Young Peoples’ Perspectives on the Role of Harm Reduction Techniques in the Management of Their Self-Harm: A Qualitative Study

Abstract

Objective

Self-harm is a common phenomenon amongst young people, often used to regulate emotional distress. Over the last decade harm reduction approaches to self-harm have been introduced as a means to minimize risk and reinforce alternative coping strategies. However, there is a stark absence of research into the perceived usefulness of such techniques amongst adolescents, and previous studies have highlighted ethical concerns about advocating ‘safer’ forms of self-harm. This study aimed to investigate the perceived usefulness of harm reduction techniques for adolescents who self-harm.

Method

We purposively recruited current clients of a British early intervention program supporting young people in managing self-harm. We conducted semi-structured interviews and analyzed transcripts using thematic analysis.

Results

Eleven interviews with service users aged 14–15 years identified three main themes: (1) Controlling the uncontrollable; (2) Barriers to practising safer self-harm; and (3) Developing a broad repertoire of harm reduction techniques. Participants expressed mixed views regarding the usefulness of such approaches. Some described greater competence and empowerment in self-harm management, whilst others described the utility of harm reduction methods as either short-lived or situation-specific, with the potential for misuse of anatomical knowledge to cause further harm to high-risk adolescents.

Conclusion

The findings from our sample suggest harm reduction techniques have a place in self-harm management for some individuals, but their usage should be monitored and offered alongside alternative strategies and therapeutic support. Our study highlights the need for further research on who would benefit from these techniques and how they can be implemented successfully.

HIGHLIGHTS

1. Harm reduction can help people who self–harm manage distress and maintain autonomy

2. People who self-harm have a broad repertoire of harm reduction techniques

3. Harm reduction can help reduce long-term damage and frequency of self-harm

Keywords:

• Harm minimization
• harm reduction
• self-harm
• self-injury
• young people

ACKNOWLEDGEMENTS

We would like to thank Mind and Body for their assistance in recruitment and providing interview rooms in youth hubs, and all the secondary schools throughout Kent that consented to participate and provide interview rooms. We would also like to thank the 12 interviewees, as well as all parents/guardians who consented to their child’s participation.

DISCLOSURE STATEMENT

All authors declare no conflict of interests. Mind and Body helped in the recruitment of participants but had no influence over the data provided within the interviews; the design and conduct of the study; collection, analysis, and interpretation of the data, or the writing of the final manuscript. The views expressed are those of the authors and not necessarily those of MAB.

Additional information

Funding

JB, AP, and SR are funded by the NIHR University College London Hospitals Biomedical Research Centre (NIHR UCLH BRC). This work was funded by the UCL Division of Psychiatry MSc fund to JD.

Notes on contributors

Jessica Davies

Jessica Davies is a graduate of the MSc Clinical Mental Health Sciences at University College London. She has previous clinical experiences working with children and high-risk adolescents in community settings and within the NHS. Her research interests include self-harm, suicidality, mental health and education, and child and adolescent mental health.

Alexandra Pitman

Dr Alexandra Pitman is a Clinical Associate Professor in the University College London Division of Psychiatry and an Honorary Consultant Psychiatrist at Camden and Islington NHS Foundation Trust. She is interested in understanding risk factors for suicide attempt and in developing interventions to address them.

Victoria Bamber

Victoria Bamber is a graduate of the MSc Clinical Mental Health Sciences at University College London. She has previous clinical experiences working with high-risk adolescents within NHS settings.

Joanne Billings

Dr Joanne Billings is a Clinical Associate Professor in the Division of Psychiatry. Her clinical and research interests include complex trauma, vicarious trauma, trauma and psychosis, early intervention, mental health wellbeing and resilience, and qualitative methodology.

Sarah Rowe

Dr Sarah Rowe is an Associate Professor at University College London Division of Psychiatry and Deputy Director of the MSc in Mental Health Sciences programme. Her research interests include harm-minimization for self-harm, child and adolescent mental health, personality and eating disorders.