Year: 2026
Type: dissertation
Abstract: BACKGROUND: Self-harm is a significant public health issue and people who self-harm often have contact with health services. It is important to understand how these services can best respond to people who self-harm. There are different sub-sectors of the population who may require specific responses. These include autistic people and people who are supported by community-based secondary care mental health services. This thesis explores the needs of these separate populations. AIMS: The aim of this thesis is to contribute to knowledge about service responses to self-harm by explaining what is helpful from those who experience them. Firstly, a qualitative systematic review is presented which explores the experiences of autistic people who self-harm. Secondly, an empirical project is presented which explores how clients and clinicians make sense of service responses to self-harm in a secondary care community setting. METHODS: In chapter one, a systematic review was conducted of 15 relevant studies using thematic synthesis. In chapter two, interviews and textual data were generated and analysed to create a grounded theory using a constructivist epistemology. RESULTS: In chapter one, the findings highlighted three overarching needs from the population of autistic people who self-harm: “needing to understand myself”, “needing services to understand me, and for us to understand each other”, and “needing society to understand me”. In chapter two, a theory was generated explaining that service interactions can be conceptualised as negotiating responsibility for safety, which is impacted by uncertainty, communication and relationships. CONCLUSIONS: Service responses are critical in providing support to people who self-harm. Services need to understand individuals by reducing uncertainty, building supportive relationships, and through effective communication adapted to the individual. Systemic contexts are important, both in terms of providing overarching service support to clinicians, and also in influencing societal responses.
DOI: 10.7488/era/7793
Author: Watchwell, Maisie
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7214705541