A Qualitative Study of The Experiences of People who Use A&E Services following Deliberate Self Harm or Attempted Suicide and Receive No Further Support

Deliberate self-harm, attempted suicide and Borderline Personality Disorder are problems affecting a significant number of people within the United Kingdom. Part 1 of this thesis provides a systematic review of Dialectical Behaviour Therapy (DBT) based interventions under the length of six months for these problems. 20 studies were identified assessing the effectiveness or efficacy of the interventions. The nature of the interventions being provided as well as the strength of the evidence for their effectiveness were assessed in the review. Group based skills interventions and six-month implementations of full DBT were reported to have evidence supporting their effectiveness. The need for further research on the effectiveness of shorter implementations of full DBT, in particular RCTs, is highlighted in the conclusions. Part 2 is a qualitative study exploring the experiences and views of people who repeatedly use Accident & Emergency services (A&E) for self-harm or attempted suicide and do not go on to receive input from mental health services. This was a joint project, conducted with another trainee Clinical Psychologist. Ten service users with past or present experience of visiting A&E for risk to self were interviewed. Using thematic analysis, ten themes were developed, divided into three domains. The first domain focussed on the experiences participants had in A&E, how they interpreted these experiences, and the consequences of these experiences. The second explored the beliefs participants held about themselves, clinicians and the availability of services. The final domain focussed on barriers and facilitators to accessing further care. Part 3 is a reflection on the process of planning research, recruiting participants, and the journey of reflexivity in the research