The characteristics of inpatient self harm, and the perceptions of nursing staff

Student thesis: Doctoral ThesisDoctor of Philosophy


Background: Self harm is an increasingly common behaviour, associated with poor mental health, and an increased risk of death by suicide and other causes. It is one of the principle reasons for admission to inpatient psychiatric services, however very little is known about self harm on wards.
Aims: This thesis set out to address a number of gaps in the literature identified following a systematic review of studies of inpatient self harm. Main aims were to describe the characteristics of self harming behaviour within a national sample of services, and to investigate perceptions of self harm and views of harm minimisation practices amongst inpatient nursing staff.
Methods: Aims were addressed in two studies using a mixed methods approach. Study 1 investigated the characteristics of self harming behaviour within inpatient mental health services across the UK, through a cross-sectional documentary analysis of incident reports. Study 2 was a sequential explanatory study of nursing staff attitudes towards self harm, composed of two phases; Phase I measured staff attitudes and their relationship to staff characteristics, using the Self Harm Antipathy Scale, and Phase II was a qualitative interview study of staff understandings of self harm.
Results: Inpatient self harm was more frequent within acute vs forensic services, largely took place in the private areas of the ward, during the evening hours, and constituted a wide range of behaviours of which cutting was the most common. Inpatient nursing staff generally demonstrated positive attitudes towards self harm, however being a healthcare assistant, or from a non-white ethnic group were associated with more negative attitudes, as were lower SF-36 scores. Staff differentiated between acts of ‘self harm’ and ‘attempted suicide’ using a wide range of criteria which differed between individual participants. Views of harm minimisation practices were mixed.
Conclusions: Specialist training in mental health would be beneficial to all practitioners working with people who self harm, and should particularly focus on the interpersonal reasons for self harm. Amongst culturally diverse teams of staff there are likely to be multiple understandings of self harm, and those from high religiosity minority ethnic backgrounds may be less accepting of the behaviour. Use of the term ‘attempted suicide’ is problematic and should be avoided. A harm minimisation approach, whilst potentially beneficial to service users, will present significant challenges to some nursing staff.
Date of Award2017
Original languageEnglish
Awarding Institution
  • King's College London

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