The Role of Mental Health Nurse in Supporting Clients with Self Harm and Suicidal Ideas on an Acute Ward In-Patient Wards

By

TABLE OF CONTENTS

CHAPTER 2: LITERATURE REVIEW1

2.1 Introduction1

2.2 Background of the Search2

2.3 Facts and Figures of Mental health-United Kingdom3

2.4 Concept of Self Harm and Suicidal Ideation4

2.5 Causes of Self-Harm and Suicidal Ideation5

2.6 Self-Harm and Suicide: Separate or Connected8

2.7 Self-Harm-Suicide Variant9

2.8 Deliberate Self-Harm10

2.9 Policy, Ethical and Legal Issues Relating To Care People Who Self Harm13

2.10 Implications for Mental Health Practice15

2.10.1 Mandatory Ethics16

2.10.2 Best Practice Ethics16

2.10.3 Issues Related to Ethics16

2.10.4 Multicultural Issues Related To Ethics17

2.11 Role of the Mental Health Nurse in Caring For Individuals Who Self-Harm17

2.11.1 Mindfulness20

2.11.2 Interpersonal effectiveness20

2.11.3 Emotional regulation20

2.11.4 Distress tolerance21

REFERENCES24

CHAPTER 2: LITERATURE REVIEW

2.1 Introduction

Every year, one in 600 people deliberately injure themselves sufficiently to require hospital treatment (Tantam & Whittaker, 1992). Self-harming behaviour is a widespread problem. It is hard to estimate the true prevalence of self-harming behaviour, however, because it is widely under-reported and many self-inflicted injuries, even serious ones that are brought to medical attention, are passed off as accidental. What is clear is that reported self-harming behaviour appears to be on the increase, especially in young men aged 18 to 25 (Hawton, et al, 1997) and in adolescents. In a survey of schools, 13% of adolescents aged 15 or 16 reported having self-harmed at some time in their lives, 7% having done so in the previous year (Hawton et al, 2002).

The UK has one of the highest incidences of self injury in Europe, especially in schoolchildren and younger adults (Hawton et al, 2002). The Office for National Statistics' household survey of psychiatric morbidity among adults in Great Britain in 2000 found that 2% of men and 3% of women interviewed admitted to self-harm without suicidal intent; by age-group, the reported incidence decreased from 5% in young people to 0.2% of those aged 65-74 (Meltzer et al, 2002). Compared with individuals who present to general hospitals with self-poisoning, those who present with self-cutting are more likely to be single, unemployed males with a previous history of self harm, living alone, misusing alcohol and to have low suicidal intent (Hawton et al, 2004). Among young adults, significantly more males than females use self-injury to kill themselves (Van Heeringen & De Volder, 2002).

Individuals with personality disorders with or without an Axis I diagnosis are over represented among people who harm themselves. Personality disorders have been highly correlated with self-injurious behaviour in a number of studies (Horrocks et al, 2003) and repeated self-injury is one of the operational criteria for borderline personality disorder in DSM-IV (American Psychiatric Association, 1994). It is said of these patients that their stories are 'written on their bodies' (Barker & Buchanan-Barker, 2004).

2.2 Background of the Search

The suicide and suicide attempts are the most significant public health problem. The increase suicide rates are remarkably uneasy, because it reflects the suffering and distress of a large number of people and in society. Although 'in recent years, suicide rates are more stable and appear to decline to some ...