Negative experiences of clinical services may perpetuate a cycle of self-harm

24 October 2023

Negative attitudes towards clinical services reported by people who self-harm have persisted over time and may perpetuate a cycle of self-harm, a review involving UCL researchers suggests.

Person putting on PPE Photo by Laura James, Pexels

A new systematic review published in Psychological Medicine reveals that people presenting to services after self-harm have more positive attitudes towards non-clinical services providing therapeutic contact, such as voluntary sector organisations and social services, than clinical services, such as emergency departments and inpatient units.

Overall, the review’s findings suggested that there has been little change in the generally negative attitudes towards and experiences of services for patients who self-harm since a previous systematic review of research 16 years ago

Many patients trying to access help for self-harm experienced stigmatising attitudes from professionals, minimisation of their distress, superficial or rushed psychological and social assessments, and organisational barriers such as long waiting times and limited access to care. A person with lived experience of self-harm, who provided a commentary on the review said: 

While therapeutic relationships are central to recovery, they are rare in a system that discourages ‘dependency’.” 

Views suggested that perceptions of unsupportive care may perpetuate a cycle of self-harm. 

The research team, which includes researchers from UCL’s Division of Psychiatry, the University of Oxford and two NHS foundation trusts, analysed 29 studies that met inclusion criteria from high- or middle-income countries and were generally felt to be of high methodological quality.  

The review recommends that these findings should be used to reform clinical guidelines and staff training across clinical services to promote patient-centred and compassionate care and deliver more effective, acceptable, and accessible services

Dr Sarah Rowe, the senior author on the study, said: 

“It is deeply disappointing that the experience of seeking treatment remains largely negative for people who self-harm, as demonstrated in literature covering the 16 years since the last review.  We need to invest in specialised staff training that is co-developed with people who have lived experience of self-harm, to address the issue of perfunctory assessments and stigmatising attitudes.
It was striking that patients held much more positive views of non-clinical services, and we need to look more carefully at what they are getting right. Another high priority is improving access to ongoing treatment and support for people who self-harm rather than relying on crisis services as a temporary band-aid.”