Table 2 Table of the factors affecting the reporting or recording of self-harm within a healthcare setting

Bailey et al. 2017 [23]

England

N/A

Editorial

N/A

GP

REPORTING

(i) Giving the YP the opportunity to talk about their SH in their own words

(ii) Guided self-help information- Worked through with GPs rather than being given to the YP to read after a consultation

RECORDING

(i) Talking to YP about what is recorded and for staff to be trained to support consistency of recording

REPORTING

(i) YP having poor intrapersonal and communication skills

(ii) YP having concerns about whether shared information will stay confidential and/or negative consequences of disclosure

(iii) YP struggle to explain SH and fear not being taken seriously or respectfully because of age

(iv) Short appointments not comprehensive enough. (v) Ineffective screening tools- Screening tools too formal for time-limited consultations, yet need to assess risks, whilst not exacerbating current risk or cause the YP more distress

RECORDING (i) Stigma of DSH due its connotations of blame and associated stigma

MEDIUM RISK

Bellairs-Walsh et al. 2020 [57]

Australia

To explore YP's views and experiences related to the identification, assessment and care of suicidal behaviour and SH in primary care settings with GPs

Qualitative- Focus groups

Two focus groups with 10 YP

GP

REPORTING (i) Important to have a collaborative and ongoing dialogue

(ii) YP want to be informed about sharing information to enhance feelings of comfort and safety. (iii) Language should be positive, inviting and warm. (iv) GPs should listen to YPs concerns, preferences and support them as an individual. (v) GPs displaying attentive body language, including eye contact and posture, and active listening. (vi) Rather than onus being on the YP, YP wanted GPs to initiate conversations

REPORTING (i) YP often had poor mental health literacy or felt hopeless or ‘like a burden’. (ii) YP described how failure by GPs to ask, could lead to missed opportunities. (iii) YP described fearing the consequences of disclosure, due to confidentiality and privacy of medical records and what may happen to information. (iv) YP viewed the language around risk as problematic, ‘negative’ and ‘intimidating'. (vi) An indifferent or impersonal attitude was seen as a barrier to honesty and disclosure. When risk-related assessments were a ‘tick-box’, formulaic manner, which could impact on the dynamics of the practitioner and patient relationship. This also hindered disclosure

RECORDING (i) YP were worried about around what personal information was recorded

LOW RISK

Fisher & Foster, 2016 [63]

England

To develop an evidence-based care plan/ pathway for children and YP in paediatric inpatient settings presenting with SH/ suicidal behaviour

Qualitative and Quantitative- Delphi survey

5 junior and senior staff nurses

General Paediatric ward

REPORTING (i) Staff knowledge and understanding (ii) Being able to recognise behaviour when presented

REPORTING (i) Staff expressed need for further training due to suicidal behaviour being unpredictable (ii) Fear of making YP's difficulties worse. (iii) Negative perceptions of YP who SH- reported as disruptive, demanding, aggressive, and difficult to understand and communicate with. (iv) Difficult environment for disclosure- setting was busy, and chaotic with large workloads

LOW RISK

Hawton et al., 2009 [47]

UK

To compare the characteristics of YP who reported deliberate SH episodes and presented at a hospital with those not attending hospital

Quantitative Question-naire

6020 YP- 3186 males, 2810 females, 24 gender unknown)

Hospital

REPORTING (i) Previous Support- YP were more likely to present to hospital with DSH if they had sought help from parents, friends, or a psychologist/psychiatrist

REPORTING (i) Perceived severity of SH- Hospital presentation was rare following self-cutting, but more common after self-poisoning, other single methods of deliberate SH and multiple methods

LOW RISK

Jennings & Evans, 2020 [56]

Wales

To explore the YP SH management and prevention practices, following reports that multi-agency teams were not effectively operating

Qualitative- Interviews and Focus Groups

Residential carers

(n = 15) and foster carers (n = 15)

Foster carers talking about their experience of clinicians in Wales

REPORTING (i) Clinicians learnt from experience not knowledge

(ii) Distinguishing RC role from clinicians- exchange knowledge to further own knowledge on the YP

REPORTING (i) Not an individual approach- Clinicians were reliant on abstracted knowledge and did not always have a direct encounter with a YP. (ii) Not understanding YP- Often situations were complex with wider factors. (iii) Clinicians not respecting carers- Clinicians as dominant and not seeing other views/experience (iv) Negative perception of YP in care

LOW RISK

Miettinen et al. 2021 [62]

Finland

To describe experiences of help related to SH in YP

Qualitative Essays and Interviews

27 YP aged between 12–22 who had harmed themselves during adolescence

Different social contexts, and with different backgrounds in relation to treatment in Finland

REPORTING

(i) Access to range of professionals to talk to and have continuity of care once in the system

REPORTING- (i) Access to Help- Getting an appointment was slow. (ii) Threshold to seek help- YP required many GP visits and multiple referrals

(iii) YP were uncertain about the severity of their SH (being taken seriously) and requesting help. (iv) YP were unwilling to burden loved ones and unwilling to get help (v) Consequences- YP were afraid of disclosing and not being taken seriously. (iv) Parents were often reluctant about a YP’s need for treatment

RECORDING- (i) Avoidance- YP reported injuries were ignored, despite being asked. (ii) Not Recording- Professionals were unable to deal with SH and recording. Staff were reported as not reacting after having seen SH

LOW RISK

Saini et al., 2021 [48]

England

To use Delphi methodology to reach consensus between different stakeholders and researchers on research priorities in suicide and SH to develop regional SH and suicide prevention and reduction schemes

Delphi Method

88 conference attendees-clinicians, researchers, experts, police, third sector workers, commissioners and pharmacists

The Suicide and Self-harm Research North West (SSHARE NOW) conference

REPORTING (i) Training for those working with YP in non-medical settings, such as schools or community settings. (ii) Help-seeking- Understanding more about how and when YP seek help

REPORTING and RECORDING (i) Services working together- The communication between different services and how they can work together can facilitate processes

REPORTING (i) Stigma. (ii) Lack of knowledge from organisational practices

MEDIUM RISK

Tørmoen et al., 2014 [49]

Norway

To explore child and adolescent psychiatric services (CAPS) with both suicide attempts and non-suicidal SH, and to assess the psychosocial variables of YP

Quantitative Question-naire

11,440 YP aged 14–17 years

75 of 91 junior and senior high schools

REPORTING (i) Service Use- YP who reported SH were more likely to have used CAPS

REPORTING (i) A YP with a non-Western immigrant background was associated with a lower likelihood of accessing CAPS. (ii) In YP with both suicide attempts and NSSH, symptoms of depression, eating problems, and the use of illicit drugs were associated with a higher likelihood of CAPS contact

LOW RISK