Harm-reduction approaches for self-cutting in inpatient mental health settings: development and preliminary validation of the Attitudes to Self-cutting Management (ASc-Me) Scale

Introduction

Harm-reduction approaches for self-harm in mental health settings have been under-researched.

Aim

To develop a measure of the acceptability of management approaches for self-cutting in mental health inpatient settings.

Methods

Stage one: scale items were generated from relevant literature and staff/service user consultation. Stage two: A cross-sectional survey and statistical methods from classical test theory informed scale development.

Results/Findings

At stage one N=27 staff and service users participated. At stage two N=215 people (n=175 current mental health practitioners and n=40 people with experience of self-cutting as a UK mental health inpatient) completed surveys. Principal components analysis revealed a simple factor structure such that each method had a unique acceptability profile. Reliability, construct validity, and internal consistency were acceptable. The harm-reduction approaches 'advising on wound-care' and 'providing a first aid kit' were broadly endorsed; 'providing sterile razors' and 'maintaining a supportive nursing presence during cutting' were less acceptable but more so than seclusion and restraint.

Discussion

The Attitudes to Self-cutting Management scale is a reliable and valid measure that could inform service design and development.

Implications for practice

Nurses should discuss different options for management of self-cutting with service users. Harm reduction approaches may be more acceptable than coercive measures. This article is protected by copyright. All rights reserved.