Health services, suicide, and self-harm: patient distress and system anxiety

Smith, M. J., Bouch, J., Bradstreet, S. , Lakey, T., Nightingale, A. and O'Connor, R. C. (2015) Health services, suicide, and self-harm: patient distress and system anxiety. Lancet Psychiatry, 2(3), pp. 275-280. (doi:10.1016/S2215-0366(15)00051-6) (PMID:26359905)

Full text not currently available from Enlighten.

Abstract

Patients often become distressed in health settings, and provision of emotional support is a routine part of clinical care. However, in some situations, patient distress can become disturbing to both clinicians and patients, and can affect ordinary therapeutic engagement. We argue that health systems that support people presenting with suicidal acts and self-harm are particularly at risk of providing maladaptive responses, which we have termed dysregulation. If health systems become dysregulated, staff and patients might find it difficult to think clearly and respond adaptively. We describe some common characteristics of dysregulation, including negative feelings about patients, an inappropriately narrow focus on diagnosis and risk assessment, and ad-hoc, abrupt, and inconsistent decision making. These dysregulated responses might impair more adaptive responses such as containment of distress, safety planning, and negotiated responsibility with patients and carers. We discuss the main drivers of dysregulation and the implications for clinical practice in the management of self-harm and suicide risk.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Bouch, Dr Joe and O'Connor, Professor Rory and Smith, Dr Michael and Bradstreet, Dr Simon and Nightingale, Dr Anne
Authors: Smith, M. J., Bouch, J., Bradstreet, S., Lakey, T., Nightingale, A., and O'Connor, R. C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
Journal Name:Lancet Psychiatry
Publisher:Elsevier
ISSN:2215-0366
ISSN (Online):2215-0374

University Staff: Request a correction | Enlighten Editors: Update this record