Exploring the differences between self-harm and suicide in women with complex mental health needs.

Self-harm and suicidal are major public health problems, which can contribute to many life long adverse outcomes. The costs of self-harm and suicide are high on both an individual and societal level and have considerable financial implications for health services. Self-harm and suicide are known to be more prevalent amongst the forensic mental health population than in the general population and the wider mental health population. Whilst some claim that self harm and suicide are distinctly different behaviours, recent literature advocates that the separation of self-harm and suicide may be more challenging than originally thought, as an additional type of self-harm behaviour has been noted. Life-threatening self-harm refers to self-harm that without medical intervention, is serious enough to bring about death. As current literature situates life-threatening self-harm in the context of suicidal ideation, survivors of life-threatening self-harm are considered the best proxies to inform research and practice about suicide. It is however important to note that amongst the limited literature, there is a proportion of people who self-harm using highly lethal methods but do without suicidal intent. Consequentially, further investigation is warranted. Whilst a picture is forming for the general and prison population, to date there is yet to be a study that explores the reasons for life-threatening self-harm amongst women receiving forensic mental health services. The lack of literature is important, as currently literature from the prison and general population informs clinical practice, without understanding whether the findings are generalisable to the female forensic mental health population. This includes the use of self harm and suicide prevention strategies, including restricting access to means. Therefore, the current research aimed to address the gap in literature, in a bid to better understand the functions of, and pathways to, life-threatening self-harm amongst women in forensic mental health services. Sixteen members of staff and seven women from various levels of security were enlisted to take part in semi-structured interviews. The interviews aimed to hear the voices of women and staff and use them to provide a unique picture of life-threatening self-harm within a hard to access population; to determine the functions of, and pathways to life-threatening self-harm; and to explore the impacts of restricting access to means on life-threatening self-harm. The findings indicate that women in forensic mental health services do not enact life-threatening self-harm suicidal with intent. Instead, the women and staff who took part in the research posit there are seven functions of, and pathways to, life-threatening self-harm. The findings also indicate that working with or living amongst women who enact life-threatening self-harm is emotionally taxing. Furthermore, the findings suggest that restricting access to means plays a contributory role in life-threatening self-harm. The findings of the research are discussed with reference to directions for future research, the clinical implications and the methodological limitations