Sharp Hannah, Johnson Judith, Brennan Cathy, Baker John
School of Healthcare, University of Leeds, Leeds, United Kingdom.
School of Health Sciences, University of Manchester, Manchester, United Kingdom.
PLoS One. 2025 Jul 1;20(7):e0327358. doi: 10.1371/journal.pone.0327358. eCollection 2025.
The management of self-harm is a critical focus for staff in inpatient mental health settings. This study aimed to better understand how staff are guided through policies to manage self-harm via the following objectives: 1) to assess the alignment of policies from English NHS Mental Health trusts with national guidelines, 2) identify which aspects of the national guidelines are most and least frequently reflected in these policies, and 3) determine whether trusts with dedicated self-harm policies better reflect national guidelines. We conducted a content analysis of self-harm-related policies across 50 English NHS mental health trusts against a framework of 20 standards created from National Institute for Health and Care Excellence self-harm guidelines. Our analysis revealed a significant difference (U = 36.50, p = .002) in the number of standards met by trusts with a specific self-harm policy (M = 11.44, SD = 3.00) compared to those without (M = 7.26, SD = 3.00), with the number of standards met ranging from zero to 15. Notably, trusts failed to meet the majority of standards (M = 11.69, SD = 3.30). The findings of this study highlight several new insights into NHS trust policy on self-harm: 1) trusts exhibit variability in how they organise information across their policies, 2) dedicated self-harm policies may support trusts to better meet guidance but risk complicating guidance for staff, 3) policy content varies across trusts, 4) the importance of patient voice is acknowledged but the facilitators of good participation are poorly supported in the same policies, 5) trusts rarely define self-harm and some trusts use definitions which do not reflect guidelines, and 6) harm-reduction remains underrepresented in policies, reflecting ongoing contention surrounding its implementation. Further research is needed to understand the role that policy and guidelines play in guiding staff practices when managing self-harm.
在住院心理健康机构中，自我伤害的管理是工作人员的关键关注点。本研究旨在通过以下目标更好地了解工作人员如何依据政策来管理自我伤害：1）评估英国国民健康服务体系（NHS）心理健康信托机构的政策与国家指南的一致性；2）确定国家指南中哪些方面在这些政策中最常和最不常得到体现；3）确定拥有专门自我伤害政策的信托机构是否能更好地反映国家指南。我们对照由英国国家卫生与临床优化研究所（NICE）自我伤害指南制定的20项标准框架，对50个英国NHS心理健康信托机构中与自我伤害相关的政策进行了内容分析。我们的分析显示，与没有专门自我伤害政策的信托机构（M = 7.26，标准差 = 3.00）相比，拥有专门自我伤害政策的信托机构达到的标准数量（M = 11.44，标准差 = 3.00）存在显著差异（U = 36.50，p = 0.002），达到的标准数量从零到15不等。值得注意的是，信托机构未能达到大多数标准（M = 11.69，标准差 = 3.30）。本研究的结果凸显了对NHS信托机构自我伤害政策的几个新见解：1）信托机构在其政策中组织信息的方式存在差异；2）专门的自我伤害政策可能有助于信托机构更好地遵循指南，但也有使工作人员的指南变得复杂的风险；3）不同信托机构的政策内容各不相同；4）虽然承认患者声音的重要性，但在同一政策中对良好参与的促进因素支持不足；5）信托机构很少对自我伤害进行定义，一些信托机构使用的定义不符合指南；6）减少伤害在政策中仍然未得到充分体现，这反映了围绕其实施的持续争议。需要进一步研究以了解政策和指南在指导工作人员管理自我伤害实践中所起的作用。
