“A girl started with it when she was extremely
young - almost before she could speak (i3).”
4.2.4. Allowing and/or Preventing External Self-Harm. Patients
are searched when being admitted to a unit, and
the participants sought to ensure that this occurred in
partnership with the patient and in a voluntary spirit. Patients
are only allowed a limited number of personal belongings.
Staff removed and stored lighters, sharp objects, narcotics,
and more. The participants experienced that diverse attitudes
toward whether or how much a patient is allowed to selfharm
while in care varied between units and even MHNs.The
study results indicate that two different approaches to setting
boundaries for patients’ actions exist.
The first approach is that patients are not allowed to
self-harm at all. All self-harm is stopped through the use
of control, such as physically holding patients, medication,
close monitoring, the use of metal detectors, seclusion, or
restraints:
“A patient who is restrained who is engaging in
self-harm does not, to be sure, always receive so
much medication, but - that the patient should
have it better and be calmer (i5).”
The second approach is that patients are allowed to harm
themselves to a mild or moderate degree while admitted
to a unit; patients often possess or can access tools with
which to harm themselves and are not physically restrained.
The participants experienced that allowing patients to harm
themselves to a mild or moderate degree can prevent serious
self-harm in that it relieves patients’ inner mental pain. Some
participants pointed out that this way of relating to selfharm
can help patients master and cope with their problem.
The participants stated that some variation between units
exists; on some units patients were not allowed to self-harm
in the common areas of the unit. In general, patients were
encouraged to relinquish their tools once the self-harm act
was completed:
“We do not stop it because for some it is important
to see blood (i9)”;
“Simply with the [physical environment] that
there are locked doors and they are not allowed
to have many different things so, it is difficult to
give them the responsibility they should have to
learn and cope with this. How they should learn
to master to not cut themselves when they do not
have anything to cut themselves with (i1).”
The participants reported that serious self-harm that can
lead to suicide is always stopped, whether through the use of
seclusion or restraints or constant observation for shorter and
longer periods of time.
4.2.5. Taking Responsibility for Patients’ Wounds and Injuries.
Care and treatment was provided in accordance with the
degree of severity of wounds and injuries. Mild injuries were
dressed with adhesive bandages, whereas the most severe