type: Article
• Acceptance Date: Apr 29, 2022
• Online Publication Date: Jun 3, 2022
• Publication Date: Jun 3, 2022
• Journal: BMJ Open
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 12
• Issue: 6
• Article Number: ARTN e056199
• DOI: https://doi.org/10.1136/bmjopen-2021-056199
• Keywords: qualitative research; mental health; suicide & self-harm
• Publisher URL: https://bmjopen.bmj.com/content/12/6/e056199