Exploring Access to Support for People Who Self-Harm

Abstract

This thesis is presented as three papers. Paper one is a systematic review and meta-synthesis investigating individuals' experiences of accessing support for self-harm. Three databases were systematically searched, and 15 papers were identified for inclusion in the meta-synthesis, with a total of 170 participants. Using a Meta-ethnographic approach, two overarching themes were identified: 1. Prior experiences of services shape future help-seeking, and 2. Psychological barriers to support. The roles of self-harm-related shame and stigma were important to individuals’ experiences, which emerged through a line of argument of synthesis. Clinical implications include consideration of the role shame and stigma can play in preventing access to care, including awareness of the impact on engagement and secrecy regarding self-harm. Paper two explored adult stakeholder perspectives and experiences of the barriers to and facilitators of accessing self-harm support. Semi-structured interviews were conducted with 19 participants, including nine clinicians (i.e. clinical psychologists and mental health practitioners) supporting people who self-harm and 10 individuals with lived experience of self-harm. A Reflexive Thematic Analysis revealed three main themes. Both stakeholder groups reported feeling powerless to make changes within the system. The importance of understanding the person behind self-harm behaviour was outlined. Both stakeholder groups highlighted what self-harm support could look like, which included recommendations that services prioritise person-centred care, expert-by-experience involvement and early intervention. Clinical implications include the importance of considering the barriers and facilitators that individuals who self-harm may face when accessing psychological interventions, which could inform the development of more inclusive and accessible services. Paper three provides a critical appraisal of the meta-synthesis, the empirical paper and of the overall research process. Consideration of strengths and weaknesses of approaches to design, implementation and interpretation are provided. In addition, clinical implications, recommendations for further research and personal reflections are provided.

Date of Award	1 Jan 1824
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Catherine Robinson (Supervisor), Peter Taylor (Supervisor) & Kamelia Harris (Supervisor)