Exploring How Intent of Self-harm Affects Trainee Healthcare Practitioners’ Views, Attitudes and Clinical Decision-making in Northwest England: A Qualitative Study.

Abstract

Self-harm is often stigmatised by healthcare professionals. Little is known about how certain characteristics of the behaviour, like the degree of suicidal intent, affects clinicians’
judgements and responses. This study explored how intent of self-harm (suicidal or nonsuicidal) affects trainee practitioners’ views, attitudes towards the behaviour and clinical
decision-making. A qualitative study using semi-structured online interviews was conducted. Interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis. Fifteen trainee healthcare practitioners (psychological wellbeing practitioners, clinical/counselling psychologists, nurses, medics) were interviewed. Three themes were identified: (1) interpreting intent in self-harm: clinical utility and challenges, (2) perceived responsibility of self-harm and (3) Trainees struggle for equal care in a
hierarchical system. Participants observed staff expressing pejorative views towards both forms of self-harm but did not share them. Across most clinical decisions, intent informed
trainees’ judgements and beliefs. Clients presenting with suicidal-related self-harm received more urgent care but fewer therapeutic interventions. Trainees felt ambivalent about distinguishing intent. Nevertheless, this distinction was evident across treatment, risk and care decisions. A consistent approach towards suicidal and non-suicidal self-harm is important. Trainees should be supported in addressing difficult emotions arising from this work, helping shift the blame culture and promote a more empathic approach.