Organisation-Wide Policies, Procedures, and Practices for Managing Self-Harm in Adult Inpatient Mental Health Services: A Scoping Review

Keeping people safe is a core purpose of inpatient mental health services and therefore managing self-harm is an everyday concern for organisations delivering this care. Recent research on patient safety in inpatient mental health settings has largely focused on the use of restrictive interventions applied at an individual level including restraint, seclusion, rapid tranquilisation, and enhanced patient observations. Limited focus has been given to organisation-wide practices which aim to manage self-harm. This scoping review therefore aims to identify what practices are operating at this level. Across the 32 publications identified for inclusion, 43 practices were identified which operated to directly prevent self-harm, or to control the behaviours of staff and patients with the aim of preventing it. These included a broad range of practices such as environmental design measures, staff training, and leadership oversight of safety information. Whilst this review does not draw conclusions on the effectiveness or prevalence of the use of the identified practices, it provides a useful overview of the toolkit of practices available to organisations for managing self-harm. It also notes that most of the practices identified took a restrictive approach to prevention, which suggests that future research could consider alternative and more positive approaches.