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
2012 ◽  
Vol 26 (38) ◽  
pp. 51-56 ◽  
Author(s):  
Chris Holley ◽  
Rachel Horton ◽  
Lisa Cartmail ◽  
Eleanor Bradley

2008 ◽  
Vol 32 (2) ◽  
pp. 60-63 ◽  
Author(s):  
Nicky Pengelly ◽  
Barry Ford ◽  
Paul Blenkiron ◽  
Steve Reilly

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).


Author(s):  
Patrick Joseph Sullivan

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.


2017 ◽  
Vol 44 (3) ◽  
pp. 209-210 ◽  
Author(s):  
Patrick J Sullivan

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.


2018 ◽  
Vol 13 (2) ◽  
pp. 88-97 ◽  
Author(s):  
Patrick J Sullivan

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.


2007 ◽  
Vol 41 (4) ◽  
pp. 36
Author(s):  
TIMOTHY F. KIRN
Keyword(s):  

Author(s):  
Alexander Blaszczynski

Abstract. Background: Tensions exist with various stakeholders facing competing interests in providing legal land-based and online regulated gambling products. Threats to revenue/taxation occur in response to harm minimisation and responsible gambling policies. Setting aside the concept of total prohibition, the objectives of responsible gambling are to encourage and/or restrict an individual’s gambling expenditure in terms of money and time to personally affordable limits. Stakeholder responsibilities: Governments craft the gambling environment through legislation, monitor compliance with regulatory requirements, and receive taxation revenue as a proportion of expenditure. Industry operators on the other hand, compete across market sectors through marketing and advertising, and through the development of commercially innovative products, reaping substantial financial rewards. Concurrently, governments are driven to respond to community pressures to minimize the range of negative gambling-related social, personal and economic harms and costs. Industry operators are exposed to the same pressures but additionally overlaid with the self-interest of avoiding the imposition of more stringent restrictive policies. Cooperation of stakeholders: The resulting tension between taxation revenue and profit making, harm minimization, and social impacts creates a climate of conflict between all involved parties. Data-driven policies become compromised by unsubstantiated claims of, and counter claims against, the nature and extent of gambling-related harms, effectiveness of policy strategies, with allegations of bias and influence associated with researchers supported by industry and government research funding sources. Conclusion: To effectively advance policies, it is argued that it is imperative that all parties collaborate in a cooperative manner to achieve the objectives of responsible gambling and harm minimization. This extends to and includes more transparent funding for researchers from both government and industry. Continued reliance on data collected from analogue populations or volunteers participating in simulated gambling tasks will not provide data capable of valid and reliable extrapolation to real gamblers in real venues risking their own funds. Failure to adhere to principles of corporate responsibility and consumer protection by both governments and industry will challenge the social licence to offer gambling products. Appropriate and transparent safeguards learnt from the tobacco and alcohol field, it is argued, can guide the conduct of gambling research.


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