مقاله انگلیسی رایگان در مورد مدیریت بحران استاندارد برای خودزنی و خودکشی – NCBI 2017

As stated by the National Institute for Health and Care Excellence [1] “The experience of care for people who self-harm is often unacceptable.” There is a misconception even amongst some health care providers that individuals who self-harm are choosing their suffering. This creates stigma regarding self-harm, about which individuals with lived experience are often well aware. Similar experiences with respect to stigma have been reported by people diagnosed with borderline personality disorder (BPD [2]). General psychiatric admission (GPA) is of uncertain therapeutic value amongst self-harming and suicidal individuals, and potentially harmful if lengthy and unstructured for those with BPD [3–5]. Specialized evidence-based services developed for these individuals at times they cannot keep themselves safe is often needed, but more often lacking. These services are particularly necessary in situations of unique vulnerability, such as suicidal crises. When suicide and severe self-harm are acute risks it is essential that services are offered in a compassionate manner that honours the human dignity of the person who is suffering [6, 7]. A report commissioned by Sweden’s National Self-harm Project examined the prevalence of self-harm among individuals receiving mental health services across 84 psychiatric settings from 15 cities [8]. The sample was comprised of participants aged 12 years and older. Results indicated that almost half of the participants currently receiving mental health services had self-harmed during the past 6 months, with one in six adults self-harming five or more times the last 6 months. Three out of four young women between the ages of 12 and 18 reported self-harming over the same time period. Of those who had engaged in selfharming behaviour, more than half had attempted suicide at least once during their lifetime [8]. For a sub-group of individuals, often with BPD, self-harming behaviours are frequent and risk for suicide is recurrent [9]. Over the last 20 years several psychotherapeutic interventions have evolved for the treatment of individuals with self-harm as well as BPD [3, 5, 10, 11]. However, during crises and associated increases in self-harm and suicidal ideation, recommendations for clinical care are still conflicting. For individuals with imminent suicidal ideation, without recurrent self-harm, the routine practice is to offer psychiatric admission to an inpatient unit [12]. For individuals with recurrent suicidal ideation and self-harm, often diagnosed with BPD, the risk for iatrogenic effects may be considerable. Lengthy hospital admissions without a clear treatment structure are associated with clinical and functional decompensation amongst this group [3–5]. Consequentially there is a clinical practice of avoiding inpatient admission of individuals with these presenting features. The absence of consensus amongst crisis management recommendations is a regular burden requiring strategic planning at junctures that would be better suited to the provision of seamless clinical care. Ideally, the situation would not require having to re-negotiate the entire process (to admit or not admit) on behalf of every acutely suicidal individual when they themselves feel out of control.