• Redefining the targets for mental illness

      Murdock, Debbie (1995)
      This article reviews the initiatives which have been developed in mental health services in an attempt to meet the targets set out in the government's Health of the Nation White Paper (1). The author argues that the targets for mental health were crudley defined and more funding is needed to address primary care problems which are currently badly neglected.
    • Lifetime risk of suicide in affective disorders

      Davies, Steffan (1998)
      Comments on the H. M. Inskip et al (see record 1998-00590-008) study on the lifetime risk of suicide for affective disorder, alcoholism, and schizophrenia. While Inskip et al propose that we revise the lifetime risk of suicide in patients with affective disorders from 15% to 6%, the current authors take this argument further, and suggest that this 6% mortality expectation should refer to patients from undefined catchment areas with 2 or more admissions for affective disorder. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Risk assessment and suicide prevention in primary care

      Milton, John; Ferguson, Brian G. (1999)
      General practitioners (GPs) are assumed to occupy an important position in the prevention of suicide through the introduction of risk assessment techniques commonly used in psychiatric practice. Despite this theoretical role for primary care services, it remains unclear how frequently GPs implement risk assessment in patients who may be vulnerable to suicide. To address this, a retrospective survey of probable suicides was conducted within a primary care setting utilizing a questionnaire of GPs who had experienced a patient suicide and was augmented by hospital and coroners' records. 85% of questionnaires were returned and 61 deaths were adjudged as suicides during the year long census period. 75% of suicides were male and 54% were aged under 35.28% were in contact with psychiatric services prior to death, although 60% had some diagnosis of mental disorder. GPs had little knowledge of a patient's life circumstances in up to half of cases. Recording of risk assessment occurred in 38% of subjects, was positively associated with prior psychiatric contact (p = 0.001) but negatively associated with presence of physical illness (p = 0.004), older patient age (p = 0.04), and GPs length in practice (p = 0.05). One GP felt their suicide case was preventable. The low rate of risk assessment and limited knowledge of patient lifestyle point to the need for active engagement of GPs in future suicide prevention strategies and should influence the content of training programs in primary care.
    • Childhood trauma, dissociation and self-harming behaviour: A pilot study

      Low, Gail; Jones, David; Duggan, Conor (2000)
      OBJECTIVE: Childhood trauma is known to be an important antecedent in those who engage in deliberate self-harm (DSH). We aimed to explore the mediating mechanisms between childhood trauma and subsequent DSH in a sample of women detained in a high secure setting.
    • The prevalence and frequency of deliberate self-harm among male patients in a maximum secure hospital

      Jackson, Neil (2000)
      Aims: This study was undertaken to ascertain the prevalence and frequency of deliberate self-harm (DSH) among male patients in a high security hospital, to determine whether males who harm themselves are younger than those who do not, and to determine whether the legal category of patients distinguished frequency of DSH. Background: This is the first study to examine whether such differences exist to a statistically significant extent among male patients in a maximum secure hospital. Previous studies on such female patients have found that those who engage in DSH are significantly younger and have had significantly shorter length of stay in the institution than those who do not. Additionally, the frequency of DSH by female patients with psychopathic disorder has been found to be significantly greater than that by those with mental illness. Method: Nursing daily ward report books were examined on four wards for a 30-month period. Results: In a sample of 127 male patients at Rampton Hospital in England, 24 (19% of the sample) engaged in deliberate self-harm. In total, 122 incidents of DSH occurred during the study period. Five patients (4% of the sample) contributed 82 incidents between them (67% of the total). Patients who engaged in DSH were significantly younger than those who did not. This was true for the entire sample considered together, regardless of their Mental Health Act (1983) classification and for patients solely with mental illness and those solely with psychopathic disorder. Although the period of time since admission to the hospital was shorter for those who engaged in DSH, it was not so to a significant extent. There were no differences between the frequency of DSH by psychopathic disorder patients and that by those with mental illness.
    • The treatment of deliberate self-harm in borderline personality disorder using dialectical behaviour therapy: A pilot study in a high security hospital

      Low, Gail; Jones, David; Duggan, Conor (2001)
      Deliberate self-harm (DSH) presents a significant health problem, especially as treatments have not been particularly successful in reducing repetition. Dialectical behaviour therapy (DBT; Linehan, 1993) is one approach that has reported some success in reducing self-harm rates in borderline personality disorder patients, who self-harm frequently, though it remains largely untested outside its original setting. The present study aimed to assess the effectiveness of DBT in self-harming women in an institutional setting in the United Kingdom where self-harm is common. Female patients at Rampton Hospital who were displaying self-harming behaviour and met criteria for borderline personality disorder (N = 10) participated in the full one-year treatment package of DBT. Patients were assessed on self-harm rates and on a number of psychological variables, pre-, during- and post-therapy, including a 6-month follow-up. There was a significant reduction in DSH during therapy, which was maintained at 6-month follow-up. This was paralleled by a reduction in dissociative experiences and an increase in survival and coping beliefs, alongside improvements in depression, suicide ideation, and impulsiveness. The findings are preliminary but the results suggest that DBT might provide an effective treatment for severe self-harm in institutional settings, and also highlight some of the psychological mechanisms that might mediate these improvements in self-harming behaviour.
    • Dialectical behaviour therapy as a treatment for deliberate self-harm: Case studies from a high security psychiatric hospital population

      Low, Gail; Duggan, Conor (2001)
      Deliberate self-harm has recently assumed increasing importance in outpatient clinics, accident and emergency units, and psychiatric settings. One approach that has been shown to be effective in randomly controlled clinical trials is Dialectical Behaviour Therapy (DBT; Linehan, 1993). DBT is a cognitive-behavioural approach developed for Borderline Personality Disorder, the criteria of which include suicidal attempts, threats and gestures, as well as impulsive behaviour, including deliberate self-harm. We assessed the efficacy of DBT in a high security psychiatric setting, where deliberate self-harm is particularly common among the women patients. From the group of patients who participated in the therapy (N = 15), three cases were identified which illustrate the application of DBT, and which highlight specific strategies and their uses in different situations. Specific strategies which were most useful involved the skills training of Distress Tolerance, and Emotion Regulation. DBT is an holistic approach, addressing problematic thoughts as well as behaviour, and the package of skills taught can be considered particularly useful in regulating emotions and alleviating some of the distress experienced by individuals who engage in this behaviour. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Self-harm in young people: A perspective for mental health nursing care

      Armstrong, Marie (2004)
      Aim: This paper addresses the assessment and management of self-harm in young people by a nurse consultant-led self-harm service in the UK. The purpose of the paper is to present some of the theoretical perspectives of the service and how these have influenced current practice with this group of young people. Background: Self-harm in young people continues to be a serious concern for health services globally. Rates of self-harm in teenagers in the UK are among the highest in Europe. The current literature offers information on the nature of self-harm and some evidence of specific interventions mainly from a 'psychiatric perspective'. This paper examines the development of a locally based nurse-led self-harm team involved in the care of this group of young people. A sociological view of children and young people is applied in examining the way society construes self-harm and the formation of the behaviour as a deviant act. Self-harm is considered in the context of transition through adolescence and the growth of self-identity. Conclusion: The locally based child and adolescent mental health service has drawn together the evolving nurse consultant role, mental health nursing and medical sociology. This integration of people and theory will enhance the services understanding of self-harm in young people. At an international level, there is a need to consider the sociological dimensions of self-harm in young people as a way forward for mental health nurses who are involved in working with this group of people.
    • Repeated self-wounding: Women's recollection of pathways to cutting and of the value of different interventions

      Huband, Nick (2004)
      Background: More information is needed on the processes that result in self-wounding and how these are modulated by the selection and delivery of interventions available to those working in non-specialist settings.; Methods: Ten women participated in a semi-structured interview where they recalled their experiences of cutting and the helpfulness of specific interventions. Transcripts of these self-reports were analysed using grounded theory methods.; Results: Having a long-term relationship with a key worker and being encouraged to express feelings were viewed as the most helpful strategies, whereas relaxation was often reported as making self-injury worse. The helpfulness of a given intervention was reduced when delivered by someone perceived as underconcerned, overprotective or incompetent. Two pathways to self-wounding were identified: cutting may result when there is a steady increase of tension until a threshold is reached (the 'spring' path), or as a result of the 'switching on' of the impulse (the 'switch' path). Dissociation during cutting and a craving for cutting were more often associated with switching to the impulse. Different management strategies are called for when the switch path has developed, which appears particularly the case for individuals who have been repeatedly self-wounding over a substantial period of time.;
    • The challenge of suicide prevention: An overview of national strategies

      Anderson, Martin (2005)
      Suicide is a global phenomenon. It is estimated that 0.5-1.2 million people worldwide die by suicide each year. Taking into account the global epidemiologic data concerning suicide and the economic impact of this phenomenon on diverse societies, this review aims to examine national suicide prevention strategies. Recognition of suicide as an international public health problem, increased reporting by countries on suicide rates to the WHO, and recognition of the costs (associated with suicide) to society have been crucial influences on the establishment of national strategies. Past reviews on national suicide prevention strategies highlight the fact that those countries with established national strategies share a number of themes relating to intervention. These are grounded in international guidance on suicide prevention and accepted epidemiologic and treatment-based research. This paper highlights comparative rates of suicide around the world, explores the economic implications of suicide and the nature of specific established national strategies for prevention. This paper highlights the urgency for the development of national suicide prevention strategies in all countries. Clearly, countries can learn from each other and integrate established, shared themes. It is argued that nations need to move towards nation-specified prevention strategies with effective structures for research, monitoring, and evaluation. This has been seen in countries such as Finland and New Zealand, where strategies have been effective in building inter-agency working and so benefiting different stake-holders. © 2005 Adis Data Information BV. All rights reserved.
    • Self-harm, young people and nursing

      Armstrong, Marie (2006)
      Nurses in schools, hospitals, prisons and community settings may come into contact with children and young people who harm themselves. This chapter explores some of the myths and realities about self-harm and uses an evidence-based framework to guide nurses who are required to assess, treat and support such children in both frontline services and residential settings. Self-harm is heterogeneous, which means it that it means different things to different people, therefore current evidence for the assessment of self-harm and clinical interventions are discussed. The development of mental health nursing in relation to self-harm is also described here and case vignettes are used to illustrate the different ways in which self-harm is understood and how a variety of nursing interventions can be used to meet young people's needs.
    • The national suicide prevention strategy for England: The reality of a national strategy for the nursing profession

      Anderson, Martin (2006)
      Suicide is recognized as a global phenomenon and many countries now have national suicide prevention strategies. International guidance on suicide prevention and accepted epidemiological and treatment-based research underpins healthcare policy relating to suicide reduction. There has been an established comprehensive strategy in England since 2002. However, the rate of suicide continues to be a concern and nurses hold a key role in the implementation of national, regional and local policy into practice. The aim of this paper is to consider the current implications of the national suicide prevention strategy in England for nursing. This discussion paper draws upon both empirical evidence-based literature, governmental guidance and policy-related documentation. The national suicide prevention strategy for England currently continues to have a multifaceted impact on the nursing profession. This ranges from clinical practice issues such as risk assessment through to broader public health responsibilities. If nurses and allied health professionals are to be effective in their role within suicide prevention, they will need to be supported in building awareness of the wider context of the national policy. In particular, this will mean working effectively and collaboratively with the voluntary sector, service users and other non-medical agencies.
    • The prediction of imminent aggression and self-harm in personality disordered patients of a high security hospital using the HCR-20 Clinical Scale and the Dynamic Appraisal of Situational Aggression

      Daffern, Michael; Howells, Kevin (2007)
      Drawing on recent advances in the violence risk assessment literature, this study tested the predictive validity of two structured measures designed to support risk related decision making, the HCR-20 and the Dynamic Appraisal of Situational Aggression (DASA), for the prediction of imminent aggression and self-harm in personality disordered patients of a high secure psychiatric hospital. For four months nursing staff completed daily assessments of patients using the DASA and the Clinical scale items from the HCR-20. On the following day they documented whether patients had behaved aggressively and/or self-harmed. Results revealed modest predictive validity, significantly better than chance, for both the prediction of imminent self-harm and aggression for both measures. Furthermore, these results suggest that personality disordered patients in a negative psychological state characterized by irritability, impulsivity and disagreeableness are at an increased risk of aggression and self-harm during involuntary psychiatric inpatient treatment and that this state is sensitive to structured risk assessment. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Self-harm in first-episode psychosis

      Lloyd, Tuhina (2008)
      Background: Little is known about self-harm occurring during the period of untreated first-episode psychosis. Aims: To establish the prevalence, nature, motivation and risk factors for self-harm occurring during the untreated phase of first-episode psychosis. Method: As part of the ÆSOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study, episodes of self-harm were identified among all incident cases of psychosis presenting to services in south-east London and Nottingham over a 2-year period. Results: Of the 496 participants, 56 (11.3%) had engaged in self-harm between the onset of psychotic symptoms and first presentation to services. The independent correlates of self-harm were: male gender, belonging to social class I/II, depression and a prolonged period of untreated psychosis. Increased insight was also associated with risk of self-harm. Conclusions: Self-harm is common during the pre-treatment phase of first-episode psychosis. A unique set of fixed and malleable risk factors appear to operate in those with first-episode psychosis. Reducing treatment delay and modifying disease attitudes may be key targets for suicide prevention. Suicide is the main cause of premature death among individuals with schizophrenia.1 There is some evidence that the risk factors for self-harm may be different for those with schizophrenia compared with other groups.2 In addition, there is some emerging evidence that risk factors for self-harm may alter during the course of a psychotic illness.3, 4 It is well established that suicidal behaviour is more common during the early phases of a psychotic illness.5 The period between the onset of psychotic symptoms and an individual’s first contact with services may be a time of particularly high risk,4 although few studies have examined this period in detail. In this study we aimed to describe both the frequency and the nature of self-harm in individuals presenting with psychosis for the first time, and to investigate whether there were any identifiable pre-treatment differences between those who engaged in self-harm and those who did not. We aimed to specifically focus on self-harm that occurred during the period between the onset of psychotic symptoms and an individual’s first presentation to services.
    • Self-harm among UK female prisoners: A cross-sectional study

      Vollm, Birgit A. (2009)
      Psychiatric morbidity and suicide rates in prisoners are high. The detection of mental illness and its associated risks in prison are low. The aim of this study was to ascertain the prevalence of psychiatric symptomatology, needs and self-harming behaviour among UK female prisoners and to identify differences between individuals with and without a history of self-harm. We conducted a cross-sectional study including 638 female prisoners from two prisons in the North-West of England. Outcome measures used were the Prison Screening Questionnaire (PriSnQuest), a questionnaire on self-harming behaviour and suicidal ideation and the Camberwell Assessment of Need ? Forensic Version (CANFOR). 241 women (37.8%) screened positive on the PriSnQuest; 281 women (45.9%) had a history of self-harm. An average of 8.5 needs was identified with more than half of those needs classified as unmet. Differences between women with and without history of self-harm were identified on offending history, PriSnQuest scores and the CANFOR total and unmet needs. Previous contact with a psychiatrist, total and symptoms of depression on the PriSnQuest were independently associated with a history of self-harm. This study confirmed that the prevalence of psychiatric symptomatology and self-harm in female UK prisoners is high. Individuals at risk of self-harming behaviour may be identified using screening questionnaires.
    • Self-harm and aggression in dangerous and severely personality disordered patients of a high-security hospital

      Daffern, Michael; Howells, Kevin (2009)
      This study examined the frequency, prevalence and co-occurrence of aggression and self-harm in patients admitted for assessment and treatment to a high-security dangerous severe personality disorder (DSPD) hospital. Results showed that most patients admitted to this unit were aggressive and many patients self-harmed during the period of study. Few patients were neither aggressive nor self-harming. Patients who self-harmed and behaved aggressively were typically aggressive before their first episode of self-harm, and the likelihood of self-harm seemed to increase during the later stages of their hospital stay. Possible explanations for these findings are offered. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Self-harm in a dangerous and severely personality disordered population

      Mannion, Aisling (2009)
      The present paper reports on a total of 309 incidents of self-harm recorded between October 2004 and September 2007, for a group of male patients deemed to be dangerous and severely personality disordered (DSPD), within the Peaks Unit at Rampton high security hospital. The first part of this paper describes self-harm within this group of patients, to see whether, as well as posing danger to the public, these patients also pose a risk of harm to themselves. Second, the paper investigated the antecedents of the self-harm incidents recorded. Finally, statistical analyses were conducted to assess the relationships between self-harm and patient/environmental characteristics. No significant differences were found between those who self-harmed and those that did not, although some differences were found within the self-harming group. Implications for future research and treatment are discussed.
    • Self-harm in women's secure services: Reflections and strategies for treatment design

      Lawday, Rebecca (2009)
      This chapter will provide some background to the development of specialist services for women in secure healthcare. It will consider what we mean by "enhanced" medium secure care, and present the overarching "treatment stage" model that the author and her colleagues are in the early stages of applying in their service. It will present considerations as to specific treatment needs, multiprofessional working and integrating approaches as well as discuss responsivity factors such as engagement, the importance of therapeutic relationships and the process of change, especially in relation to self-injury. Self-injury is a common problem for women in this service and was in the minds of the author and her colleagues when they designed it. While not focusing on it exclusively, the treatment program is intended to address the underlying difficulties that give rise to self-harming behavior and feelings. A client has contributed two sections to this chapter, giving her perspective on the development of services for women and her own insights into self-injury within such services. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(chapter)
    • Suicidal behaviour among psychiatric inpatients

      Thangavelu, Karthik (2010)
      Deliberate self-harm is a serious issue that health professionals constantly try to prevent. This article examines the case notes and psychosocial assessments of 37 patients in the psychiatric ward of a district general hospital who have attempted self-harm. It finds that the most common final trigger in these incidents appears to be interpersonal difficulties and suggests some feasible measures to prevent self-harm incidents in these circumstances.