How do mental health hospitals in England manage self-harm? A review of policy

What is it about?

Self-harm is a common and serious issue in mental health hospitals, and services use policy as one way to guide staff in how they respond to it. This study looked at how well the policies on self-harm from 50 NHS mental health trusts in England matched national guidance on self-harm. We compared each trust’s policies against a list of 20 key standards based on English national good practice guidelines. We found that trusts with a dedicated self-harm policy generally did better at reflecting the standards within their policies than those without one. But overall, the average number of standards each trust reflected was less than half. We also found that trusts organise and present important information for staff within their policies in very different ways. We highlighted how this might make finding this information more complicated for staff. We know that clear information and consistency is important for patient safety and so this led us to caution that whilst having a self-harm-specific policy might seem positive, it is important that services think about how they organise their information so that if one is introduced it does not make things more complex. Other findings included that most trusts don’t clearly define what self-harm means. Of the small number that do, some use definitions that don’t match national guidance. We shared how this could cause problems for comparing patient safety data between services. We also highlighted that guidance on harm-reduction approaches (which aim to reduce the risks of self-harm rather than stop it completely) is rarely included in policies. We discussed how this could leave staff at risk of legal challenges should they use these approaches, despite the fact they were recommended for some patients within the national guidelines. This study suggests that NHS policies on self-harm could benefit from being clearer, more consistent, and better aligned with national guidance. However, more research is needed to understand what actual impacts on the actions staff take to support patients who self-harm, including if policy is important in this.

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Photo by Viktor Talashuk on Unsplash

Photo by Viktor Talashuk on Unsplash

Why is it important?

This research helps improve our understanding of the approaches trusts tell staff to take to manage self-harm. It is a crucial step in the process of improving the systems which surround staff which aim to help keep patients safe.