TY - JOUR

T1 - Health services, suicide, and self-harm

T2 - patient distress and system anxiety organisations and anxiety

AU - Smith, Michael J.

AU - Bouch, Joe

AU - Bradstreet, Simon

AU - Lakey, Trevor

AU - Nightingale, Anne

AU - O 'Connor, Rory C.

PY - 2015/3

Y1 - 2015/3

N2 - Patients often become distressed in health settings, and provision of emotional support is a routine part of clinical care. However, in some situations, patient distress can become disturbing to both clinicians and patients, and can challenge [A: interfere with or affect?] ordinary therapeutic engagement. We argue that health systems that support people presenting with suicidal acts and self-harm are particularly at risk of providing maladaptive responses, which we have termed dysregulation. If health systems become dysregulated, staff and patients might find it difficult to think clearly and respond adaptively. We describe some common characteristics of dysregulation, including negative feelings about patients, an inappropriately narrow focus on diagnosis and risk assessment, and ad-hoc, abrupt, and inconsistent decision making. These dysregulated responses might impair more adaptive responses such as containment of distress, safety planning, and negotiated responsibility with patients and carers. We discuss the main drivers of dysregulation and the implications for clinical practice in the management of self-harm and suicide risk.

AB - Patients often become distressed in health settings, and provision of emotional support is a routine part of clinical care. However, in some situations, patient distress can become disturbing to both clinicians and patients, and can challenge [A: interfere with or affect?] ordinary therapeutic engagement. We argue that health systems that support people presenting with suicidal acts and self-harm are particularly at risk of providing maladaptive responses, which we have termed dysregulation. If health systems become dysregulated, staff and patients might find it difficult to think clearly and respond adaptively. We describe some common characteristics of dysregulation, including negative feelings about patients, an inappropriately narrow focus on diagnosis and risk assessment, and ad-hoc, abrupt, and inconsistent decision making. These dysregulated responses might impair more adaptive responses such as containment of distress, safety planning, and negotiated responsibility with patients and carers. We discuss the main drivers of dysregulation and the implications for clinical practice in the management of self-harm and suicide risk.

U2 - 10.1016/S2215-0366(15)00051-6

DO - 10.1016/S2215-0366(15)00051-6

M3 - Journal article

VL - 2

SP - 275

EP - 280

JO - Lancet Psychiatry

JF - Lancet Psychiatry

SN - 2215-0366

IS - 3

ER -