Self-cutting and harm reduction : evidence trumps values but both point forward

Self‐harm is common on mental health wards, an unsurprising fact given that the patient group comprises some of the most unwell people from the local community. One systematic review of 25 studies (Swannell, Martin, Page, Hasking, & St John, 2014) suggested a pooled prevalence for self‐harm by inpatient mental health service users of 17.4% (range 0.7%–68.8%) including up to 21% specifically by self‐cutting. It has long been recognized that custodial, coercive approaches to inpatient self‐harm management are problematic, invalidate the individual's distress and disrespect their agency and autonomy. Over the years, the issue of harm‐reduction approaches to self‐harm has been periodically raised, most commonly as discussions of ethical and legal obligations and boundaries (Sullivan, 2017). While periodic re‐examination of the fundamental principles underlying different courses of nursing management is meritorious, it is only by the generation or acquisition of new data that we can truly move the debate forward. Put bluntly, while values are important, new evidence can create the conditions for change. Recently, two studies have made important contributions. James, Samuels, Moran, and Stewart (2017) published work detailing qualitative results from interviews with UK mental health practitioners regarding their use of harm‐minimization techniques. They reported patchy implementation and considerable ambivalence about their use. Our own research, recently published in this journal, took a different approach. We developed a means of quantifying support for the various approaches to management of self‐cutting in the inpatient setting. The result is the Attitudes to Self‐cutting Management Scale (ASc‐Me), and we think the results offer some important pointers for policy and practice in mental health nursing.