Harm‐reduction approaches for self‐cutting in inpatient mental health settings: Development and preliminary validation of the Attitudes to Self‐cutting Management (ASc‐Me) Scale [2018]

Harm‐reduction approaches for self‐harm in mental health settings have been under‐researched.

To develop a measure of the acceptability of management approaches for self‐cutting in mental health inpatient settings.

Stage one: scale items were generated from relevant literature and staff/service user consultation. Stage two: A cross‐sectional survey and statistical methods from classical test theory informed scale development.

At stage one N=27 staff and service users participated. At stage two N=215 people (n=175 current mental health practitioners and n=40 people with experience of self‐cutting as a UK mental health inpatient) completed surveys. Principal components analysis revealed a simple factor structure such that each method had a unique acceptability profile. Reliability, construct validity, and internal consistency were acceptable. The harm‐reduction approaches ‘advising on wound‐care’ and ‘providing a first aid kit’ were broadly endorsed; ‘providing sterile razors’ and ‘maintaining a supportive nursing presence during cutting’ were less acceptable but more so than seclusion and restraint.

The Attitudes to Self‐cutting Management scale is a reliable and valid measure that could inform service design and development.

Implications for practice
Nurses should discuss different options for management of self‐cutting with service users. Harm reduction approaches may be more acceptable than coercive measures.

Leah Hosie, Geoffrey L Dickens

Journal of Psychiatric and Mental Health Nursing, 26 September 2018