Clinical Care of Self-Harm Patients: An Evidence-Based Approach

Self-harm is often related to interpersonal and social problems. It has been linked to certain psychological characteristics, including deficiencies in problem solving, low self-esteem and impulsivity. There is a strong association between self-harm and suicide. Dialectical behavior therapy for patients with borderline personality disorder and a history of self-harm has been compared with treatment as usual in three trials. This chapter considers how the care of self-harm patients, especially those presenting to hospital, might be improved. It examines what can be learned, first, from studies of patients' attitudes to clinical services; second, from investigation of staff attitudes to patients; third, from clinical trials of different therapeutic approaches to aftercare; and, finally, from studies of services, including what seems to work. It concludes the chapter with a summary of how this information can be used to design more effective services for self-harm patients.