Self-harm: from risk management to relational and recovery-oriented care

Publication Date08 Jan 2018
AuthorJean Morrissey,Louise Doyle,Agnes Higgins
SubjectHealth & social care,Mental health,Mental health education
Self-harm: from risk management to
relational and recovery-oriented care
Jean Morrissey, Louise Doyle and Agnes Higgins
Purpose The purpose of this pape r is to examine the discou rses that shape nursesun derstanding
of self-harm and explore st rategies for working w ith people who self-harm i n a relational and a
recovery-oriented manner.
Design/methodology/approach Self-harm is a relatively common experience for a cohort of people who
present to the mental health services and is, therefore, a phenomenon that mental health nurses will be
familiar with. Traditionally, however, mental health nursesresponses to people who self-harm have been
largely framed by a risk adverse and biomedical discourse which positions self-harm as a symptomof a
diagnosed mental illness, most often borderline personality disorder.
Findings This has led to the development of largely unhelpful strategies to eliminate self-harm, often in the
absence of real therapeutic engagement, which can have negative outcomes for the person. Attitudes
towards those who self-harm amongst mental health nurses can also be problematic, particularly when those
who hurt themselves are perceived to be attention seeking and beyond help. This, in turn, has a negative
impact on treatment outcomes and future help-seeking intentions.
Research limitations/implications Despite some deficiencies in how mental health nurses respond to
people who self-harm, it is widely recognised that they have an important role to play in self-harm prevention
reduction and harm minimisation.
Practical implications By moving the focus of practiceaway from the traditional concept of risktowards
co-constructed collaborative safety planning, mental health nurses can respond in a more embodied
individualised and sensitive manner to those who self-harm.
Originality/value This paper adds further knowledge and understanding to assist nursesunderstanding
and working with people who self-harm in a relational and a recovery-oriented manner.
Keywords Engagement, Risk, Self-harm, Recovery
Paper type Conceptual paper
Contemporary mental health policies articulate the need for services to be driven by the
principles of quality and safety (Higgins et al., 2016). In the context of safety and risk, self-harm
has become a major health issue and a cause of concern internationally (Fleischmann and
Shekhar, 2013). Mental health nurses are at the frontline of service provision and are likely to
encounter in almost every practice setting people who may have thoughts of self-harming and/or
engaged in self-harming behaviour. They are therefore in a pivotal position to utilise their
knowledge and skills to support people who present with self-harm and as such have an
important role to play in self-harm prevention, reduction and harm minimisation. People who
self-harm experience many needs and challenges related to their emotional distress. A positive
and open attitude by nurses is critical, if they are to engage with the person in a manner that
supports and promotes the persons safety and recovery (Morrissey, 2015). However, how
nurses conceptualise and think about self-harm strongly influences their action, interactions and
the strategies they use to support people (Higgins et al., 2015), which in turn impacts on the
persons treatment, recovery and safety outcomes. This paper aims to examine the discourses
that shape nursesunderstanding of self-harm and explores strategies for working with people
who self-harm in a relational and recovery-oriented way.
Received 15 March 2017
Accepted 14 June 2017
Jean Morrissey is an Assistant
Professor, Louise Doyle is an
Assistant Professor in Mental
Health Nursing and Agnes
Higgins is a Professor in Mental
Health Nursing, all at the School
of Nursing & Midwifery,
University of Dublin Trinity
College, Dublin, Ireland.
VOL. 13 NO. 1 2018, pp.34-43, © Emerald Publishing Limited, ISSN 1755-6228 DOI 10.1108/JMHTEP-03-2017-0017

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