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Harm minimisation for the management of self-harm: a mixed-methods analysis of electronic health records in secondary mental healthcare

Cliffe, C; Pitman, A; Sedgwick, R; Pritchard, M; Dutta, R; Rowe, S; (2021) Harm minimisation for the management of self-harm: a mixed-methods analysis of electronic health records in secondary mental healthcare. British Journal of Psychiatry Open , 7 (4) , Article e116. 10.1192/bjo.2021.946. Green open access

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Abstract

BACKGROUND: Prevalence of self-harm in the UK was reported as 6.4% in 2014. Despite sparse evidence for effectiveness, guidelines recommend harm minimisation; a strategy in which people who self-harm are supported to do so safely. AIMS: To determine the prevalence, sociodemographic and clinical characteristics of those who self-harm and practise harm minimisation within a London mental health trust. METHOD: We included electronic health records for patients treated by South London and Maudsley NHS Trust. Using an iterative search strategy, we identified patients who practise harm minimisation, then classified the approaches using a content analysis. We compared the sociodemographic characteristics with that of a control group of patients who self-harm and do not use harm minimisation. RESULTS: In total 22 736 patients reported self-harm, of these 693 (3%) had records reporting the use of harm-minimisation techniques. We coded the approaches into categories: (a) ‘substitution’ (>50% of those using harm minimisation), such as using rubber bands or using ice; (b) ‘simulation’ (9%) such as using red pens; (c) ‘defer or avoid’ (7%) such as an alternative self-injury location; (d) ‘damage limitation’ (9%) such as using antiseptic techniques; the remainder were unclassifiable (24%). The majority of people using harm minimisation described it as helpful (>90%). Those practising harm minimisation were younger, female, of White ethnicity, had previous admissions and were less likely to have self-harmed with suicidal intent. CONCLUSIONS: A small minority of patients who self-harm report using harm minimisation, primarily substitution techniques, and the large majority find harm minimisation helpful. More research is required to determine the acceptability and effectiveness of harm-minimisation techniques and update national clinical guidelines.

Type: Article
Title: Harm minimisation for the management of self-harm: a mixed-methods analysis of electronic health records in secondary mental healthcare
Open access status: An open access version is available from UCL Discovery
DOI: 10.1192/bjo.2021.946
Publisher version: https://doi.org/10.1192/bjo.2021.946
Language: English
Additional information: Creative Common License - CCCreative Common License - BY This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Self-harm, non-suicidal self-injury, harm minimisation, harm reduction
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/10130227
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