What activities might facilitate personal recovery for adults who continue to self-harm? A meta-synthesis employing the connectedness/hope and optimism/identity/meaning/empowerment framework.

Self-harm is an international concern. While treatment in health care focusses on methods to reduce the act, there is less exploration in how to assist adults who are unable to minimize their self-harm. In order to aid these people, in the present systematic review, we employed a qualitative meta-synthesis to explore the lived experience of what activities might facilitate personal recovery for adults who continue to self-harm. Findings were interpreted by drawing on the CHIME framework; a taxonomy of personal recovery comprising of connectedness, hope and optimism, identity, meaning and purpose, and empowerment. The located activities in the review converged on different support groups, and although face-to-face groups were discovered, the majority highlighted the benefits of Internet forums where mutuality and reciprocity were key to promoting personal recovery. Adults desired time to share accounts of themselves, to develop connection and identity. Furthermore, hope was established by group members accepting that self-harm has a role, while congregating with others who did not judge the act. Helping relationships also promoted hope by having a balance between goals and protection against disappointment. The nature of writing online seemingly had cathartic properties fostering meaning, alongside empowerment being facilitated by adults controlling the narrative of their self-harm. It is hoped that these insights might guide self-harm research to develop beyond the confines of minimizing self-injury in health care.