Harm minimisation used with minority of patients who self-harm despite perceived value
28 June 2021
In a new study conducted by the UCL Division of Psychiatry, researchers found that only a minority of patients who self-harm report using harm minimisation techniques, despite the fact the vast majority find these helpful.
The prevalence of self-harm in the UK was reported as 6.4% in 2014. Despite sparse evidence for effectiveness, guidelines recommend harm minimisation; a strategy in which people who self-harm are supported to do so safely.
Harm minimisation refers to strategies that are used to reduce the risks associated with health risk behaviours such as alcohol or drug use or self-harm, without stopping the behaviour completely. It is an approach that is often used in clinical practice in the field of substance use (for example, methadone for opioid dependence or needle exchange for injecting drug users). It may include strategies such as pinging rubber bands encompassing the wrist, teaching wound care, or providing access to clean sharp objects.
The study’s senior author Dr Sarah Rowe said: “We wanted to know the proportion of people who self-harmed within a population of psychiatric patients, and the proportion of these who used harm minimisation strategies, as well as identify the different methods of harm minimisation used. We also wanted to compare the characteristics of patients who self-harm who do and do not use harm minimisation for self-harm.”
To answer these questions, Dr Rowe and her team analysed anonymised electronic health records for psychiatric patients treated by the South London and Maudsley NHS Trust for the study which was published in BJPsych Open.
They found the recorded proportion of people who self-harmed within a population of South London psychiatric patients was 22,736. Of these, the proportion of patients using harm minimisation was very low at 693 (around 3%).
The most common methods of harm minimisation used were substitution methods that replace or replicate pain such as holding ice or using an elastic band, (51.9%). Other methods such as simulating self-harm, delaying self-harm or avoiding areas that cause more physical damage, and minimising the risk of infection were much less common. However, for a quarter of the cases who described using harm minimisation for self-harm, it was not clear which strategy they used.
Dr Rowe said the most interesting finding was that of the majority of patients who used harm minimisation strategies (92%) found it helpful.
“Self-harm can result in scarring, infection, tissue damage and other physical injuries, which can greatly impact a person’s quality of life. It’s important that we consider strategies that can help minimise these risks, providing appropriate and safe clinical advice on harm minimisation whilst people are receiving other indicated treatment and support for their self-harm,” Dr Rowe said.
“We need research on the acceptability and effectiveness of harm-minimisation approaches for self-harm. It would be helpful to have a framework of harm minimisation approaches for self-harm that are acceptable to patients and clinicians and could be used consistently across different settings. There need to be clear guidelines for clinicians on how to discuss harm-minimisation with patients who self-harm, so that they feel confident and professionally supported when using this approach.
“It is important that the development of a range of harm minimisation approaches for self-harm continues to be co-produced with experts by experience,” she added.