‘If one doesn't happen, the other will’: forensic mental health service patients’ experiences of co-occurring self-harm and aggression
Background Co-occurring self-harm and aggression (dual harm) is particularly prevalent among forensic mental health service (FMHS) patients. There is limited understanding of why this population engages in dual harm. Aims This work aims to explore FMHS patients’ experiences of dual harm and how the...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2025-01-01
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| Series: | BJPsych Open |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S2056472424008342/type/journal_article |
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| author | Matina Shafti Peter Taylor Andrew Forrester Louise Robinson Sandeep Mathews Daniel Pratt |
| author_facet | Matina Shafti Peter Taylor Andrew Forrester Louise Robinson Sandeep Mathews Daniel Pratt |
| author_sort | Matina Shafti |
| collection | DOAJ |
| description | Background
Co-occurring self-harm and aggression (dual harm) is particularly prevalent among forensic mental health service (FMHS) patients. There is limited understanding of why this population engages in dual harm.
Aims
This work aims to explore FMHS patients’ experiences of dual harm and how they make sense of this behaviour, with a focus on the role of emotions.
Method
Participants were identified from their participation in a previous study. Sixteen FMHS patients with a lifetime history of dual harm were recruited from two hospitals. Individuals participated in one-to-one, semi-structured interviews where they reflected on past and/or current self-harm and aggression. Interview transcripts were analysed using reflexive thematic analysis.
Results
Six themes were generated: self-harm and aggression as emotional regulation strategies, the consequences of witnessing harmful behaviours, relationships with others and the self, trapped within the criminal justice system, the convergence and divergence of self-harm and aggression, and moving forward as an FMHS patient. Themes highlighted shared risk factors of dual harm across participants, including emotional dysregulation, perceived lack of social support and witnessing harmful behaviours. Participants underlined the duality of their self-harm and aggression, primarily utilising both to regulate negative emotions. These behaviours also fulfilled distinct purposes at times (e.g. self-harm as punishment, aggression as defence). The impact of contextual factors within FMHSs, including restrictive practices and institutionalisation, were emphasised.
Conclusions
Findings provide recommendations that can help address dual harm within forensic settings, including (a) transdiagnostic, individualised approaches that consider the duality of self-harm and aggression; and (b) cultural and organisational focus on recovery-centred practice.
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| format | Article |
| id | doaj-art-81da1fd0794f4364b626839fb09d84ac |
| institution | Kabale University |
| issn | 2056-4724 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj-art-81da1fd0794f4364b626839fb09d84ac2025-01-22T04:31:43ZengCambridge University PressBJPsych Open2056-47242025-01-011110.1192/bjo.2024.834‘If one doesn't happen, the other will’: forensic mental health service patients’ experiences of co-occurring self-harm and aggressionMatina Shafti0https://orcid.org/0000-0001-5612-7076Peter Taylor1Andrew Forrester2Louise Robinson3https://orcid.org/0000-0001-6455-1360Sandeep Mathews4Daniel Pratt5https://orcid.org/0000-0001-8843-1224Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; and School of Human Sciences and Institute for Lifecourse Development, University of Greenwich, London, UKDivision of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UKDivision of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UKDivision of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; and Lancashire and South Cumbria NHS Foundation Trust, Preston, UKGreater Manchester Mental Health NHS Foundation Trust, Manchester, UKDivision of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UKBackground Co-occurring self-harm and aggression (dual harm) is particularly prevalent among forensic mental health service (FMHS) patients. There is limited understanding of why this population engages in dual harm. Aims This work aims to explore FMHS patients’ experiences of dual harm and how they make sense of this behaviour, with a focus on the role of emotions. Method Participants were identified from their participation in a previous study. Sixteen FMHS patients with a lifetime history of dual harm were recruited from two hospitals. Individuals participated in one-to-one, semi-structured interviews where they reflected on past and/or current self-harm and aggression. Interview transcripts were analysed using reflexive thematic analysis. Results Six themes were generated: self-harm and aggression as emotional regulation strategies, the consequences of witnessing harmful behaviours, relationships with others and the self, trapped within the criminal justice system, the convergence and divergence of self-harm and aggression, and moving forward as an FMHS patient. Themes highlighted shared risk factors of dual harm across participants, including emotional dysregulation, perceived lack of social support and witnessing harmful behaviours. Participants underlined the duality of their self-harm and aggression, primarily utilising both to regulate negative emotions. These behaviours also fulfilled distinct purposes at times (e.g. self-harm as punishment, aggression as defence). The impact of contextual factors within FMHSs, including restrictive practices and institutionalisation, were emphasised. Conclusions Findings provide recommendations that can help address dual harm within forensic settings, including (a) transdiagnostic, individualised approaches that consider the duality of self-harm and aggression; and (b) cultural and organisational focus on recovery-centred practice. https://www.cambridge.org/core/product/identifier/S2056472424008342/type/journal_articleSelf-harmaggressionco-occurrencesuicideforensic mental health |
| spellingShingle | Matina Shafti Peter Taylor Andrew Forrester Louise Robinson Sandeep Mathews Daniel Pratt ‘If one doesn't happen, the other will’: forensic mental health service patients’ experiences of co-occurring self-harm and aggression BJPsych Open Self-harm aggression co-occurrence suicide forensic mental health |
| title | ‘If one doesn't happen, the other will’: forensic mental health service patients’ experiences of co-occurring self-harm and aggression |
| title_full | ‘If one doesn't happen, the other will’: forensic mental health service patients’ experiences of co-occurring self-harm and aggression |
| title_fullStr | ‘If one doesn't happen, the other will’: forensic mental health service patients’ experiences of co-occurring self-harm and aggression |
| title_full_unstemmed | ‘If one doesn't happen, the other will’: forensic mental health service patients’ experiences of co-occurring self-harm and aggression |
| title_short | ‘If one doesn't happen, the other will’: forensic mental health service patients’ experiences of co-occurring self-harm and aggression |
| title_sort | if one doesn t happen the other will forensic mental health service patients experiences of co occurring self harm and aggression |
| topic | Self-harm aggression co-occurrence suicide forensic mental health |
| url | https://www.cambridge.org/core/product/identifier/S2056472424008342/type/journal_article |
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