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Cited by 256Suicide and Self-Harm StudiesPsychiatric care and mental health servicesMental Health Treatment and Access

Attitudes towards clinical services among people who self-harm: systematic review

Open access
Taylor, Tatiana L., Hawton, Keith, Fortune, Sarah, Kapur, Navneet·2009·British Journal of Psychiatry
DOI 10.1192/bjp.bp.107.046425
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Abstract

Background: Self-harm is increasingly common in many countries, is often repeated and may have other negative outcomes. Aims: To systematically review people's attitudes towards clinical services following self-harm in order to inform service design and improvement. Method: A search of electronic databases was conducted and experts in the field were contacted in order to identify relevant worldwide qualitative or quantitative studies. Data were extracted independently by two reviewers with more weight given to studies of greater quality and relevance. Results: Thirty-one studies met the inclusion criteria. Despite variations in healthcare systems and setting, participants' experiences were remarkably similar. Poor communication between patients and staff and a perceived lack of staff knowledge with regard to self-harm were common themes. Many participants suggested that psychosocial assessments and access to after-care needed to be improved. Conclusions: Specific aspects of care that might increase service user satisfaction and treatment adherence include staff knowledge, communication and better after-care arrangements. A standard protocol could aid regular audits of users' experiences of services.

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Crossref · 10.1192/bjp.bp.107.046425

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  • Healthcare service design and provision too often relies on practices that ignore or minimize the basic interpersonal aspects of care and thus fail to capitalize on their potential.

    “However, healthcare service design and provision too often relies on practices that ignore or minimize the basic interpersonal aspects of care and thus fail to capitalize on their potential [2, 3].”

    From Suicide attempt survivors’ recovery-related agency in the relational context of services: a qualitative analysis (2024) · cites this paper as [3]

    The Discussion reports that many people receiving care after self-harm perceived poor staff behaviour and insufficient involvement in decisions; the Suggestions for clinical practice and service improvement identify the therapeutic relationship as a way to improve adherence and outcomes. This supports the concern about neglected interpersonal care, but the review concerns services following self-harm, not healthcare service design and provision generally. (LLM, conf=0.84)

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  • The current findings are congruent with previous studies showing that perceived staff attitudes critically affect help-seeking behaviors and that suicidal service users readily retreat from services not perceived as helpful.

    “The current findings are congruent with previous studies that have found, e.g., that perceived staff attitudes critically affect help-seeking behaviors and that suicidal service users readily retreat from services that are not perceived as helpful [3, 4].”

    From Suicide attempt survivors’ recovery-related agency in the relational context of services: a qualitative analysis (2024) · cites this paper as [3]

    The Post-hospitalisation management section says perceptions of staff were important to engagement with care and reports that some service users ended treatment because of difficulties with therapists or because sessions did not help. The Discharge and referral section says some people who self-harm would not return to hospital after another episode. These findings support the general point, but do not establish that suicidal service users *readily* retreat from services they perceive as unhelpful. (LLM, conf=0.85)

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  • Finding meaningful ways to respond to service users in suicidal crises presents an ongoing challenge for health services internationally.

    “Yet finding meaningful ways to respond to service users in suicidal crises presents an ongoing challenge for health services internationally [2–4].”

    From Suicide attempt survivors’ recovery-related agency in the relational context of services: a qualitative analysis (2024) · cites this paper as [3]

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Research works printed but not linked: 3

  1. Whitehead L. Therapeutic aspects of the psychosocial assessment following overdose. Unpublished MSc thesis. Oxford Brookes University, 2002.
  2. Crockwell L, Burford G. What makes the difference? Adolescent females' stories about their suicide attempts. J Child Youth Care 1995; 10: 1-14.
  3. Hood A. Improving outcomes for suicidal individuals. Unpublished PhD thesis. University of Auckland, 2006.

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Authors
Taylor, T. L., Hawton, K., Fortune, S., & Kapur, N.
Affiliations
  • University of Oxford (GB)
  • University of Leeds (GB)
  • University of Manchester (GB)
Corresponding author
Hawton, Keith
ORCID
Venue
British Journal of Psychiatry
Publisher
Royal College of Psychiatrists
Published
2009-02
Volume
194
Issue
2
Pages
104-110
ISSN
  • 0007-1250 (ISSN-L)
  • 1472-1465
DOI
10.1192/bjp.bp.107.046425
OpenAlex
W2063451130
Cited by
256
References
32
Citations by year
2026: 5 · 2025: 13 · 2024: 7 · 2023: 14 · 2022: 17 · 2021: 22 · 2020: 20 · 2019: 17 · 2018: 16 · 2017: 19 · 2016: 16 · 2015: 17 · 2014: 14 · 2013: 22 · 2012: 14
FWCI
1.61
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified, 3257 d)
Locations
  • The British Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion)
  • Research Portal (King's College London) (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
self-harm, service user experiences, staff-patient communication, follow-up care, psychosocial assessment, service design, medication adherence, user satisfaction
MeSH terms
Adolescent, Adult, Attitude of Health Personnel, Female, Hospitalization, Humans, Male, Mental Health Services, Patient Participation, Databases, Bibliographic, Self-Injurious Behavior, Patient Satisfaction, Qualitative Research, Drug Overdose

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