James Karen, Samuels Isaac, Moran Paul, Stewart Duncan
Kingston University and St George's University of London, Joint Faculty of Health, Social Care and Education, London, SW17 ORE United Kingdom.
Person with lived-experience of self-harm, United Kingdom.
J Affect Disord. 2017 May;214:67-73. doi: 10.1016/j.jad.2017.03.002. Epub 2017 Mar 6.
Harm reduction has had positive outcomes for people using sexual health and substance misuse services. Clinical guidance recommends these approaches may be appropriately adopted by mental health practitioners when managing some people who self-harm. There has, however, been very little research in this area.
We explored practitioners' views of harm reduction as a strategy for supporting people who self-harm. The Self Harm Antipathy Scale (SHAS) was administered to a random sample of 395 mental health practitioners working on 31 wards in England, semi-structured interviews were then conducted with 18 survey respondents.
Practitioners who had implemented the approach reported positive outcomes including a reduction in incidence and severity of self-harm and a perceived increase in empowerment of service users. Practitioners with no experience of using harm reduction were concerned that self-harm would increase in severity, and were unsure how to assess and manage risk in people under a harm reduction care plan. Some fundamentally disagreed with the principle of harm reduction for self-harm because it challenged their core beliefs about the morality of self-harm, or the ethical and potential legal ramifications of allowing individuals to harm themselves.
This study was conducted solely with practitioners working on inpatient units. The majority of staff interviewed had no experience of harm reduction and so their concerns may not reflect challenges encountered by practitioners in clinical practice.
Harm reduction is being used to support people who self-harm within inpatient psychiatry and some practitioners report potential benefits of this approach. However, this raises particularly complex practical, ethical and legal issues and further research is needed to assess the safety, acceptability and efficacy of the approach.
减少伤害对使用性健康和药物滥用服务的人群产生了积极效果。临床指南建议，精神科医生在管理一些有自残行为的患者时，可适当采用这些方法。然而，该领域的研究非常少。
我们探讨了医生对于将减少伤害作为支持自残者的一种策略的看法。对在英格兰31个病房工作的395名精神科医生进行随机抽样，使用自残反感量表（SHAS）进行调查，然后对18名受访者进行半结构化访谈。
实施该方法的医生报告了积极成果，包括自残发生率和严重程度降低，以及服务使用者的自主权有所增强。没有减少伤害经验的医生担心自残严重程度会增加，并且不确定如何评估和管理接受减少伤害护理计划的患者的风险。一些人从根本上不同意对自残采用减少伤害原则，因为这挑战了他们关于自残道德性的核心信念，或者允许个人伤害自己的伦理和潜在法律后果。
本研究仅针对住院部的医生开展。大多数接受访谈的工作人员没有减少伤害的经验，因此他们的担忧可能无法反映临床实践中医生遇到的挑战。
在住院精神科中，减少伤害被用于支持自残者，一些医生报告了这种方法的潜在益处。然而，这引发了特别复杂的实践、伦理和法律问题，需要进一步研究来评估该方法的安全性、可接受性和有效性。
