Harm minimisation for self-harm: a cross-sectional survey of British clinicians' perspectives and practices.

Autor:	Haris AM; Division of Psychiatry, University College London, London, UK., Pitman A; Division of Psychiatry, University College London, London, UK.; Camden and Islington NHS Foundation Trust, London, UK., Mughal F; School of Medicine, Keele University, Keele, UK.; Affiliate, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, Greater Manchester, UK., Bakanaite E; Division of Psychiatry, University College London, London, UK., Morant N; Division of Psychiatry, University College London, London, UK., Rowe SL; Division of Psychiatry, University College London, London, UK s.rowe@ucl.ac.uk.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2022 Jun 03; Vol. 12 (6), pp. e056199. Date of Electronic Publication: 2022 Jun 03.
DOI:	10.1136/bmjopen-2021-056199
Abstrakt:	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. Competing Interests: Competing interests: FM is a member of the current National Institute for Health and Care Excellence Self-harm Clinical Guideline Development Committee. FM was Royal College of General Practitioners (RCGP) Clinical Fellow in mental health 2015-20 and has received research grant funding from National Institute for Health and Care Research (NIHR), NIHR School for Primary Care Research and RCGP Scientific Foundation Board for self-harm in primary care. FM is a member of the expert reference group advising on community and primary care self-harm services in the National Health Service. (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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