Nick Huband

Attitudes to self-injury within a group of mental health staff

BACKGROUND Self-wounding is a behaviour which remains poorly understood and which can evoke strong reactions from clinical staff. Such reaction may adversely influence treatment outcome and there have been calls for changes in the attitudes of professional staff towards this client group through improved training and awareness. There has, however, been little systematic study of how clinicians perceive those who self-injure or of how their attitudes are modified by training and other factors. METHOD This study aims to identify and explore factors governing professional attitude towards self-injury through postal survey of a large group of mental health staff. The survey assessed attitudes towards a representative case described in a vignette. RESULTS Five key factors were identified, with perception of control being the most dominant. Attitudes of clinical staff who had obtained additional qualification in counselling or psychotherapy differed significantly from those who had not. In contrast, no effect was found for specific training in handling self-injury. Attitude to the self-wounding woman was unaffected by gender, but was affected by age and work setting. The innate potential for the sample to self-polarize was examined statistically; a line of cleavage emerged between less tolerant staff who perceived her to have more control and to be more difficult to understand and those with opposing views. CONCLUSION Qualification in counselling or psychotherapy may modify attitude by reducing defensive attribution, allowing staff improved containment of their anxiety; alternatively, pre-existing attitudes may encourage certain staff to obtain such qualification.

Clinical management of women who self-wound : A survey of Mental Health professionals' preferred strategies

Aim: To evaluate professional opinion of various strategies advocated for the clinical management of self-wounding in female patients. Method: A postal survey of all 386 NHS staff working within multi-disciplinary teams in one English county using a specially developed questionnaire assessing preferred management of a case described in a vignette. Results: A return of 55% (n =213) was achieved, with 94% of respondents reporting direct clinical contact with women who had self-wounded. Responses were scored according to the extent to which respondents endorsed each of 19 management strategies. The strategies of maintaining regular discussion amongst involved staff and of encouraging the client to ventilate unexpressed feelings were seen as the most helpful, with medication and hospital admission regarded as unhelpful. Ambivalence and uncertainty were evident for many of the suggested strategies. Conclusions: A range of opinion has been demonstrated amongst a multi-disciplinary group of mental health profess...