scholarly journals Balancing costs and benefits: a clinical perspective does not support a harm minimisation approach for self-injury outside of community settings

2017 ◽  
Vol 43 (5) ◽  
pp. 324-326 ◽  
Author(s):  
Hanna Pickard ◽  
Steve Pearce
Keyword(s):  
Clinical Perspective ◽  
Community Settings ◽  
Costs And Benefits ◽  
Harm Minimisation ◽  
Self Injury

scholarly journals Sometimes, not always, not never: a response to Pickard and Pearce

2017 ◽  
Vol 44 (3) ◽  
pp. 209-210 ◽  
Author(s):  
Patrick J Sullivan
Keyword(s):  
Healthcare Professionals ◽  
Clinical Perspective ◽  
Community Settings ◽  
Costs And Benefits ◽  
Ongoing Debate ◽  
Harm Minimisation ◽  
Self Injury

This paper provides a response to Hanna Pickard and Stephen Pearce’s paper ‘Balancing costs and benefits: a clinical perspective does not support a harm minimisation approach for self-injury outside of community settings.’ This paper responded to my article ‘Should healthcare professionals sometimes allow harm? The case of self-injury.’ There is much in the paper that I would agree with, but I feel it is important to respond to a number of the criticisms of my paper in order to clarify my position and to facilitate ongoing debate in relation to this important issue.

Gaining Clinical Perspective on Self-Injury

PsycCRITIQUES ◽  
2017 ◽  
Vol 62 (47) ◽  
Author(s):  
Andrew Nocita
Keyword(s):  
Clinical Perspective ◽  
Self Injury

scholarly journals Harm minimisation after repeated self-harm: development of a trust handbook

2008 ◽  
Vol 32 (2) ◽  
pp. 60-63 ◽  
Author(s):  
Nicky Pengelly ◽  
Barry Ford ◽  
Paul Blenkiron ◽  
Steve Reilly
Keyword(s):  
The Self ◽  
Service Users ◽  
Harm Minimisation ◽  
Suicidal Intent ◽  
Self Help ◽  
Self Injury ◽  
Safe Limits ◽  
Self Harm ◽  
Voluntary Organisations ◽  
Effective Treatments

Repeated self-harm without suicidal intent occurs in approximately 2% of adults (Meltzer et al, 2002). Service users report that professionals can respond to self-harm with unhelpful attitudes and ineffective care. Although evidence for effective treatments is poor (Hawton et al, 1999), this therapeutic pessimism is not found in the self-help approaches promoted by voluntary organisations such as Mind: ‘If you feel the need to self-harm, focus on staying within safe limits' (Harrison & Sharman, 2005). User websites frequently offer advice on harm minimisation: ‘Support the person in beginning to take steps to keep herself safe and to reduce her self-injury – if she wishes to. Examples of very valuable steps might be: taking fewer risks (e.g. washing implements used to cut, avoiding drinking if she thinks she is likely to self-injure)’ (Bristol Crisis Service for Women, 1997).

scholarly journals Risk and responding to self injury: is harm minimisation a step too far?

2019 ◽  
Vol 14 (1) ◽  
pp. 1-11
Author(s):  
Patrick Joseph Sullivan
Keyword(s):  
Health Professionals ◽  
Design Methodology ◽  
Legal Obligation ◽  
Clinical Environment ◽  
Harm Minimisation ◽  
Content Type ◽  
Self Injury ◽  
Legal Literature ◽  
Legal Implications ◽  
The Law

Purpose The purpose of this paper is to consider some of the legal implications of adopting a harm minimisation approach in supporting people who self-injure within inpatient mental health units. It is argued that a focus on risk and the increasing influence of the law and legal styles of thinking often associated with the allocation of blame have produced a more risk adverse clinical environment. As a result health professionals are more likely to err on the side of caution rather than engage in practices that although potentially therapeutic are not without their risks. Design/methodology/approach The analysis draws on the clinical, philosophical and legal literature to help understand how harm minimisation may support people who self-injure. It considers some of the complex medico-legal issues that arise in a clinical environment dominated by risk. Findings A focus on risk and accountability has produced an environment where the law and legal styles of thinking have come to influence practice. This is often associated with blame in the minds of the health professional. Given the legal obligation to prevent suicide, health professionals may take a conservative approach when working with people who self-injure. This makes the adoption of harm minimisation difficult. Originality/value This paper provides a legally informed analysis of some of the challenges associated with using harm minimisation techniques with people who self-injure. It adds to the literature regarding this area of clinical practice.

Self-injury and harm minimisation on acute wards

2012 ◽  
Vol 26 (38) ◽  
pp. 51-56 ◽  
Author(s):  
Chris Holley ◽  
Rachel Horton ◽  
Lisa Cartmail ◽  
Eleanor Bradley
Keyword(s):  
Harm Minimisation ◽  
Self Injury ◽  
Acute Wards

A clinical perspective of the U.S. anti-vaccination epidemic: Considering marginal costs and benefits, CDC best practices guidelines, free riders, and herd immunity

Vaccine ◽  
2020 ◽  
Vol 38 (50) ◽  
pp. 7877-7879
Author(s):  
Michael G. Anderson ◽  
Eric A. Ballinger ◽  
David Benjamin ◽  
Lawrence D. Frenkel ◽  
C. William Hinnant ◽  
...  
Keyword(s):  
Best Practices ◽  
Herd Immunity ◽  
Clinical Perspective ◽  
Costs And Benefits ◽  
Free Riders ◽  
Marginal Costs ◽  
The U.S

Clinical characteristics and functions of non-suicide self-injury in youth

2014 ◽  
Vol 29 (8) ◽  
pp. 503-508 ◽  
Author(s):  
O. Rodav ◽  
S. Levy ◽  
S. Hamdan
Keyword(s):  
Mental Health ◽  
Emotion Regulation ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Clinical Characteristics ◽  
Social Influences ◽  
Self Report ◽  
Community Settings ◽  
The Past ◽  
Self Injury

AbstractPurposeLittle is known about the clinical characteristics and motivations for engaging in non-suicide self-injury (NSSI) behaviors in adolescence. The aim of this study was to examine the prevalence, characteristics and functions of NSSI among adolescents in community settings, and to explore risk factors related to this behavior.Subjects and methodsTwo hundred and seventy-five adolescents aged 12 to 17 were recruited randomly from different High Schools in Israel. They completed self-report questionnaires assessing NSSI (Ottawa Self-Injury Inventory), depression (Children's Depression Inventory – CDI) and impulsivity (Barratt Impulsiveness Scale – BIS-II).ResultsIn the past year, 20.7% of the participants reported engaging NSSI at least once. Among them, 42.1% declared they are still engaging in NSSI at the present. Motives for NSSI were internal emotion regulation reasons, external emotion regulation reasons for social influences. In addition, the NSSI group reported significantly higher levels of depressive, impulsivity and suicidal ideations. Depressive symptoms were found as significant predictors of NSSI in the future.Discussion and conclusionsHigh rates of NSSI among community adolescents were found. Depression, impulsivity and suicidal ideation were found significantly related to NSSI. Mental health professionals in schools and in primary care should routinely assess NSSI among adolescents.

scholarly journals Allowing harm because we care: Self-injury and harm minimisation

2018 ◽  
Vol 13 (2) ◽  
pp. 88-97 ◽  
Author(s):  
Patrick J Sullivan
Keyword(s):  
Health Care ◽  
Health Care Professional ◽  
Harm Minimisation ◽  
Self Injury ◽  
Psychodynamic Understanding ◽  
Moral Blame ◽  
Specific Objection

Harm minimisation has been proposed as a means of supporting people who self-injure. When adopting this approach, rather than trying to stop self-injury immediately the person is allowed to injure safely whilst developing more appropriate ways of dealing with distress. The approach is controversial as the health care professional actively allows harm to occur. This paper will consider a specific objection to harm minimisation. That is, it is a misguided collaboration between the health care professional and the person who self-injures that is morally and clinically questionable. The objection has two components. The first component is moral in nature and asserts that the health care professional is complicit in any harm that occurs and as a result they can be held morally responsible and subject to moral blame. The second component is clinical in nature and suggests that harm minimisation involves the health care professional in colluding in the perpetuation of self-injury. This element of the objection is based on a psychodynamic understanding of why self-injury occurs and it is argued that harm minimisation is merely a mechanism for avoiding thinking about the psychotherapeutic issues that need to be addressed. Thus, the health care professional merely reinforces a dysfunctional pattern of behaviour and supports the perpetuation of self-injury. I will consider this objection and argue that it fails on both counts. I conclude that the use of harm minimisation techniques is an appropriate form of intervention that is helpful to certain individuals in some situations.

Self-injury and harm minimisation on acute wards

2012 ◽  
Vol 26 (38) ◽  
pp. 51-56 ◽  
Author(s):  
Chris Holley ◽  
Rachel Horton ◽  
Lisa Cartmail ◽  
Eleanor Bradley
Keyword(s):  
Harm Minimisation ◽  
Self Injury ◽  
Acute Wards
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