40 | Nursing in Practice | Winter 2022
CLINICAL
How to manage selfharm in primary care
Mental health specialist nurse Karen Lascelles explains how to approach patients who are self-harming and offer appropriate care and support in line with new NICE guidance
Self-harm is a common and complex behaviour that many people , including some healthcare professionals , can find difficult to comprehend . Nurses in all spheres of practice are likely to encounter people who self-harm , so it is important to be aware of the common functions of this behaviour and interventions that might help . New NICE guidance on the assessment , management and prevention of recurrence of self-harm includes recommendations for primary care . 1 This article draws on aspects of the guidance to discuss ways community and primary care nurses can respond to self-harm .
Who is at risk of self-harm ? Self-harm involves interlinked biological , social , environmental , cultural , situational and psychological factors . Many people who self-harm have experienced difficult life events , including but not limited to abuse , neglect , bullying , relationship difficulties , displacement , and stress related to work , study or finances . They might also have been exposed to others ’ self-harm or suicide , loss and bereavement . 2 Rates of self-harm are higher among some groups , including young people , 3 LGBTQ + populations , 4 people with mental illness or personality disorders , 5 , 6 people with autism 7 and those with ADHD . 8 Factors such as substance misuse , deteriorating mental health or anticipated stress might increase the likelihood of self-harm . However , discerning exactly who is at risk of self-harm is difficult ; not everyone with known risk factors will self-harm , and individuals who do self-harm cannot ( and should not ) be squeezed into predefined stereotypes . NICE guidance makes it clear that people who self-harm should be treated in accordance with their individual needs , and assessments should not be reliant on stratification or predictive tools to determine risk . 1 In order to offer individualised care effectively , it is important to have an understanding of the reasons why the person might self-harm .
Functions of self-harm Self-harm is frequently precipitated by strong negative emotions that have become overwhelming for the individual . Alternatively , antecedent states may include detachment and numbness . Self-harm can be a way to regulate emotions or terminate a detached state of mind . Additional motives include distraction from intrusive thoughts , elicitation of care or attention , self-punishment ( and sometimes punishment of others ), exerting control over oneself or a situation , or a desire to feel exhilarated where it is a struggle to achieve this sensation in other ways . For many people , self-harm is not suicidal in nature but for others , it may be a suicide attempt . Others might experience suicidal ideation when self-harming , even though it is not intended to be a suicidal act . Indeed it may be a way to avert a suicide attempt . It is important not to assume self-harm is suicidal in nature , although equally it is important to be aware of the link between self-harm and suicide ; a previous history of self-harm , particularly in people who have attended hospital following an episode , is strongly associated with suicide . 2
GETTY IMAGES