1. © Manchester self-harm project, University of Manchester. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright holder. “I can't bring it into my own mind, why it's all happened, why it could've happened at that time” Exploring the experience of self and services after self-harm Presenter: Cheryl Hunter Friday 27 August 2010 Supervisors: Dr Jayne Cooper, Prof Navneet Kapur and Dr Khatidja Chantler

2. © Manchester self-harm project, University of Manchester. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright holder. Contents of Talk Background Study – Focus, Method, Sample Theme 1: Impact on the self Theme 2: Hospital Environment Theme 3: Experience of Assessment Reflections Acknowledgements

3. © Manchester self-harm project, University of Manchester. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright holder. Background Self-harm Complex, over-determined behaviour Different methods, reasons and functions Occurs in the context of a wide range of psychological and social difficulties One of the strongest predictors of suicide but suicidal intent not always present Over 3,000 presentations per year in Manchester Self-harm does not occur in a social vacuum – social and cultural ideas and preconceptions surround the act

4. © Manchester self-harm project, University of Manchester. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright holder. Study – Focus, Methods, Sample Focus - Key aspect of management (psychosocial assessment) from service user perspective Methods - Semi-structured Interviews - Recruited via letter from hospital staff - Interpretative Phenomenological Analysis Sample - 13 participants – 7 men, 6 women - Majority White British - 7 suicidal - 5 overdose; 7 self-injury; 1 thoughts only

5. © Manchester self-harm project, University of Manchester. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright holder. Failing the Self “I was really upset about it, because I’d swore I’d never do it again” P11 “I didn’t need to do that, you know, there could have been something else I could have done” P5 Struggling to understand “I can’t bring it into my own mind, why it’s all happened, why it could’ve happened at that time” P12 “I felt quite desperate, you know, why have I done this? Why have I done this?” P10 Theme 1 – Impact on the self

6. © Manchester self-harm project, University of Manchester. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright holder. Theme 2 – Hospital environment Feeling Safe/Unsafe “While I was there, I felt comforted in the notion that if things got really awful… I couldn’t kill myself” P6 “I knew where I was and I knew that I was secure” P12 Toll of Waiting “When you’re going through that… all that in your head, and then you’re stuck there in the waiting room… it can send you a bit loopy” P5 “You shouldn’t leave someone like that, sat there waiting, covered in blood” P3

7. © Manchester self-harm project, University of Manchester. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright holder. Theme 3 – experience of assessment Feeling legitimated “Genuinely you are ill, in the mind, you are ill” P5 Feeling judged “You’re playing a bit of a stupid game” P2 Feeling understood “She listened to you more, and did more with you” P7 Struggle to be heard “I was telling them and… they just said well, you’re alright to go back home” P1 “I don’t need you to tell me about your story” P9

8. © Manchester self-harm project, University of Manchester. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright holder. Reflections Self-harm often evoked shame and a sense of failure Participants often sought help to feel understood/help them understand their own actions Environment can have significant emotional impact on participant Psychosocial assessment as an opportunity to demonstrate acceptance in order to protect the self from a self- and other-stigmatised act

9. © Manchester self-harm project, University of Manchester. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright holder. Acknowledgements Cheryl Hunter is in receipt of a PhD studentship funded by the Medical Research Council and the MASH project The MASH project is funded by the Department of Health (project reference number DH/DSH2008). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Department of Health Acknowledgements: the MASH team, Dr Cooper, Dr Chantler and Professor Kapur of the University of Manchester