The British Journal of Psychiatry (2009) 194: 104-110. doi: 10.1192/bjp.bp.107.046425
© 2009 The Royal College of Psychiatrists
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REVIEW ARTICLE

Attitudes towards clinical services among people who self-harm: systematic review

Tatiana L. Taylor, MSc and Keith Hawton, DSc, DM, FRCPsych

Centre for Suicide Research, University of Oxford

Sarah Fortune, PhD

Academic Unit of Psychiatry and Behavioural Sciences, School of Medicine, University of Leeds

Navneet Kapur, MD, FRCPsych

Centre for Suicide Prevention, University of Manchester, UK.

Correspondence: Professor Keith Hawton, Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK. Email: keith.hawton{at}psych.ox.ac.uk

Declaration of interest

None. Funding detailed in Acknowledgements.

Background

Self-harm is increasingly common in many countries, is often repeated and may have other negative outcomes.

Aims

To systematically review people's attitudes towards clinical services following self-harm in order to inform service design and improvement.

Method

A search of electronic databases was conducted and experts in the field were contacted in order to identify relevant worldwide qualitative or quantitative studies. Data were extracted independently by two reviewers with more weight given to studies of greater quality and relevance.

Results

Thirty-one studies met the inclusion criteria. Despite variations in healthcare systems and setting, participants' experiences were remarkably similar. Poor communication between patients and staff and a perceived lack of staff knowledge with regard to self-harm were common themes. Many participants suggested that psychosocial assessments and access to after-care needed to be improved.

Conclusions

Specific aspects of care that might increase service user satisfaction and treatment adherence include staff knowledge, communication and better after-care arrangements. A standard protocol could aid regular audits of users' experiences of services.


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