Motives for self-harm: views of nurses in a secure unit

Self-harm is a widespread behaviour among people with mental health problems. Although guidance on how to manage self-harm is offered, it is still a behaviour that is misunderstood by many nurses. Such misunderstanding is generally attributed to the perceived motives for self-harm and lack of specialized education to manage the behaviour. As a consequence, the care provided is usually inadequate and inappropriate. Yet, research concerning nurses' reasons of users' self-harming behaviours is limited.

This paper reports on a study that explores nurses' explanations of the motives for self-harm in a secure adolescent unit in England.

The study utilized a phenomenological methodology with semi-structured individual interviews (n = 25). The data were analysed thematically using interpretative phenomenological analysis.

The findings indicate that the behaviour of self-harm has multiple motives. Examples of these include affect regulation, coping with distress, averting death, regaining control and attention seeking.

Self-harm is a complex behaviour commonly experienced in secure environments. Nurses assume that users who self-harm are motivated by a desire to seek attention and manipulate others. Users may find these beliefs humiliating. Such feelings may increase users' risks for further self-harm. Most adolescents who self-harm experience unbearable emotions because of their past sexual abusive encounters. They self-harm to regulate these emotions. These affect regulatory functions may act as reinforcers of self-harming behaviours.

Improved understanding of self-harm and its motives may result in improved nurse-user relationships and thus safer and more effective care provision.