A Thematic Exploration of the Experience of Inpatient Mental-Health Service-Users Who Are Prevented from Self-Harming.

Abstract

Research and expert by experience (EBE) testimony has created a foundational understanding of self-harm as a mediator of psychological distress. However, risk-management is frequently prioritised in mental-healthcare services approaches. This research builds on existing understandings of self-harm to explore "if self-harm mediates psychological distress, then does preventing self-harm have consequences that must be understood and navigated?". This research thus explores the lived experience of preventive measures (i.e. means-restrictions) which limit participants' use of self-harm and the impact this has on their distress whilst in an inpatient environment. Seven semi-structured interviews were conducted with individuals with a history of self-harm who had experienced an admission to psychiatric hospital. A Reflexive Thematic Analysis was conducted. Participants described their understanding of how their; past-experiences, understandings of their own self-harm, and their emotional and behavioural responses to being unable to self-harm determined their experience of means-restrictions. The ways in which their psychological and emotional experience changed upon means-restrictions are outlined and explored; the ways in which they coped, experienced benefits and support, and how their testimonies positioned self-harm as secondary to the primary problem - emotional distress. Implications for theory and practice are discussed with regards to negotiating the psychological impacts while maintaining safety.