Self harm in adult inpatient psychiatric care: A national study of incident reports in the UK

BackgroundWe know little about the nature of self harming behaviour within inpatient psychiatric services. The few studies in this area have mainly investigated the correlates self harm, or have been restricted to forensic services, within single hospitals.ObjectivesTo describe the demographic characteristics of those who self harm, and the characteristics of self harming behaviour within adult psychiatric wards across the UK.MethodsAnalysis of 500 reports of self harm within inpatient services across England and Wales, randomly selected from a total of 14,271 reports collected by the National Patient Safety Agency.ResultsMost episodes of self harm were by women, and did not put the service user's life at risk. The most common form of self harm involved breaking the skin. Women were more likely to use methods of restricting their breathing, whilst men were more likely to use outwardly aggressive methods. Self harm was often a private act, which took place in bedrooms, bathrooms and toilets, and during the evening hours. Taking into account the numbers of beds within each service nationally, there were more episodes of self harm within forensic services. The most common interventions for self harm were verbal de-escalation, and manual restraint. The most common antecedents to self harm were a distressing psychological state, conflict behaviours (behaviours which threatened staff, or service user safety), and conflict with staff.ConclusionsSelf harm within inpatient care constitutes a wide range of behaviours, and it may be useful for clinicians to discuss the particular meaning of the methods of self harm used with service users. In general, self harm is a private act, suggesting that most acts of self harm are not intended to have an impact on others. More research into the social nature of self harm, and the meaning of different self harming behaviours (particularly outwardly aggressive methods of self harm such as headbanging), would help to increase our understanding of these acts, and develop more appropriate ways of supporting service users. Future research should also investigate how staff behaviour may contribute to self harm. The development of a reporting system which requires a detailed account of incidents would aid future research in these areas.